A document intended to outline the ministry’s position on the hormone treatment has been delayed multiple times since its intended release date, reports Stewart Sowman-Lund.

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The long-awaited release of an “evidence brief” related to the safety, reversibility, mental health and wellbeing outcomes of puberty blockers has been delayed several times, though the reasons for this aren’t clear, documents released to The Spinoff show.

The brief, which is expected to be accompanied by a position statement to guide clinical advice on the use of the puberty-delaying treatments, was initially set to be made public in late 2023, before the timeline was bumped to the middle of April this year – but this never eventuated. The Spinoff requested a series of documents and correspondence pertaining to the brief under the Official Information Act, which confirms that a ministry communications plan had been drafted up in preparation for the April release date. However, subsequent communication shows that this was pulled at the eleventh hour.

The documents do not reveal why the brief was never released, but a statement that accompanied the release of the information from the ministry’s chief medical officer for clinical community and mental health, Dr Joe Bourne, noted “changes to the intended timing of the evidence brief as the ministry worked through this complex issue”.

The issue of puberty blockers is vexed both in New Zealand and around the world, and it’s possible the release of the evidence brief could further inflame tensions. As Julia de Bres explained for The Spinoff earlier this year, puberty blockers are “a form of gender-affirming healthcare” used to pause the physical changes of puberty that may “cause distress or dysphoria for trans youth”. Opponents argue that some effects of the treatment are irreversible and children are too young to be aware of any risks. The brief is expected to lay out the ministry’s and ultimately the government’s official position on the safety and availability of puberty blockers for young people. Currently, puberty blockers can be prescribed by a clinician once someone reaches puberty. 

The decision to draft an evidence brief followed the ministry’s scrubbing of official advice about the safety of puberty blockers from its website in 2022. Emails released to Newsroom showed a line stating puberty blockers were “a safe and fully reversible medicine” was removed in the hope it “creates fewer queries”. 

It’s expected New Zealand’s new guidelines on puberty blockers will be, at least in part, informed by the release of a similar report in the UK that was led by Dr Hilary Cass. The release of the “Cass report” has been controversial due to it leading to a pause on the use of puberty blockers outside of clinical trials and prompting an overhaul of Britain’s gender identity services for under 18s. As part of the report, the British Medical Journal published a series of reviews on puberty blockers that, according to clinical psychologist Dr Paul Skirrow in comments to the Science Media Centre, highlighted that “we currently do not know how effective these treatments will be” but that “there are many reports of benefit from the people who use them”.

The report has since been reviewed and critiqued, with other researchers taking issue with what they called “unfounded speculation” that “social transition and puberty-pausing medications may cause harm by putting youth onto a medical path.”

Asked to explain the ongoing delay in releasing the evidence brief, a Ministry of Health spokesperson told The Spinoff there had been “significant new publications internationally relating to puberty blockers that [need] to be considered”.

Where the government stands on the issue

During the election campaign, then-opposition leader Christopher Luxon was occasionally asked to comment on the topic of puberty blockers during town hall meetings, often choosing to lump it into issues regarding sex education and freedom of speech. “Issues of sexuality and stuff are I think issues for parents to talk about and their families to talk about,” Luxon told a Taranaki crowd last year. Since becoming prime minister, Luxon has tended to offer a “wait and see” approach, diverting to the Ministry of Health and the impending release of the brief.

However, his deputy – New Zealand First leader Winston Peters – has been more outspoken. In a recent interview with Bob McCoskrie, who leads the conservative lobby group Family First, Peters signalled he would like to see limits on who can access hormone treatments. “Young people unable to make up their mind are being destroyed for life by what I might call loose, liberal views of what their entitlement is to make decisions at an early time when their minds are not framed,” he said, when asked to comment on the Cass report.

“Here we’ve got people prepared to condone this when a child could make a decision, [with] no chance to turn that decision backwards if they’ve made a mistake and they’ll be living their life with that mistake because adults didn’t have enough courage or common sense to ask them to wait until they could make a decision at an age of maturity. It’s that simple.”

According to the American medical centre the Mayo Clinic, puberty blockers “don’t cause permanent physical changes” as they pause puberty, offering a chance for a user to “explore gender identity” and “ time to plan for the psychological, medical, developmental, social and legal issues that may lie ahead”. When a person stops taking the treatment, puberty starts again, the clinic said.The UK’s Endocrine Clinic also endorsed the position that “puberty-blocking medications are fully reversible” while acknowledging risks, including infertility. New Zealand’s Ministry of Health, despite editing its own website, has previously described puberty blockers as safe while noting that “all treatments have risks and benefits”.

The timeline

April

Emails and the initial communications plan confirm the original “live date” for the Ministry of Health’s evidence brief was set to be April 23, less than a fortnight after the Cass report was released on April 10. The evidence brief was not released on April 23.

While a draft version of the evidence brief itself was redacted in the documents provided to The Spinoff, the communications plan provides some details about what it might contain. It confirms the Ministry of Health has a “duty of care” to young New Zealanders, including those with gender dysphoria, and also acknowledges that there are “strong and varied views” relating to gender affirming healthcare. “In this work the focus has been on clinical safety and recognises that, as with all types of clinical care, there is an ongoing need to keep abreast of emerging evidence,” reads one of the “key messages” released. “The ministry’s evidence brief and position statement will inform the advice healthcare providers and clinicians give patients and their families.” 

May

Media queries from a Newstalk ZB producer about the delay were received by the ministry across the month of May, with emails showing a spokesperson was told to say that the director general of health had requested “more work to inform the position statement”. After being asked whether the brief had been delayed “indefinitely”, Bourne told a ministry staffer it was “safest not to give a definitive no” while another staffer said “we’ve been burnt so often”. The producer was told to follow up “in a week or two”, while Bourne suggested “perhaps say two or three weeks… or four”.

By late May, the documents reveal the ministry had prepared a “revised timeline” for publication of the evidence brief. The week of June 17 was ruled out as this was parliament’s “scrutiny week” and instead it was determined the brief would be released on July 23 or the week after. “This timeline allows us to incorporate the latest information from the evidence brief into te memo [sic] on the prescribing environment; allows time for the EAG [expert advisory group] to provide initial advice regarding our proposed next steps; develop our finalised position statement; provide a full briefing to the minister with time for it to be shared for information as required by the government,” Bourne said in an email to health officials.

It was also around this time that Bourne said he had a conversation with Hilary Cass – who oversaw the UK’s report – and that she provided “valuable insights into their process”.

Also in May, the Ministry of Health fielded a question from a Stuff reporter regarding the evidence brief and the number of young people that have been prescribed puberty blockers in New Zealand. A spokesperson confirmed that, in 2023, 387 people between the ages of 12 and 17 were given two drugs that can delay the onset of puberty, of which 127 were prescribed for the first time. A spokesperson told the reporter this data – which “needs to be treated with caution as it is currently collected for payments purposes and is not clinical information” – did indicate that prescription rates had been increasing in New Zealand “as they have across other countries”.

June

According to the refreshed timeline, an updated version of the evidence brief was to receive sign-off in early June, followed by an “updated prescribing environment memo” and a “draft position statement”. This was all working towards a publication date of no later than July 31.

July

The evidence brief was not released in July.

August

The documents do not contain any information for the month of August (possibly due to the Official Information Act request being received by the ministry in July) and there was, at least publicly, no update on a revised release date. On August 2, deputy prime minister Winston Peters voiced concerns about gender rules in sport, singling out Olympic boxer Imane Khelif for apparently failing “a gender test”. 

September

It’s now early September and there has still been no update on the whereabouts of the evidence brief. However, Bourne, in comments released alongside the tranche of documents, claimed the delay wasn’t unusual due to the “rapidly developing clinical issues”. 

He added: “It is also important for the ministry to ensure that the government is aware of the evidence and the ministry’s position on these issues.” The revised publication timeline from May stipulated that a week be set aside in order to “socialise the ministry’s position as appropriate across government”.

An Official Information Act request for government correspondence about the brief identified an email from health minister Shane Reti to associate health minister Casey Costello that was within scope, but it was not released in order to maintain the exchange of “free and frank” opinions between ministers.

Asked for further comment on the delay, a ministry spokesperson told The Spinoff there was no confirmed publication date at present. “We recognise the considerable public interest in this sensitive issue. Our focus remains on the wellbeing of young people with issues relating to their gender identity. The evidence brief remains under active consideration.”

Do you know more about the evidence brief’s publication? Get in touch.