Scotland Pauses Gender Medications for Minors

Scotland’s National Health Service has stopped all new prescriptions of puberty-blocking drugs and other hormone treatments for minors, citing a sweeping review of youth gender services released in England last week. It is the sixth country in Europe to limit such treatments, and its changes are among the most restrictive.

The review, commissioned by N.H.S. England and carried out by Dr. Hilary Cass, an independent pediatrician, over the course of four years, concluded that the evidence for benefits of youth gender treatments was “remarkably weak” and that pressing questions remained about potential long-term risks.

This month, following recommendations by Dr. Cass, N.H.S. England halted puberty blockers for children outside of clinical trials. Hormone therapies, including estrogen and testosterone, are still available to teenagers in England aged 16 and up.

Scotland’s new changes go further, pausing prescriptions of puberty blockers while also restricting hormone therapies until teenagers turn 18. The changes will not affect patients already getting these medications from the country’s Young People Gender Service.

“We will continue to give anyone who is referred into the Young People Gender Service the psychological support that they require while we review the pathways in line with the findings,” said Dr. Emilia Crighton, director of public health for N.H.S. Greater Glasgow and Clyde, which houses Scotland’s sole youth gender clinic, Sandyford Sexual Health Services.

Concerned about soaring demand for adolescent gender treatments in recent years, health officials in Finland, Sweden, Norway, Denmark and England have changed national health guidelines to limit medical treatments for adolescents with gender distress, known as dysphoria.

Transgender advocacy groups in Scotland criticized the changes, saying they were motivated by a rising backlash against transgender people.

“We’re saddened that this change will result in some young people being unable to access the care they need at all, or having to wait even longer for it,” Vic Valentine, manager of the advocacy group Scottish Trans, said in a statement.

Prescriptions for puberty blockers in Scotland have been “exceptionally rare and cautious,” leading to long waiting lists, the group said.

According to public records obtained by The Guardian, the Sandyford clinic referred 71 children for puberty blockers from 2016 to 2023. And BBC Scotland reported that by the end of 2023, 1,100 children were on the waiting list for youth gender services, with some waiting for more than four years to be seen.

In 2022, a proposed law that would have made it easier for transgender people to change gender markers on identification documents in Scotland galvanized a coalition of conservative lawmakers and feminists pushing for the exclusion of transgender women from women’s spaces.

Top health officials in Scotland welcomed the recommendations from Dr. Cass’s review, citing an increasingly polarized debate over transgender rights that had compromised medical care for youth.

“We agree with Dr. Hilary Cass when she highlights that ‘increasingly toxic, ideological and polarized public debate’ does nothing to serve the young people accessing this care,” Neil Gray, the Scottish health secretary, said in a statement. “They are who should be at the center of our thoughts when we discuss this issue.”