Puberty blocker pause not fuelled by ideology, says top doctor

Scotland’s pause on puberty blockers was not driven by ideology, the country’s top doctor has said.

Earlier this year, the decision was taken to pause the prescription of puberty blockers to young trans people following the publication of the Cass review, which raised fears about the long-term impacts of the drugs.

Health boards and the Scottish Government pledged to research the impacts.

The document, conducted by retired paediatrician Dr Hilary Cass, now Baroness Cass, for NHS England, also lamented the “toxic” nature of the conversation around transgender people.

Speaking before the Health, Social Care and Sport Committee at Holyrood on Tuesday, Professor Sir Gregor Smith, Scotland’s Chief Medical Officer, said the decision had not been impacted by the fraught public debate around the issue of gender.

“In any of the discussions that I’ve been a part of, I’ve never seen evidence of an ideology driving this, but I’ve seen evidence of a real desire to get to the bottom of scientific process about where the evidence lies, either in support or against the use of theses drugs, and trying to determine fully just what impacts they have,” he said in response to a question from Green health spokeswoman Gillian Mackay.

Ms Mackay also mentioned a Holyrood petition which had been filed to reverse the pause, with those behind it claiming ideology had played a part in the decision, the MSP said.

Sir Gregor said: “I’ve never seen any ideology that’s actually been behind as the driver for any decisions in this space from anyone that I’ve had any conversations with.”

Ms Mackay asked why the drugs in question – Gonadotrophin-releasing hormone (GnRH) analogues – are still being prescribed to those in puberty early, but not for trans young people.

Professor Alison Strath, Scotland’s chief pharmaceutical officer, told Ms Mackay: “We haven’t tested in the age groups that we’re treating and with the dosages we’re treating, they haven’t been testing in the way that the medicines that are licensed for use have been.

“So it is really important that when we’re looking at that, we are understanding whether there’s any additional harm that’s caused, whether the actual product, the doses that we’re using, are efficient and effective.”

Sir Gregor also pushed back on criticism of the Cass Review, which had prompted the British Medical Association (BMA) to announce it would “critique” the study, but the union clarified last month it would do so from a position of “neutrality”.

The Chief Medical Officer said two studies which had informed the BMA decision have had their “credibility undermined quite significantly” as a result of being “critiqued through normal scientific process”.

He also asked for the committee and MSPs in general to show “leadership” in “making sure we have a different dialogue about services and care in this area”.

He added: “Actually, we need a different dialogue for society that is perhaps more tolerant of the difference that people experience in this area.

“If we can do that, I think we can create a different environment for people who have that motivation to come in and work in this area, to provide this type of care.”

Dr Sandesh Gulhane, the Scottish Conservative health spokesman and a GP, questioned why the drugs were supplied in the first place without the required testing.

Sir Gregor said “evidence develops all the time” in the prescription of medications, adding that “sometimes uncertainty begins to develop around a particular approach”.

Prof Strath said the Medicines and Healthcare products Regulatory Agency, which licenses medications, uses “evidence from randomised control trials and they will think about the quality, the safety and the efficacy of those medicines”.

But doctors can decide to prescribe medications “off-label”, meaning it is being used for a purpose other than what it was licensed to do.