There will be upcoming legislative changes that introduce new restrictions on the prescribing and supply of puberty supressing hormones known as ‘puberty blockers’, to children and young people under 18 in England, Wales and Scotland.

• The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (England, Wales and Scotland) Order 2024 (legislation.gov.uk)
• The National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) (Amendment) Regulations 2024 (legislation.gov.uk)

The emergency order applies to England, Scotland and Wales and comes into force on 3 June 2024. It introduces a temporary ban for a period of three months (ending on 3 September), on the sale or supply of gonadotrophin releasing hormone (GnRH) analogues when used to suppress puberty as part of treating gender incongruence or gender dysphoria in children and young people who are under 18 years of age.

During this period it is expected no new patients under the age of 18 will be initiated on these medicines for the purposes of puberty suppression in those experiencing gender dysphoria/incongruence and will ban the sale or supply of these medicines for new patients against private (i.e. non-NHS) prescriptions.

From 3 June, it will become a criminal offence for a doctor, pharmacist, or any other individual in Great Britain to sell or supply these drugs to patients under the age of 18 except in certain circumstances, which are outlined below and in the NHS England guidance.

Private prescriptions by non-UK registered prescribers

From 3 June, pharmacies in Great Britain will no longer be able 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 will continue to be able 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

Pharmacies will continue to be able to supply GnRH analogues against private prescriptions by UK registered prescribers for people aged 18 or over on the date the prescription was written provided that it is either annotated “SLS” by the prescriber, or the pharmacy is able to verify the age of the patient by seeing their UK birth certificate or a current national identity document. 

Pharmacies will continue to be able to supply GnRH analogues against private prescriptions by UK registered prescribers for anyone under 18 years of age provided that it is either annotated “SLS” by the prescriber, or the pharmacy is able to verify the age of the patient by seeing their UK birth certificate or a current national identity document, provided the prescriptions 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). 

Why has the ban been introduced?

The NHS has stopped the routine prescription of puberty blockers to children and young people in line with the recommendations of the Independent Review of gender identity services for children and young people led by Dr Hilary Cass (The Cass Review) earlier this year.

This action has been taken to address risks to patient safety. Patients already established on these medicines by a UK prescriber for these purposes can continue to access them. They will also remain available for patients receiving the drugs for other indications, from a UK-registered prescriber.

The National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) (Amendment) Regulations 2024 (legislation.gov.uk)

In England, the government has also introduced indefinite restrictions to the prescribing of these medicines within NHS primary care in England, in line with NHS guidelines. These Regulations will come into force on 26 June 2024.

Similar Regulations are not currently in place for Scotland and Wales, however they are likely to be introduced at a later date.

The regulations will add GnRH analogues to the list of medicines which can be prescribed by NHS general practitioners only in limited circumstances.

Once the regulations come into force, GPs will not be allowed to initiate the prescribing of GnRH analogues for children and young people under the age of 18 for the treatment of gender dysphoria/incongruence. 

GPs will continue to be able to prescribe GnRH analogues for people aged 18 or over, to children and young people under the age of 18 for the treatment of conditions other than gender dysphoria/incongruence, and to children and young people under the age of 18 for the treatment of gender dysphoria/incongruence where treatment commenced before 3 June 2024 or where treatment commenced on or after 3 June 2024 provided it is part of a National Institute for Health and Care Research clinical trial.

Additional information

NHS England has issued guidance for patients, prescribers and pharmacists entitled new UK Government restrictions on use of Puberty Suppressing Hormones (Puberty Blockers); Information for prescribers and pharmacists/dispensing doctors.

Any further guidance produced by Wales and Scotland will be shared with members when available. The NHS England guidance provides information on:

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

NHS England has also issued a letter with advice for patients in light of new Government restrictions on the prescription and supply of puberty blockers.

The RPS plan to publish a position statement in response to the Cass Review and The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (England, Wales and Scotland) 2024/272 and continues to engage with the Government, other professional bodies and relevant stakeholders.

In additions to the communications published by the government, further information and advice can be found in the following resources:

• NHS England Clinical Policy: puberty suppressing hormones
• The Cass Review: Final Report