The Rainbow Support Collective objects to cabinet’s
decision to ban puberty blockers for transgender children,
and disputes their claims that this decision was made in the
interests of protecting the wellbeing of young
people.
The banning of puberty blockers is an example
of government overreach and political attacks on healthcare.
The
announcement on 19 November that cabinet would be using
the Medicines Act in order to put a restriction exclusively
on young trans people seeking access to puberty blockers as
treatment for gender incongruence, is described as a
‘precautionary approach’. In reality, it is an
unprecedented and inherently discriminatory use of the
Medicines Act to deny healthcare to a particular population
on the basis of their sex (being transgender). The
announcement also says that the decision will be in effect
pending the outcome of the clinical trial in the UK, which
is an extreme measure given that trial will not end until
2031, denying a generation of transgender young people
crucial healthcare.
The evidence does not say what
the government are claiming
To justify this decision,
Healthcare Minister Simeon Brown cites the Ministry of
Health’s evidence brief (which was finished in April 2024,
but was delayed due to pressure from the Government to
incorporate findings from the widely debunked Cass
Report), and similar restrictions being imposed by the
UK Government. The Minister has claimed that the evidence
brief found a “lack of high-quality evidence that
demonstrates the benefits or risks of the use of [puberty
blockers]”. In practice, clinical
guidance and evidence-based medicine are based on three
tenets: the academic evidence, clinical experience, and
the values and wishes of the patient. The limits of getting
good quality evidence are due to the ethical and practical
limitations, and it is always unethical to deny healthcare
to a control group simply for the purpose of testing
efficacy. Because of this limitation across all healthcare,
it is extremely common for medicines to be used when there
are limitations in the quality of evidence, and the fact
that trans health is uniquely held to an impossible standard
is political. Of further concern is that the Ministry
of Health report focused solely on the mental health
benefits of puberty blockers, which ignores that their
primary medical purpose is simply to stop
puberty.
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While the quality of the evidence supporting
the prescription of blockers is low, the evidence that
exists shows a
positive impact reducing depression, anxiety, self-harm and
suicidal ideation. The position
statement of the Ministry of Health, (informed by the
results of the evidence review) recommend funding better
research, and an approach where young people and their
whānau are informed of the low quality of evidence when
they make decisions about starting puberty blockers. The
findings of the evidence brief do not justify a ban. At no
point is a ban suggested, let alone recommended, which is an
even more extreme response than the recommendations of the
Cass report, which called for transgender children in that
jurisdiction to still have access to puberty blockers,
through a clinical trial.
The Cass report was not
commissioned to be a clinical guideline, and should not be
regarded as such. Critically, the Cass report goes well
beyond its scope of investigating puberty blockers and leans
into opposing gender affirming healthcare in principle. This
is historically a failed
and experimental approach to trans healthcare that goes
against decades of medical
consensus. When discussing puberty blockers, the Cass
report encounters the same problems with its evidence as the
Ministry evidence review. Even though it finds more evidence
to support the ongoing use of puberty blockers than it does
to prohibit them, the recommendations of the report are a
direct contradiction to these findings. Researchers
specialising in systemic reviews like those used for Cass
and the Ministry of Health’s evidence brief have
condemned using these studies for politically interfering
with the provision of healthcare:
“Following
fundamental principles of humane medical practice,
clinicians have an obligation to care for those in need,
often in the context of shared decision making. It is
unconscionable to forbid clinicians from delivering
gender-affirming care.”
The researchers urge
clinicians to consider the autonomy of their patients, and
their own capacity to be reliable narrators regarding their
own bodies and needs. Every person and their whānau have a
right to make informed decisions about their own healthcare,
rather than have those decisions made for them by the
government.
This is political, and it is
discrimination
Policies that target transgender
patients to reduce access to gender affirming healthcare are
sex discrimination. Phrases such as ‘young people
experiencing gender dysphoria or incongruence’ obscure
that gender dysphoria is a diagnosis almost exclusively
given to transgender patients. This announcement offered no
restriction of access to these medicines for cisgender
people – including five-year olds experiencing early-onset
puberty, teenagers experiencing endometriosis, and adults
with prostate cancer. There is also an assumption behind
this language that puberty blockers can only cause harm in
the case that a young person who accesses them may go on to
find they are not transgender. What this decision ignores is
the harm that is done by denying blockers to transgender
young people, and therefore forcing them to go through an
otherwise avoidable and irreversible puberty which causes
them lifelong distress, increases the discrimination they
will face throughout their life and will require them to
undergo expensive surgery as adults.
Despite the
claims made by the Minister of Health, it is not a
precautionary approach and it is not about making sure that
treatments are safe or carefully managed. It is a kneejerk
reaction with political motivations that are not aligned
with medical best practice, or the evidence he himself
cites. Further contradicting the Minister’s claims, his
coalition partners in New
Zealand First have been open about their ideological
opposition to gender affirming healthcare, which
directly conflicts with their past claims to oppose
government overreach in healthcare.
This decision
will cause significant harm
This decision was
announced the afternoon before Transgender Day of
Remembrance, when transgender communities worldwide remember
those transgender people who have been killed by direct
violence, and those who have died because of systemic
discrimination. As a collective of community leaders, health
promoters, counsellors, social workers, and others who work
directly with young transgender people every year, we
believe that this decision is dangerous and is likely to
result in not only the suffering of transgender youth, but
the names we will be remembering in the years to
come.
To the Ministers who made this decision:
you are responsible for the weight of its
consequences.
To the transgender youth who
will not be able to access these medicines: our member
organisations will continue to fight for your rights. We
will keep working with the many healthcare providers who
want to make sure you get to choose the treatments that are
right for you. We will continue to listen to you, to share
information with you, and to respect your choices. We see
you, we value you, and we want you to stay alive
The
safety of trans children in this country requires us to put
science and evidence first. This announcement intends to put
politics above this.
This statement is written on
behalf of the signing members of the Rainbow Support
Collective. Our collective is made up of organisations doing
the day to day work of providing support for rainbow people
throughout Aotearoa, our membership includes both national
and regional organisations, as well as organisations who
specialise in supporting transgender, intersex and youth
populations.
Rainbow Youth – Intersex Aotearoa –
Gender Minorities Aotearoa – Qtopia – Rainbow Hub Waikato –
Te Ngākau Kahukura – Burnett Foundation Aotearoa –
InsideOUT
Kōaro
