London — The only gender identity clinic in Scotland has paused prescribing puberty blockers to new patients under 18 years old, mirroring action taken by England’s health authorities after a landmark review found young people had been let down by “remarkably weak” evidence backing medical interventions in gender care. 

The report, commissioned by Britain’s National Health Service, also found that the “toxicity” of the debate around gender identity meant physicians were operating in fear.

Dr. Hillary Cass, who led the review that produced the 388-page report published earlier this month, said “we don’t have good evidence” that puberty blockers are safe to use to prevent changes that come during puberty.

“It is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood, and that’s been a particular problem, that we haven’t had the follow-up into adulthood to know what the results of this are,” Cass told CBS News partner BBC News.

Puberty blockers suppress the release of hormones that cause puberty. They can be prescribed to children who are questioning their gender in order to stop physical changes such as the growth of facial hair or breasts.

“The next step from here is to work with the Scottish government and academic partners to generate evidence that enables us to deliver safe care for our patients,” Emilia Crighton, the director of the public health service for the Glasgow region, said in a statement. “We echo the views of Dr. Hilary Cass that toxicity around public debate is impacting the lives of young people seeking the care of our service and does not serve the teams working hard to care and support them. We understand the distress that gender incongruence can cause and, while all referrals to endocrinology are paused, we will continue to give anyone who is referred into the young people’s gender service the psychological support that they require while we review the pathways in line with the findings.”

Scottish Trans, an advocacy group, said it disagreed with the decision to pause prescriptions of puberty blockers for minors, which it said “has been taken within the context where the reality of trans people’s experiences and lives is questioned almost daily in some of the media and some political circles.”

“This makes us worry that the decision has been influenced by that context rather than solely through consideration of the best interests of trans children and young people,” Scottish Trans said in a statement, adding that between 2011 and 2023, only 87 young Scottish people were prescribed puberty blockers.

“The exceptionally rare and cautious choice of puberty blocker prescription, made for a small number after huge waits, is being wrongly painted by some as though it was commonplace and rushed. Nothing could be further from the truth. We’re saddened that this change will result in some young people being unable to access the care they need at all, or having to wait even longer for it,” Scottish Trans said.

Ahead of the Cass review’s publication, the NHS said in March that it would stop prescribing puberty blockers to under-18s at gender identity clinics in England. New young patients in the U.K. can still get a prescription for hormone blockers, but only as part of a clinical trial.

Cass’ review called for better research into the medications and their long-term effects, as well as the characteristics of children seeking treatment.

“The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” she wrote in the review.

She encouraged a holistic assessment of patients, taking into consideration issues that may not relate to their gender identity, including screening for conditions such as autism to address “diagnostic overshadowing” that could occur when issues of gender are brought up.

“What’s unfortunately happened for these young people is that, because of the toxicity of the debate, they’ve often been bypassed by local services who’ve been really nervous about seeing them,” Cass told the BBC. “So, rather than doing the things that they would do for other young people with depression or anxiety, or perhaps undiagnosed autistic spectrum disorder, they’ve tended to pass them straight on to the GID (Gender Identity Disorder) service.”

The Cass review was commissioned following a sharp rise in referrals to gender identity services in the U.K., from around 250 a year to more than 5,000 in 2022.

Haley Ott

Haley Ott is the CBS News Digital international reporter, based in the CBS News London bureau.

A Missouri judge ruled Friday that a ban on gender-affirming health care for minors can take effect on Monday, as scheduled.

The ruling by St. Louis Circuit Judge Steven Ohmer means that beginning next week, health care providers are prohibited from providing gender-affirming surgeries to children. Minors who began puberty blockers or hormones before Monday will be allowed to continue on those medications, but other minors won’t have access to those drugs.

Some adults will also lose access to gender-affirming care. Medicaid no longer will cover treatments for adults, and the state will not provide those surgeries to prisoners.

Physicians who violate the law face having their licenses revoked and being sued by patients. The law makes it easier for former patients to sue, giving them 15 years to go to court and promising at least $500,000 in damages if they succeed.

The ACLU of Missouri, Lambda Legal, and Bryan Cave Leighton Paisner last month sued to overturn the law on behalf of doctors, LGBTQ+ organizations, and three families of transgender minors, arguing that it is discriminatory. They asked that the law be temporarily blocked as the court challenge against it plays out. The next hearing in the case is scheduled for Sept. 22.

But Ohmer wrote that the plaintiffs’ arguments were “unpersuasive and not likely to succeed.”

“The science and medical evidence is conflicting and unclear. Accordingly, the evidence raises more questions than answers,” Ohmer wrote in his ruling. “As a result, it has not clearly been shown with sufficient possibility of success on the merits to justify the grant of a preliminary injunction.”

One plaintiff, a 10-year-old transgender boy, has not yet started puberty and consequently has not yet started taking puberty blockers. His family is worried he will begin puberty after the law takes effect, meaning he will not be grandfathered in and will not have access to puberty blockers for the next four years until the law sunsets.

The law expires in August 2027.

Proponents of the law argued that gender-affirming medical treatments are unsafe and untested.

Republican Attorney General Andrew Bailey’s office wrote in a court brief that blocking the law “would open the gate to interventions that a growing international consensus has said may be extraordinarily damaging.”

The office cited restrictions on gender-affirming treatments for minors in countries including England and Norway, although those nations have not enacted outright bans.

An Associated Press email requesting comment from the Attorney General’s Office was not immediately returned Friday.

Every major medical organization in the U.S., including the American Medical Association, has opposed bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately. Lawsuits have been filed in several states where bans have been enacted this year.

“We will work with patients to get the care they need in Missouri, or, in Illinois, where gender-affirming care is protected under state law,” Yamelsie Rodríguez, president and CEO, Planned Parenthood of the St. Louis Region and Southwest Missouri, said in a statement after the ruling.

The Food and Drug Administration approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that causes sexual development to begin much earlier than usual. Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders and for birth control.

The FDA has not approved the medications specifically to treat gender-questioning youth. But they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat trans patients say those decades of use are proof the treatments are not experimental.