The rate of new prescriptions of puberty-delaying medicines for youth with gender dysphoria in New Zealand has decreased since 2021, according to new research.
The study published in the NZMJ notes that the prescription rates had previously been rising since 2014. New Zealand rates were 1.7 times higher than the Netherlands by 2018, and 3.5-6.9 times higher than England and Wales up to 2020 – however there is no more recent international data to compare with NZ since prescribing rates began to drop in 2021.
The Science Media Centre asked experts to comment.
Dr Rona Carroll, General Practitioner; and Senior Lecturer, University of Otago, comments:
“Puberty blockers can have a positive effect on the mental health and wellbeing of transgender and gender diverse young people. In New Zealand, children and young people access puberty blockers through a careful assessment and support process that includes a team of healthcare professionals and psychological input.
“New Zealand is a progressive country which recognises the importance of accessibility to healthcare and support for gender diverse young people. Our model of care is different from the centralised gender clinic model used in the comparison countries in this paper. These centralised clinics overseas have often led to excessively long wait times for care.
“For these reasons, it is not surprising that New Zealand has higher rates of prescribing puberty blockers. As the authors point out, the number of transgender young people does not appear to be increasing. Instead, the higher prescribing rates may be because young people feel safe expressing their gender and healthcare needs, have access to appropriate health services and live in a country where inclusion and respect for transgender individuals is growing. It is a good sign that young people are feeling comfortable to discuss their gender with their whānau and express their needs.
“Using data from UK gender clinics might not accurately reflect the true need for puberty blockers in the UK, where accessing this care can be extremely difficult. Our goal should not be to match UK prescribing rates, but rather to ensure that gender diverse children and young people receive accessible, individualised, and holistic care. The PHARMAC data presented in the paper suggests that New Zealand is responding to this need.”
Conflict of interest statement: “I am a member of the PATHA executive committee and a GP working in gender affirming healthcare.”
Professor Paul Hofman, paediatric endocrinologist, University of Auckland, comments:
“This is a timely article examining the use of pubertal blocking drugs in NZ in children and adolescents under 17 years old in an attempt to examine the use of these medications in transgender youth. The data have been compared to UK and Dutch data of prescriptions for a similar aged population of transgender youth. These data indicate a rapid increase in the use of these agents over the past 10 years although in the past 2-3 years there has been a plateauing of use and a decline by approximately 20%. The much higher levels of use compared to the UK and the Netherlands raise some concerns about the prescribing of these medications in NZ.
“However, there are a number of caveats that the authors also comment on to some extent. Firstly, the prescriptions for pubertal suppressive medication can also be for several other reasons other than gender dysphoria. In the group over 12 years old, it is reasonable to assume that there should not have been an increase in use for these other conditions and that the observed increase most likely reflects transgender use. However, this remains conjecture and an extrapolation of the data. Secondly there could easily be bias and underreporting from the UK and the Netherlands data so their results may actually be higher and less different to those reported here.
“Even with these caveats these data are concerning – we may be prescribing substantively more pubertal suppressive therapy than two European countries. Given this is an expensive therapy and the evidence for its efficacy in transgender youth remains relatively weak, it suggests that PHARMAC should ask for a transgender diagnostic category for pubertal suppressive therapy use to confirm its prevalence in NZ. While the study cannot categorically demonstrate increased pubertal suppressive therapy use in NZ, it raises an important question that needs answering.
“Interestingly pubertal suppressive therapy in this age group has declined in recent years. If this plateauing/ decrease persists it is unclear whether this reflects a saturated market, a changing approach by physicians treating transgender youth, or concerns about the safety of use.”
Conflict of interest statement: “I reviewed this article prior to it being submitted and published.”
Professor Simon Denny, Adolescent and Young Adult Physician, Director of the Mater Young Adult Health Centre, Brisbane, Australia, comments:
Note: Dr Denny trained as a Paediatrician in New Zealand and has worked for over 18 years with adolescents and young adults at the Centre for Youth Health in south Auckland.
“The article on the use of puberty-blocking hormones for gender dysphoria in New Zealand presents the data on the use of these medications over the past decade. My concern is that the authors frame the rise in puberty-blocking prescriptions as inherently problematic. Instead, this increase could reflect improved identification of gender dysphoria and better access to appropriate, evidence-based care for young people who need it. To frame the data as alarming overlooks the reality that more individuals are actually receiving the care they need to live authentically and improve their mental well-being.
“The article also omits key information about the very small numbers of individuals who actually received these treatments compared overall numbers in the community. This lack of context risks misrepresenting how carefully these medicines are actually used and may contribute to unnecessary alarm.
“Puberty-blocking medicines have been transformative for many individuals. These treatments significantly improve mental health by alleviating distress related to the development of unwanted secondary sexual characteristics. They also provide time for individuals to explore their gender identity without the pressure of irreversible physical changes. In some cases, early intervention can reduce or eliminate the need for future surgeries or more invasive treatments, leading to better long-term outcomes for those who pursue gender-affirming healthcare. Ignoring these positive effects diminishes the crucial role these medicines play in the well-being of gender-diverse youth.
“While the article discusses the reversal of puberty blocker access in several countries, it does not address the robust criticisms of these policy changes. Many of these reversals were influenced by broader political and cultural contexts rather than conclusive scientific evidence. These complexities deserve mention to provide a more balanced view of the ongoing debates around gender-affirming healthcare.
“In sum, while the article provides useful data on prescription trends, it misses critical aspects of the discussion—namely, the potential benefits of increased access to care, the small number of individuals affected, and the broader political influences shaping policy changes in other countries. Puberty-blocking treatments are an essential part of gender-affirming care, helping many young people to live healthier, more authentic lives, with far-reaching mental and physical health benefits.”
No conflict of interest.