Mental Health Minister stalls release of ‘puberty blockers’ health advice

Thursday, 5 September 2024

Associate Health Minister Matt Doocey is “considering” an evidence brief about the use of puberty blockers.

New advice about when to prescribe “puberty blockers” has been kept sealed, months after health officials asked to release the updated best practice guidelines.

Through 2023, Ministry of Health experts worked to write an “evidence brief” assessing the efficacy, safety, physical and mental outcomes of prescribing “puberty blockers” to young transgender patients and those experiencing gender dysphoria.

At the same time, the UK was working on its own independent review into gender identity healthcare. Its report, the Cass Review, found political ideologies from both sides of the debate had muddied evidence about gender identity healthcare. It found there was “no good evidence” regarding the long term effects of treatments.

The UK Labour Party and most, but not all, UK medical groups accepted the findings. As a result, England’s National Health Service (NHS) has effectively stopped the use of puberty blockers in almost all cases - awaiting further evidence.

Amid international debate about the use of puberty blockers, the New Zealand Ministry of Health has its own advice about their use.

But the ministry has not released the document, even though officials said in April that it was ready for publication.

Stuff understands the brief was filed for publication as far back as December. At the time, the Ministry of Health advised an updated evidence brief would be published “early in the new year”.

The Government is now refusing to release the evidence brief under the Official Information Act, saying its release would be inappropriate because Associate Health Minister Matt Doocey - who has had a finalised version of the brief for many months - is “actively considering” the document.

Puberty blockers have become a controversial topic, especially amongst conservative groups such as Destiny Church.

According to emails released under the Official Information Act, the evidence brief has been ready for public release since April. Although it was updated in early June, following a conversation with Dr Hilary Cass, the British paediatrician who authored the Cass Review.

On April 23, officials prepared a media release and “talking points” for Doocey - so he could answer reporters’ questions about the document.

But the document was never released.

Earlier this week, Doocey said more time was needed to consider the brief.

Why it matters

Hormone treatments can be prescribed to young people who are seeking or considering gender affirming healthcare.

Transgender issues have also become a topic of political debate worldwide. Through the election campaign and in Parliament, NZ First MPs have focused on the rights of transgender people - questioning their inclusion in sport, and which public bathrooms they should be able to use.

The Cass Review said the politicisation of gender identity care was on of its greatest challenges. It said, “The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it. The children are being used as a football and this is a group that we should be showing more compassion to.”

The evidence brief now sits with a minister, who is from the National Party. But the coalition Government is reliant on NZ First’s support.

Key players

Doocey, as the associate minister of health, has ministerial responsibility for transgender healthcare.

At the end of April, officials prepped him for the release of the new evidence brief. This included writing a press release and talking points, so that he could respond to questions from reporters.

Dr Joe Bourne met with the UK’s Dr Hilary Cass while preparing an evidence breif about puberty blocker usage in New Zealand.

Dr Joe Bourne, a GP and Chief Medical Officer at the Ministry of Health, led work producing a new evidence brief about the use of puberty blockers in New Zealand.

Dr Hilary Cass met with Dr Bourne in May. Bourne’s evidence brief was scheduled for publication, coincidentally, at the same time as the Cass Review was being released.

Documents released to Stuff showed the ministry didn’t appear to know the Cass Review was incoming, until the Science Media Centre let them know. It then held off on releasing its evidence brief, to see what the UK review said.

The breakdown

Ministry officials had expected to release the updated evidence brief around the end of 2023, or start of 2024.

That was pushed out to April.

In April, Doocey and officials were ready to release the new advice. A press statement was written with the date “April 23” and the minister’s office had prepared possible responses he could use to questions, including why it had taken so long for the evidence brief to be released.

At the time, his plan was to blame the ministry for any delay.

Between April 2 and April 23, on numerous occasions, emails between Ministry of Health staff showed declarations that they had “the green light” and were “ready to publish”.

They aimed for April 10, set a “go live” deadline for April 23, and many other dates. All of those publications deadlines, including one in July, were missed.

Director-General of Health Dr Diana Sarfati was offered multiple chances to review the puberty blockers evidence brief.

Conversations between Director-General of Health Dr Diana Sarfati and the minister’s office about this issue were held in-person and details have been redacted or omitted in the ministry’s Official Information Act response.

Bourne met with Cass at the end of May, and wrote to Sarfati and other senior leaders on the 30th, offering to provide “a full debrief of the meeting”.

He said Cass “was able to provider valuable insights into their process”, and he suggested delaying publication to “incorporate the latest information”.

Who said what

In a statement, Doocey said the delays were justified.

“We are taking the time needed to ensure the most up to date advice has been considered,” he said.

Matt Doocey says more time is needed to consider international evidence before releasing the puberty blockers evidence breif.

“There have been significant new publications internationally relating to puberty blockers that needed to be considered.”

In the Official Information Act response, officials said an updated document arrived with the minister on June 7 - following the meeting between Bourne and Cass.

They proposed releasing the document on July 24, as they said it was “unsuitable for publication” in June due to the minister’s commitments and Parliament holding a Scrutiny Week.

Yet the minister says more consideration is still needed, in September.

The arguments

The Cass Review questioned the use of hormone treatments. It said the standard of care was often sub par after “puberty blockers” had been prescribed. There had been a lack of follow up treatment, and Cass criticised “remarkably weak evidence” for the efficacy of “puberty blockers”.

Many trans people have advocated for greater accessibility of these treatments.

In a statement, the Professional Association for Transgender Health Aotearoa rejected the Cass Review.

Puberty blockers work by blocking hormones, testosterone and estrogen, that cause the effects of puberty. This can make it easier for further gender-affirming procedures.

The current Ministry of Health advice is that puberty blockers can be prescribed to give families time to consider gender affirming options. If the patient stops taking the puberty blockers, then hormone changes will trigger puberty.

The New Zealand evidence brief was set to give clearer advice to local physicians about how to prescribe puberty blockers and provide ongoing support to young patients and their families.

This story has been updated to make it entirely clear the fourth par refers to UK medical organisations.