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Irish College of GPs no longer claims puberty blockers and hormonal sex changes are reversible

The Irish College of GPs (ICCP) has amended its newly published transgender heath guidelines to remove statements which said that puberty blockers were “reversible”, and that oestrogen and testosterone therapies were “partially reversible”.

The report now says that “There is limited research evidence available regarding the long-term effects of hormone and puberty blockers in children and adolescents”, that there is only “low-quality evidence” to suggest that “that hormonal treatments for transgender adolescents can achieve their intended physical effects”, and that further research “to address these knowledge  aps and improve understanding of the long-term effects of these treatments is required.”

Last week, following the receipt of detailed questions from Gript about the document and the evidence base behind some of the claims made within the document, the ICGP removed the guidelines from their website without explanation. A heavily amended version of the guidelines has now been uploaded to the ICGP website.

The ICGP say that decided to amend the document, which was released only a few weeks ago, to reflect “recently published recommendations from the Final Report of the Steering Committee on the Development of HSE Transgender Identity Services.” That, long-delayed, report was published in December of last year, nearly a month before the ICGP released their transgender health guidelines. It is unclear why the report was not initially considered to be worth inclusion in the guidelines.

The original document, which was co-written by the Health and Education Manager of TENI, had directed GPs to consult with TENI about treatment pathways for their patients, to consult with TENI to ensure they were up to date with general transgender health information, and to consult with TENI regarding the “development of an Irish specific gender service for children and adolescents”. These references have now been removed as has a statement instructing GPs that “there is an urgency to make referrals to these services if the child is nearing pubertal age.”

One line that did remain in the amended version of the guidelines was a statement that the Dutch Protocol, which argues for the usage of puberty blockers at age 12, cross-sex hormones at 16, surgery at 18, and which has become increasingly controversial, is “best practice internationally”.

The Dutch Protocol was originally detailed in a 2006 study from the Amsterdam Gender Clinic. The study authors thanked the Ferring Pharmaceuticals “for the financial support of studies on the treatment of adolescents with gender identity disorders.” Ferring Pharmaceuticals are a privately owned Swiss biopharmaceutical company which produce, amongst other things, a drug called Triptorelin, which has been used as a puberty blocker.

The ICGP’s claim regarding the Dutch Protocol is referenced to the Final Report of the Steering Committee on the Development of HSE Transgender Identity Services, but that report does not mention the Dutch Protocol at all. The original document referenced the claim to a 2014 comment piece, but that original reference still does not claim that the Dutch Protocol is “best practice internationally” – although it does say that the publication of another study “should help to silence critics”. The study referenced by the comment piece also does not make the claim that the Dutch Protocol constitutes best practice, rather saying that “Despite the apparent usefulness of puberty suppression, there is only limited evidence available about the effectiveness of this approach.”

The statements regarding the Dutch Protocol, as such, do not seem to be supported by the references within any version of the ICGP document. The rather distinct phrase “in keeping with best practice internationally known as the Dutch Protocol” in the ICGP guidelines is taken directly from TENI material which was published long before the publication of the Final Report of the Steering Committee on the Development of HSE Transgender Identity Services.

 

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