Children who sign up to the controversial puberty blockers trial will be told to consider freezing their eggs or sperm because of the risk posed to their fertility.
Young people experiencing ‘gender incongruence’ who take part in the NHS-backed study will be offered expert advice on preserving their ability to become parents later in life – even though they will be as young as ten.
Girls among the cohort will also be warned not to get pregnant in case the powerful drugs damage unborn babies.
And they will be reassured that they will not be taken off the medication if they report ‘upsetting’ experiences – even though the main measure of the two-year clinical trial will be questionnaires asking participants how they feel.
It comes after Health Secretary Wes Streeting admitted that the 226 children being sought for the project cannot consent to taking puberty blockers and so need a parent to agree they can go ahead with it.
He is now under renewed pressure to abandon the trial, after more than 100 MPs and peers signed a letter opposing it and a group of concerned parents began a legal challenge.
Shadow Equalities Minister Claire Coutinho told the Daily Mail: ‘No eight-year-old child can make decisions about their future fertility. Asking them to do so is completely unethical, and yet another reason why the Streeting Trial must be stopped.
‘This document shows that giving children these powerful drugs has clear, irreversible risks to their brain development and bone density. The NHS is choosing to expose children to lifelong harm.
‘These are physically healthy children being put on a medical pathway to permanent chemical castration whilst they are still in primary school. No child can consent to that, and no adult should ask or enable them to.’
Baroness Cash, a former commissioner at the Equality and Human Rights Commission, added: ‘These children need support not medicating. This is a medical scandal happening in plain sight and it must be stopped.’
Helen Joyce from charity Sex Matters said: ‘Of all the horrors hidden in the guide for participants in the puberty blockers trial, the approach to their future fertility is perhaps the worst.
‘Children who may be as young as ten are sold a fantasy that they can preserve their fertility, even as they embark on a treatment pathway that will block their normal development into adulthood and is likely to end up destroying their ability to have children naturally.
‘Some of the participants in this trial will be so young they still believe in Santa Claus. Some may not even be clear on the facts of life. This guide envisages conversations they will not be mature enough for, and which are totally inappropriate for their age group.’
Psychotherapist Stella O’Malley from Genspect said: ‘Telling children that options exist is not the same as ensuring they understand what they may be losing. In distressed young patients, ‘information given’ can easily become a box-ticking exercise. Safeguarding means honesty, clarity, and the willingness to slow down – even when that’s uncomfortable.
‘The trial information sheet tells children as young as ten they can store eggs or sperm. We’re asking children to contemplate lifelong infertility before they’ve ever fallen in love. A detransitioner who was among the first children given puberty blockers by the NHS told me he was drawing daisies and hearts on his consent form. He had no idea what he was signing away.’
The Participation Information Sheet for the clinical trial, part of a wider £10.7million project called PATHWAYS that is being run by King’s College London, explains to children that ‘gender incongruence is when a person’s gender identity does not match their sex registered at birth’.
It tells them that ‘puberty can be a difficult time for children and young people who have gender incongruence’ because ‘their body starts to change in ways that don’t match how they feel inside’.
And it claims that ‘doctors think puberty-suppressing hormones may help young people with gender incongruence explore their gender identity without worrying about their body starting to change’, although it admits that ‘doctors and other people have also been worried about possible disadvantages’ such as ‘decreased bone strength’.
The guide says those on the trial will be given injections of a puberty-suppressing hormone every six months for two years, and will then undergo physical checks as well as being given questionnaires asking about their emotions and ‘how you feel about your gender and body’.
It admits there are risks to taking the drugs, some of which ‘may not show up until later in life’ including on fertility.
The guide warns: ‘It is important that you talk to the doctors in the clinic about the options you have for your fertility for the future. These choices would include being referred to a fertility specialist to discuss storing eggs or sperm.’
It also says there are possible risks to ‘sexual development and function’ along with ‘bone health’ and ‘memory and thinking skills’.
The document tells children they can change their mind and drop out of the trial, but also reassures them that admitting they are struggling will not lead to the drugs being withdrawn.
‘Young people might worry that the answers they give could affect whether they stay on GnRHa. We know that young people’s emotions and experiences change, depending on what is happening in their lives. Your treatment will not be stopped if you tell us about difficult feelings or experiences.’
It adds: ‘When answering the questionnaires, you might find some questions upsetting or difficult to answer. We can discuss this with you if it is helpful.
‘Remember that telling us questions are difficult or upsetting will not change your treatment in the trial.’
Minutes of the NHS Research Ethics Committee that signed off on the trial reveal that questions were raised about the impact on children’s future fertility.
Clinicians ‘acknowledged that fertility impacts were a critical issue’ but added: ‘The only way to know the impact on fertility was to conduct the study.’
During a Commons debate last week, Health Secretary Mr Streeting – who has admitted he feels uncomfortable with the trial having banned puberty blockers last year – told MPs: ‘I know that there are concerns about the longer-term impacts on fertility.
‘Prospective participants will be given comprehensive information on the advantages and potential risks of the hormones, including details about preserving fertility. Doctors will explain the possible long-term consequences and available options. Young people will also be offered consultation with a fertility specialist.
‘The young person and their parent or guardian must clearly demonstrate a full understanding of all these issues—only then, after that, would a clinician sign off on admission to the trial.’
