Latest news with #hormonetherapy
Wall Street Journal
an hour ago
- Health
- Wall Street Journal
Trump Administration Weighs Eliminating Funds for Hospitals Offering Gender Care to Minors
WASHINGTON—The Trump administration is weighing cutting off funds to hospitals that it says provide gender-related treatments for children and teenagers, a move that would sharply escalate officials' scrutiny of such programs. The potential for increased federal scrutiny on gender-related healthcare comes after a 30-day deadline passed Saturday for nine children's hospitals to respond to letters from Mehmet Oz, the Centers for Medicare and Medicaid Services administrator and celebrity physician known as Dr. Oz. The former heart surgeon and television host demanded data related to sex-reassignment surgeries, hormone therapy and puberty blockers.
The Independent
6 days ago
- Health
- The Independent
Watchdog acted ‘irrationally' in registering private gender clinic, court told
The health watchdog's decision to register England's first private clinic offering gender treatment to young people was 'simply not open to it', the High Court has heard. Former nurse Susan Evans and a mother known as XX are taking legal action against the Care Quality Commission (CQC) over its decision to register the Gender Plus Hormone Clinic (GPHC) in Birmingham in January last year. The two are also challenging the regulator's decision to continue the clinic's registration and to allow it to prescribe cross-sex hormone treatment to 16 and 17-year-olds without conditions, made last December. The clinic, which was rated outstanding by the watchdog last year, treats people aged 16 and older, including through prescribing gender-affirming – masculinising or feminising – hormones, but, in line with the NHS, does not prescribe puberty blockers. Lawyers representing the two women told a hearing on Tuesday that the watchdog did not consider aspects that were 'obviously material' when making its decision, including the NHS's stance on hormone treatment for children aged 16 and 17 in light of the Cass Review. The watchdog is defending the claim, telling the court that it was 'abundantly clear that there was ample evidence' for its decision, while lawyers for the company which runs the clinic, Gender Plus Healthcare Limited, said the legal action was 'fatally flawed'. Opening the women's case on Tuesday, barrister Tom Cross KC said the clinic was believed to be the only hormone treatment provider to 16 and 17-year-olds in England, and that the claimants' concern was about safety, with Ms Evans previously stating she believed the registration 'creates a significant risk of a two-tier approach'. Mr Cross said: 'At arriving at the conclusion that the provider should continue to be registered without any conditions … the CQC has acted irrationally.' He added: 'It has not factored into its conclusion a number of aspects of the process on the NHS, informed by the Cass Review, which serve as important safeguards for children within the cohort and were obviously material.' The barrister said that had the CQC factored these in, it would have 'decided to exercise its power to halt the treatment' of under-18s, and that its decision was 'simply not open to them'. He claimed that 'at the very least' the court 'should require the CQC to think again about the adequacy of the safeguards'. Hormone treatment was previously provided on the NHS at the now-closed Gender Identity Development Service (Gids) run by the Tavistock and Portman NHS Foundation Trust, where Ms Evans previously worked. But a review published by Baroness Cass in April last year said that 'extreme caution' should be demonstrated when deciding to prescribe the treatment to 16 and 17-year-olds, and that there should be 'clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18'. The NHS has opened three specialist children's gender clinics and has plans for a further five covering the seven NHS regions in England by the end of 2026, but has said that all recommendations for hormone interventions must be endorsed by a national multi-disciplinary team (MDT). It is understood that the MDT has not yet received any recommendations for hormone treatment for 16 and 17-year-olds, since the Cass Review. GPHC was set up by Dr Aidan Kelly and is led by nurse consultant Paul Carruthers, who both worked at Gids, and has previously said it primarily treats patients aged between 16 and 25, using its own MDT. But Mr Cross said in written submissions that in the year up to June 2024, GPHC has 'accepted almost every single patient that it considered' for hormone treatment, and that the contrast with the NHS 'could not be more stark'. He said there were 'a number of key differences' between GPHC and the NHS safeguards, including that referrals to the former came from Dr Kelly's company, Kelly Psychology, which is unregulated. He said: 'It is, and ought to have been, obvious that the unregulated nature of the referrer enhanced the risk of patient safety.' He concluded: 'Either the CQC had to impose a condition which rationally ensured patient safety, or, if that were not possible, had to decide not to continue the registration.' Jamie Burton KC, for the CQC, said that there was 'ample evidence' that Kelly Psychology 'did not pose an unacceptable risk' to patients, and that a 'significant number' of those assessed by the company were not referred for treatment at GPHC. The court was told that the CQC found no evidence of 'improper decision making or anything that might flag a concern', and that the clinic was found to be 'committed to the safety and best interests of its patients'. He continued: 'CQC found GHPC to be acting in line with national guidance, including the NHS England 2024 Criteria. 'It found nothing to suggest that this was merely lip service or that GPHC management held an ideological commitment that was undermining its professional and regulatory commitments, or otherwise threatening the safety of patients.' He also said that the CQC 'had regard' to NHS processes, and that there could not be 'any legitimate doubt about the correctness of the ultimate outcome, or GPHC's continued registration'. He said: 'In its professional judgment, it found that the provider was taking reasonable steps to safeguard 16 and 17-year-olds by way of its existing processes.' Peter Mant KC, for Gender Plus Healthcare Limited, said that there was no legal requirement for a private provider to mirror NHS care and that the claimants' concerns 'do not have a high-quality evidence base'. He continued that the clinic's model was 'entirely consistent' with the Cass Review and NHS policy, and that patients 'no longer routinely have any input' from Kelly Psychology. He added that concerns related to the rate of accepting new patients were 'unjustified', and that the court should not 'go behind' the CQC's decision. The hearing before Mrs Justice Eady is expected to conclude on Wednesday, with a judgment expected in writing at a later date.
Wall Street Journal
19-06-2025
- Health
- Wall Street Journal
Good Supreme Court Sense on Trans Hormones
It shouldn't be news that the 14th Amendment doesn't give adolescents an effective right to access transgender hormone treatments, but it's still reassuring to see the Supreme Court say so. In a 6-3 decision Wednesday, the Justices upheld a Tennessee statute, called SB1, that bans giving such prescriptions to minors. Many other states have done the same. The 14th Amendment guarantees 'equal protection of the laws,' and the Biden Administration claimed that SB1 discriminates by sex and transgender status. 'A teenager whose sex assigned at birth is male can be prescribed testosterone to conform to a male gender identity,' it argued, 'but a teenager assigned female at birth cannot.' Yet the Supreme Court now holds that the law turns on age and diagnosis, neither of which demands heightened judicial scrutiny.
The Guardian
17-06-2025
- Health
- The Guardian
Sweaty and flustered, my breast cancer patient was experiencing hot flushes. The lack of good treatment is frustrating
'Doctor, stop!' she abruptly commands me. 'I can't process a thing.' I halt mid-sentence, and in the pause that follows, watch the evolution of a hot flush (also called a hot flash) in real time. First her face flushes pink, then her neck and the part of her chest visible over the tank top she is wearing on a blistering winter morning. Beads of sweat form over her forehead. Her burning ears might warm my still-cold fingers. But most notable is her expression, changing from composed to flustered in a split second. She is like a defeated firefighter, battling to bring the conflagration under control before resorting to simply biding her time. 'Sorry about that,' she grimaces. Going by the clock at the bottom of my screen, the 'event' takes two minutes from start to finish. In that time I have had a front seat to a dramatic version of the adverse effect that oncologists often mention in passing to breast cancer patients using anti-oestrogen therapy. 'How often do you experience this?' 'A dozen times on a good day,' she shrugs. Roughly three-quarters of breast cancers are oestrogen-receptor positive, which means the cancer cells are stimulated by oestrogen. Women with this type of cancer benefit from oestrogen suppression, achieved via different methods including a pill, an injection and removal of the ovaries. This induces menopause in younger women and more complete oestrogen suppression in the already menopausal. With more than 20,000 Australian women and 2 million women worldwide diagnosed with breast cancer every year, anti-oestrogen medication is akin to the penicillin of oncology. Each week, I write, renew and replace multiple scripts. But while every prescriber mentions the anticipated side-effect of hot flushes, it strikes me that no one (including me) quite explains the living horror that many patients go on to experience. Why is that? Women who have concluded an arduous trek of chemotherapy and radiation for early breast cancer express the hope of 'never having to go through this again'. Women with metastatic breast cancer harbour the hope that their cancer, while not curable, may remain at bay for years. Every woman's risk profile warrants a tailored conversation but, broadly speaking, imagine giving this advice: 'There is an effective medication to reduce recurrence risk and improve survival. Over the many years you will be on it, you could experience hot flushes, stiff joints, disturbed sleep, low mood, weight gain and sexual dysfunction.' If it sounds like punishment served at the end of a punishing diagnosis, it is. However, when a drug works, oncologists want to encourage adherence and hope that the side-effects either don't occur or can be managed. 'Vasomotor symptoms', the medical term for hot flushes, affect up to 90% of women with breast cancer and are often severe. Up to half of all women prescribed anti-oestrogen medication stop taking the drug – and they are just the ones who tell us. Every oncologist knows the heart-sink moment when a high-risk patient declines treatment. But we also know all too well the toll that led them to do so. Given the ubiquitous nature of hot flushes, the lack of good treatments is frustrating. Of the panoply of advertised options such as cognitive behavioural therapy, acupuncture, hypnosis, diet, exercise and off-label use of antidepressants and anticonvulsants, none has been shown to help in a meaningful way. Then there is the irony of taking one medication to counter the side-effect of another and gaining weight and its associated complications in the process. As a result, most women just put up with the trailing cost of having breast cancer. Now, there is hope. In a randomised controlled trial of drug versus placebo, a once-daily pill meaningfully reduced hot flushes in women taking anti-oestrogen therapy for breast cancer. Elinzanetant works by affecting the brain signals involved in temperature regulation. At baseline, women experienced a mean of a dozen daily episodes. By one month, 61% of women on active treatment reported a reduction of at least 50% in the daily frequency of moderate-to-severe hot flushes compared with 27% on placebo. Sleep quality improved, as did overall quality of life. Crossover from placebo to the active drug resulted in similar findings. No drug is without side-effects. More than 60% of women in each group reported at least one mild adverse event but severe ones were rare. Somnolence, fatigue and diarrhoea were reported more frequently in the active therapy group but they can also be caused by cancer therapy. More than 90% of women who completed one year of treatment chose to continue for an optional two years, suggesting a high rate of acceptability. The drug is yet unapproved and oncologists will seek more details before widespread prescribing. Breast cancer outcomes are poorer in non-white women but 88% of the participants were white. Will this drug be effective in, and tolerable for, all eligible patients. Does taking the 'remedy' drug improve adherence to the primary one that reduces cancer risk? This would be the point of prescribing it. Finally, patients on clinical trials are strictly selected and heavily monitored. Will the real-world experience match the clinical trial experience? We know that it rarely does. On the way out, I commend my patient's determination to persevere with difficult treatment, and she smiles gratefully at the acknowledgement. She is only two years into treatment. I allow myself to envision a day when there will be room for reprieve. Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
BBC News
07-06-2025
- Health
- BBC News
Gender treatment at Brighton GP practice under investigation
A GP practice is under investigation over concerns it may have prescribed gender-related medication to under-18s outside national clinical Sussex and NHS England is reviewing WellBN, which operates in Brighton and Hove, to assess the care of children and young people who were prescribed or supplied medication for gender Sussex said on Thursday it had launched "a rapid investigation into this activity".WellBN said it had paused all new hormone prescriptions for under-18s but it would "do our best to turn this decision around". The practice added in its statement, issued on its website in May, that it would continue to prescribe to young patients already under its care and the restriction only applies to "the initiation of new prescriptions".It said the NHS was "threatening to close us down altogether if we did not comply" and it "had to consider all 25,000 patients" registered at WellBN. NHS Sussex said the investigation followed "concerns raised about some prescribing for children and young people by WellBN in Brighton and Hove, that may fall outside of national clinical policy and guidance".It said it was working with NHS England "to determine the most appropriate care and treatment for these patients".It said: "The practice is no longer initiating prescribing of hormone medications for children and young people under 18 years for gender dysphoria."The practice will continue to provide general medical care to its patients while the investigation is carried out, and it will continue to provide gender care to adult patients who are aged 18 years and above." The NHS added it had established a helpline for under-18s receiving gender care from WellBN. Process to 'review' notes The cohort of patients whose cases are being reviewed are all aged under 18, and for whom WellBN is prescribing or arranging the supply of medication for gender dysphoria. It is thought that most of these children and young people, but not all of them, live in NHS said there would be a process to "review their notes, and consider next steps in their treatment, in line with national guidance and clinical advice".It said: "As a result of this process, there will likely be different outcomes for different patients."Some children and young people may be recommended for a transfer into specialist NHS commissioned gender services. "Some will be reviewed and supported by local Children and Young People Mental Health Services, and some will need an endocrinology (hormone) review."What happens following that review will differ for each individual and will depend on the outcome of the case note review, the person's age and medication profile." If you are affected by any of these issues, help and support is available via the BBC Action Line here. The BBC has contacted WellBN for May, the practice said: "We are sorry to be passing on this news, but rest assured we will continue to battle against this injustice."We have a strong case to present considering that bodily autonomy is one of the four pillars of modern medical ethics."
