Health Professionals Concerned At Further Delays To Gender Affirming Healthcare Guidelines

The Professional Association for Transgender Health Aotearoa (PATHA) is deeply concerned at further delays to the publication of updated Guidelines for Gender Affirming Healthcare in Aotearoa New Zealand.

PATHA has been informed by Te Whatu Ora | Health New Zealand that the updated Guidelines will not be published until the Minister of Health decides on whether to introduce regulations on the ability of medical professionals to prescribe puberty blockers as part of gender affirming healthcare.

The guideline’s advice on prescribing puberty blockers was updated in November 2024 to reflect the Ministry of Health’s position statement on the use of these medications. This advice spans just 6 of the total 182 pages of information contained in the guidelines. The guidance is evidence-based, aligns with international best practice and guidelines, and supports a holistic approach to gender affirming medical care for young people who need it.

“Medical professionals working in this area are constantly being asked by colleagues for clinical guidance on gender-affirming healthcare,” says Dr Rona Carroll, a Specialist General Practitioner and Vice-President of PATHA. “By not publishing the updated guidelines, the government is stopping healthcare providers from being guided by evidence-based, up-to-date New Zealand specific information. We have been given no timeframe for when to expect a decision about the puberty blocker consultation or the updated guidelines. Considering how many other areas of health these guidelines include, and that the advice on prescribing puberty blockers is in line with the Ministry’s position statement, the updated guidelines should be published immediately. I think clinicians would be providing safer care if they had access to these guidelines today.”

On Wednesday, 28 May, PATHA published an open letter calling on the Minister of Health, Simeon Brown and the Associate Minister for Health, Matt Doocey, to release the updated guidance.

This letter was signed by over 500 medical bodies, clinicians and community organisations. Signatories include the Royal New Zealand College of General Practitioners, the New Zealand Society of Endocrinology, the College of Child and Youth Nurses, and the Paediatric Society of New Zealand.

The evidence-based guidelines, which have been peer reviewed by clinicians with expertise in this care from within New Zealand and internationally, provide detailed information on a wide range of topics relevant to healthcare for transgender and non-binary people. This includes several revised chapters from the 2018 edition in line with emerging medical research.

“I’m proud of the amount of work the authors have put into these guidelines, bringing their extensive collective expertise into creating guidance that is broad and has a holistic view of transgender health,” says Jennifer Shields, PATHA President. “These guidelines cover so much more than puberty blocker medication, and this information is important for all healthcare workers to have.”

“It is clear that there is no evidence-based justification for considering restrictions on prescribing puberty blockers to transgender young people,” Shields says. “These medications continue to be prescribed to children for other indications, and limitations in the quality of the academic evidence are not unique to this care. Healthcare professionals are now left wondering if this government is being pulled into alarming ‘culture war’ trends away from best practice medical care, and into anti-transgender policies that lead to a reduction in patients' rights and freedoms, and set precedent for making clinical decisions based on political beliefs rather than what’s best for patients.”

“This is clear evidence of ideological interference in an operational, professional frontline medical resource that is being requested by the health sector,” Carroll said. “We reiterate our call for the Government to allow Te Whatu Ora Health New Zealand to publish these updated guidelines immediately.”

Background information

Statement on puberty blockers

On 21st November 2024, the Ministry of Health published a position statement on the use of puberty blockers in gender affirming care, emphasising that puberty blockers could continue to be prescribed when needed as part of interdisciplinary teams. The Government expressed an intention to explore further restrictions on access to this care, and opened public consultation on possible restrictions. This consultation closed on 20th January 2025.

A memo sent to then Minister of Health Shane Reti on 30 April 2024 was released to PATHA under the Official Information Act. In this memo, the Ministry of Health clarified that:

“There is currently no evidence that individual clinicians are prescribing [puberty blockers] outside of an interprofessional team.” 

This shows that concerns about individual professionals prescribing puberty blockers inappropriately are unfounded, and current prescribing practices are already in line with the Ministry’s position statement.

PATHA previously published a collective statement opposing the restrictions the Government is considering on the prescription of puberty blockers to transgender young people. This statement also received broad support from medical bodies, including the New Zealand Paediatrics Society and the New Zealand Society of Endocrinology. The statement reads [in part]:

“The Ministry of Health Evidence Brief identified that any evidence of harm associated with providing puberty-blocking medication is limited and inconclusive, and withholding this care may exacerbate gender dysphoria and negatively impact mental health. Equitable and non-discriminatory access to this care should be provided and maintained throughout the country.

Decisions about prescribing puberty blockers should continue to be made collaboratively between young people, their families or support people, and the health professionals involved in their care. These decisions are individualised, based on informed consent, and guided by professional training, clinical experience, and the best available evidence. Any move to restrict access to puberty blockers would be a political decision and not one based on clinical guidance from health experts in New Zealand and international best practice. Medical decisions should remain free from political interference.”

Background on puberty blockers

Puberty blockers are a medication called gonadotrophic releasing hormone (GnRH) agonists. They were developed in the 1980s for use in much younger children with precocious (early) puberty, and have been used in gender affirming care for over 20 years. They halt the development of secondary sexual characteristics, such as breast growth or voice deepening, and can relieve distress associated with these bodily changes for transgender young people. Puberty blockers have the benefit of allowing the young person time before making any decisions regarding starting on gender affirming hormone therapy.

The effect puberty blockers have on pausing pubertal changes is reversible. Once the puberty blocker medication has been stopped, puberty will resume as it would have done without medication.

All medications have known or potential risks, but evidence and experience to date does not raise significant concerns about the safety of puberty blockers. As is the case in all medical prescribing, risks, side effects and benefits of medications are discussed with patients as part of the informed consent process before prescribing.

There are also risks to not prescribing medications when they are indicated. Puberty results in irreversible physical changes, which can result in lifelong distress and gender dysphoria for some transgender people.

In every area of healthcare, decisions about treatment and medication prescribing take all of these aspects into account, and health professionals support patients and their families to weigh up the pros and cons for their individual situation. Gender affirming healthcare is no different. Decisions about whether to start puberty blockers are made between health professionals, young people and their whānau. These are healthcare decisions which should remain free from ideological political interference.

Clinicians who initiate puberty blockers should be experienced in providing gender affirming healthcare and working within an interdisciplinary team. It is essential that access to this care and to puberty blocker medication is maintained.

Topics covered by the updated Guidelines

Advice on the prescription of puberty blockers is a small portion of the content covered by the updated guidelines. The updated guidance also includes detailed information on a broad number of other areas of transgender health, including whānau support, creating inclusive clinical environments, non-medical and non-surgical gender affirmation, speech and language therapy, fertility and sexual health, mental wellbeing, gender-affirming hormone therapy, and detransition, as well as specific guidance for Māori, Pasifika, and refugee and asylum seeker trans people.

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