Since 3 June 2024, temporary emergency restrictions have been in place preventing the private sale and supply of gonadotrophin releasing hormone (GnRH) analogues used to suppress puberty as part of treatment for gender incongruence or gender dysphoria in children and young people under 18 years of age in England, Scotland and Wales.

The Commission on Human Medicines (CHM) has provided independent expert advice that there is currently an unacceptable safety risk of puberty blockers to children. It recommends indefinite restrictions while work is done to ensure the safety of children and young people.

On 11 December 2024 the Government passed further legislation to maintain the restrictions indefinitely following a targeted consultation and advice on patient safety from the CHM and the Cass Review. The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024 will come into force on 1 January 2025 as the current emergency order expires.

The information below summarises the restrictions in place on the private sale and supply of gonadotrophin releasing hormone (GnRH) analogues used to suppress puberty as part of treatment for gender incongruence or gender dysphoria.

Private prescriptions by non-UK registered prescribers

Since 3 June 2024, pharmacies in Great Britain have been unable to dispense private prescriptions for GnRH analogues for anyone under 18 years of age if the private prescription is dated on or after 3 June 2024 and the prescriber is registered in an EEA country or Switzerland but not the UK.    

Pharmacies can continue to supply GnRH analogues to those aged 18 or over against prescriptions from prescribers registered in an EEA country or Switzerland only where the pharmacy is able to verify the age of the patient by seeing their UK birth certificate or a current national identity document.

Private prescriptions by UK registered prescribers for people aged 18 or over

Pharmacies can supply GnRH analogues against private prescriptions by UK registered prescribers for people aged 18 or over provided that it is either annotated “SLS” by the prescriber and has included within it the patients age or the pharmacy is able to verify the age of the patient by seeing their UK birth certificate or a current national identity document. 

Private prescriptions by UK registered prescribers for people under 18 years of age

Pharmacies can supply GnRH analogues against private prescriptions by UK registered prescribers for anyone under 18 years of age in the following circumstances:

• The prescription was issued for a purpose other than the treatment of gender dysphoria/incongruence

or

• The prescription is for the treatment of gender dysphoria/incongruence and the child or young person started treatment before 3 June 2024 and has had a prescription for a GnRH analogue in the six months prior to the ban coming into force (whether or not the prescription has been dispensed).

In these circumstances the prescription must be annotated “SLS” by the prescriber and has included within it the patients age or if the prescription was issued before 3 June 2024the pharmacy is able to verify the age of the patient by seeing their UK birth certificate or a current national identity document.

NHS prescriptions

Additionally, general practitioners (GPs) and other prescribers are only able to provide NHS prescriptions for GnRH analogues in the following circumstances:

• The patient is aged 18 years or over

or

• The patient is 17 years or under, and the purpose of the prescription is for a medical condition other than gender incongruence, gender dysphoria or gender affirmation

or

• the patient is 17 years or under and has been issued with a prescription for a GnRH analogues for puberty suppression in the 6-month period prior to 26 June 2024; then they may continue to be issued with prescriptions for GnRH analogues for that purpose on and after that date

• The NHS prescription must be endorsed ‘SLS’ by the prescriber

Support for children and young people affected

Some children, young people and their families may be concerned or distressed by the initial government restrictions and the extension.

If a young person (in England) below the age of 18 years is currently taking these medicines and is unable to access further prescriptions from their usual provider, and is in psychological distress as a result, they should be advised to seek support from the NHS by contacting the NHS National Referral Support Service for the Children and Young People’s Gender Service (NRSS), who can arrange consultations with the patient’s local Children and Young People’s (CYP) Mental Health Team.

If they are already under the care of Children’s and Young People’s (CYP) mental health provider/Child and Adolescent Mental Health Services (CAMHS) they can contact their team for advice.

Additionally, distressed individuals / family members can also be signposted to advice on getting mental health support available at NHS.UK.

Anyone in need of urgent support can contact NHS 111 and choose the mental health option (option 2). The NHS.UK website also has information on where to get urgent help for mental health.

NHS England has published updated information for prescribers and pharmacists/dispensing doctors. This provides information on:

• The changes and who it will affect
• Support for children and young people affected by this change
• Advice for prescribers and pharmacy teams.

Further Information

• NHS England Updated information for primary care – government restrictions on use of puberty suppressing hormones (puberty blockers)
• DHSC press release
• The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024
• Gender Identity Services Standards (Scotland)
• NES Transgender Care Knowledge and Skills Framework (Scotland)
• NHS Wales Specialist Children and Young People Gender Identity Services
• Welsh Gender Service.