One in ten children receiving NHS gender care are self-medicating with sex hormones

Almost one in ten children currently being seen by NHS Children and Young People’s Gender Services have disclosed that they self-medicate with masculinising or feminising hormones. The figures, exclusively seen by the New Statesman and revealed through freedom of information requests, come from all three regional gender clinics currently open to young people, serving London, the south-west and north-west England.

In total, 84 children (all under 18 years old) have told staff they are taking either testosterone (for females wishing to masculinise) or oestrogen (for males wishing to feminise), out of a total open caseload of 891. These hormones cause irreversible changes to the body, helping someone who wants to transition to develop characteristics associated with their preferred gender. For example, testosterone use in a biological female can stimulate growth of facial hair (and other body hair), a drop in the pitch of their voice, and other typically male characteristics such as pattern baldness.

The south-west, Bristol-based children’s gender service has the highest proportion of its caseload self-medicating – at 13 per cent – though these numbers may be an underestimate. In its FOI response, the London-based service (where 11.8 per cent of patients are taking hormones from non-NHS suppliers) acknowledged that the totals provided “may not be a true reflection of the number in receipt of hormone therapy without an NHS prescription as some patients under our care may not have disclosed this information to us”.

All of the NHS Children and Young People’s Gender Service clinics said that they were recording the source of the hormones in patients’ medical notes, for example, whether it has been obtained from an online pharmacy, overseas supplier, or elsewhere. The Bristol and London-based services said that whenever a child disclosed they are self-medicating with hormones, they and their parents or carers would be advised “about the known and unknown risks of this, as well as informing the patient’s GP in writing”.

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The service for the north-west region, which had the lowest proportion of its caseload self-medicating (5.2 per cent), said that when staff become aware of patients self-medicating, they followed their own guidelines developed to deal with the issue of children accessing hormones from non-NHS sources. Further advice is given to clinicians in the service specification which underpins the operation of all the youth gender clinics.These NHS services will not work alongside unregulated providers who are supplying hormones, and in some circumstances might suggest that a GP or local health professional consider whether safeguarding measures are necessary to protect the child in question.

An NHS spokesperson said. “NHS England has strongly discouraged children, young people and their families from sourcing puberty suppressing or gender affirming hormones from unregulated sources or from online and unregulated providers, due to the significant risks involved, and our position on this has not changed.”

There has been widespread coverage in the media of a new NHS trial – the “Pathways” trial, run by King’s College London researchers – of puberty-suppressing hormones (puberty blockers), due to begin in January. In recent days campaigners have also criticised the forthcoming trial and called for it to be stopped. The drugs were banned in the UK for gender treatment last year after the Cass Review of NHS gender identity services for children and young people raised concerns about the lack of clinical evidence over their safety for under-18s. However, the issue of self-medicating with hormones has gone largely unreported.

Legal attempts to force the government to ban their use, as has been the case with puberty blockers, were rejected in May, after the Health Secretary Wes Streeting argued in the High Court that he was “actively reviewing” whether to introduce further restrictions on the drugs because of expert evidence that had come to light during the proceedings. An NHS England working group had been established to provide “clinical and expert advice” to the Department of Health and Social Care to help inform that decision, the court heard. Dismissing the case at the time, the judge said that “the case had moved on substantially” as a result of the government setting up the NHSE review. Yet the New Statesman revealed on 6 December that while these expert findings had been delivered to DHSC, and would inform policy, there was no plan to publish them.

None of the children self-medicating with hormones are eligible as subjects in the new trial, as anyone who has previously taken either puberty blockers or masculinising or feminising hormones (or who is doing so currently) is excluded from taking part.

But it seems unlikely they would wish to be. They are not looking to pause their development, but rather change their bodies to match how they feel. Hormones are available to those attending the NHS’s children’s gender services, but only for those aged 16 or older. The Cass Review led to the establishment of a brand-new model of care delivered by new children’s gender services, advising hormones only be prescribed with “extreme caution” and where there was a “strong clinical rationale”. Currently, any referral for the drugs must be reviewed by a national multidisciplinary team of health professionals who are not directly involved with the cases in question. Just as with puberty blockers, Cass also highlighted the weakness of the evidence base surrounding the use of hormones in under 18s and the lack of data on long-term outcomes.

Cass told the New Statesman that gathering long-term data on hormones was “absolutely just as important, if not more important than, the puberty blocker component” of the research proposals contained in her review. Perhaps the knowledge of widespread self-medicating among young people will provide the impetus to put in place the necessary infrastructure to do just that.

A spokesperson for the Department of Health and Social Care said: “The safety of children and young people is our top priority. We do not condone self-medication with cross sex hormones. These are licensed, prescription-only medicines and should only be used by people who are eligible and under medical supervision.”

Medical regulators will “crack down on any rogue prescribers, products and online services putting people in danger,” they added.

“We are continuing our work with the NHS to reform gender services to ensure young people receive timely, holistic care and support, while reviewing the use of cross-sex hormones in line with the recommendations in the Cass Review.”

[Further reading: Wes Streeting: “I’m pretty frustrated”]

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