What happened to the Ministry of Health’s ‘evidence brief’ on puberty blockers?

A document intended to outline the ministry’s position on hormone treatments has been delayed multiple times since its intended release date.

Mōrena, and welcome to The Bulletin for Monday, September 2.

In today’s edition: A special report breaks down the multiple delays to a review of access to “gender-affirming” treatment. Plus: Thousands of mourners have visited Tūrangawaewae Marae to pay their respects to the late Kīngi Tuheitia, and New Zealand won a silver and a bronze on day four of the Paris Paralympics.

A series of delays

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. 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, reported RNZ’s Ruth Hill. But this never eventuated. The Bulletin requested a series of documents and correspondence pertaining to the brief under the Official Information Act, which confirmed that a ministry communications plan had been drafted up in preparation for the April release date. However, subsequent communication showed 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”.

A controversial 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.

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. As Newsroom’s Marc Daalder reported, emails 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 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 recommending 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, explained the BBC. 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”.

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, as Jo Moir reported for Newsroom 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. “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.”

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”, reported Stuff.

The timeline, in brief

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. 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. The evidence brief was not released in July, nor August. 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.”

This is an abridged version of a full report available on The Spinoff this morning.

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

Listen: A night with Auckland’s radical leftists

Gabi Lardies joins Madeleine Chapman on Behind the Story to talk about experiential reporting, writing about your own communities and finding inspiration in a cold community hall.

Listen to Behind the Story below or wherever you find your pods. And read Gabi’s story on The Spinoff here.

Patients queuing in the cold outside Ōtara GP clinic

The Herald’s Michael Morrah has reported that patients are queuing from 6am outside an Ōtara doctors clinic due to long wait times and a lack of bookings. It’s a stark vision of the healthcare crisis we’ve talked about a few times in recent weeks, with patients pictured in Morrah’s story wrapped in warm clothes as they brave the cold to see a doctor. “To see my people sitting out here and you’ve seen the majority who are in the cold before seven o’clock are Māori and Pacific,” said the clinic’s community liaison manager, Lorenzo Kaisara. “They are already sick. They get more unwell sitting out here in the cold”. One patient, Toa Salaina, said the wait to see a doctor can be up to five hours once you make it inside, urging the government to help add more doctors and nurses. Lloyd McCann is the CEO of Tamaki Health, owners of the Ōtara clinic, and said the struggle for a booking was symptomatic of the challenges facing healthcare. “It’s absolutely heartbreaking,” he said.

PM joins mourners at Tūrangawaewae, urges unity

Thousands of mourners, including prime minister Christopher Luxon, have visited Tūrangawaewae Marae over the weekend to pay their respects to the late Kīngi Tuheitia, who died last week at the age of 69. As 1News reported, iwi, hapu and roopu from across the country visited the marae yesterday, while mourners from the public will now be invited on to farewell Tuheitia. In his speech, Luxon showed visible emotion as he reflected on his relationship with the King, reported the Herald’s Adam Pearse. “You talked with optimism and positivity, you laughed, you were kind and you were gracious as always, that is the Kīngi Tūheitia that I will remember,” Luxon said, referencing his last visit to the marae just over a week ago. “I would not know that that would be our last conversation.” RNZ’s Taiha Molyneux told First Up that today would see at least 13 iwi head to Tūrangawaewae.

Michael Cugley at Te Ao Māori News explains how a successor to Tuheitia will be confirmed, reporting that it will be determined on Thursday – the same day the King is buried.

More reading from The Spinoff:

• Jamie Tahana: Kiingi Tuheitia’s death leaves a massive void at a critical moment.

• Liam Rātana: The reign of Kīngi Tūheitia Pōtatau Te Wherowhero VII.

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Click and Collect

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• I enjoyed Claire Trevett’s analysis in this piece around bipartisanship in politics and why we can’t have nice things. It’s for Herald Premium readers, but worth a read if you have a subscription.

• The latest episode of The Detail, looking at the stalled construction of what was meant to be the country’s highest residential building, is a good listen.

• New Zealand won a silver and a bronze on day four of the Paris Paralympics.

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That’s it for today, thanks for reading. I’ll be back here tomorrow morning.

Want to get in touch? Join the conversation in the Substack comments section or via email at thebulletin@thespinoff.co.nz if you have any feedback on today’s top stories (or anything else in the news).

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