GPs under pressure to give children illegal trans drugs

Trans activists and unregulated clinics have sought to pressure GPs into illegally prescribing puberty blockers, the NHS has said.

Health leaders issued new guidance to GPs that orders them to stop prescribing trans drugs to children, after requests for clarification from doctors.

GPs have been told that they “must refuse” requests to prescribe puberty blockers because it is a criminal offence and “should refuse” cross-sex hormone requests to children unless carefully considered.

It is understood a number of GPs have felt pressured into prescribing the drugs to children or entering agreements to supply the drugs on behalf of transgender clinics.

The NHS guidance specifically singles out two unregulated clinics to be avoided – GenderGP and Anne Transgender Healthcare Ltd – both of which have “published statements that oppose the restrictions that have been put in place” by the NHS and the Government. There is no suggestion either organisation has broken any laws.

The clarification comes after The Telegraph disclosed GPs’ fears that they are being caught in a battle over a condition they aren’t trained to treat.

The guidance empowers GPs to turn away requests to prescribe the powerful drugs to under 18s.

Previously, GPs would enter “shared-care agreements” and continue a regular prescription for a child taking the drugs after they had initially been given them by transgender clinic.

Last month, the Royal College of GPs updated its “position statement” to argue that the profession should not be prescribing gender-affirming hormones to anyone under 18 because they did not have the specialist skills needed for this group of patients.

Wes Streeting announced last year that a UK-wide ban on puberty blockers would be made indefinite, outside of a clinical trial, although cross-sex drugs are still available to 16 and 17-year-olds.

‘Does not go far enough’

The guidance from the NHS tells doctors they “must refuse” to prescribe puberty blockers to under 18s to treat gender dysphoria under any circumstances.

It says: “It is a criminal offence for a healthcare professional to privately prescribe or dispense this drug to patients under the age of 18.”

It also states that “a GP should refuse to support an unregulated provider in the prescribing or supply of alternative medications that may be used to suppress pubertal development”.

Regulated clinics are limited to those registered by a UK regulator, such as the Care Quality Commission and does not include any based abroad or online, even if they adhere to regulatory rules in their respective countries.

The guidance stops short of telling GPs not to prescribe cross-sex hormones at all. The NHS says they should not be used in children under 16 but has resisted calls for a ban for under 18s.

Dr Louise Irvine, a GP and co-chairman of Clinical Advisory Network on Sex and Gender, said: “GPs can come under considerable pressure from patients to prescribe on the advice of unregistered gender clinics and this advice will give GPs much needed support to refuse in the interests of patient safety.”

But she said it did “not go far enough” because it was “not mandatory” and some GPs are “operating outside NHS prescribing protocols”. She also said it did not protect adults from the same risks.

The NHS said advice issued to pharmacists recently by the General Pharmaceutical Council (GPC) was “equally relevant to GPs who are asked to agree a shared care arrangement”.

The GPC had said: “It is not enough for a prescription to be legally valid; that is just one consideration alongside others, including judgement as to whether a prescription is clinically appropriate.”

The Cass Review, led by paediatrician Baroness Cass, said cross-sex hormones should not be given to under 16s and only ever prescribed for 16 and 17-year-olds when the “clinician making the prescribing recommendation can demonstrate extreme caution in clinical decision making”.

The NHS guidance said: “It is within this context that GPs and other prescribing professionals are cautioned against a shared care approach with unregulated providers who continue to offer access to – or facilitate access to – hormone interventions to children.”

It comes amid various legal challenges attempting to ban the use of cross-sex drugs in children, including one led by Kiera Bell, a de-transitioner who regretted trans surgery.

The legal case argues that the drugs issued to 16 to 18 year-olds pose an “irreversible” and “unacceptable” risk to the health of thousands of vulnerable children suffering from gender dysphoria.

Cross-sex hormones change the physical sexual characteristics of a person, while puberty blockers delay the onset of puberty by suppressing the release of hormones.

‘Tougher action overdue’

A GP clinic in Brighton, WellBN, faces legal action over its decision to prescribe cross-sex drugs to teenagers, with lawyers asking the High Court to prevent it from giving gender-affirming hormones to a troubled 16-year-old.

The child approached WellBN without his parents’ knowledge after the school began facilitating a “social transition” to help him align with his chosen female gender. The clinic said it was confident it assessed children “in accordance with good medical practice”.

A solicitor, who represents a number of families taking action over clinics in this country prescribing cross-sex hormones to their children, welcomed the changes but said “tougher action is long overdue”.

Paul Conrathe, of Sinclair’s Law, said: “The dangerous practices of overseas unregulated clinics have been known for some time. Tougher action is long overdue and this guidance is a step in the right direction.

“There, however, remain significant loopholes that can be lawfully exploited by these clinics. Only a ban on prescribing cross sex hormones outside of the NHS will provide the necessary measures to protect vulnerable children.”

Mr Conrathe added that it was “vital that Wes Streeting bans cross sex hormones being delivered outside of the careful protections of the NHS”.

An NHS spokesman said: “Unregulated healthcare services pose a risk to patient safety as they are not subject to the same level of scrutiny as registered services.

“In response to concerns put to NHS England by GPs about named unregulated providers who arrange for puberty blockers, hormone drugs and other medications to be given to children for gender incongruence, contrary to NHS policy, NHS England has advised GPs not to cooperate in this unsafe practice.”