Rebecca Paul
MP for Reigate · Conservative · United Kingdom
“Britain’s steel industry is not competitive, because of high energy costs and excessive red tape, but instead of addressing the root causes, this Labour Government revert back to their default solution of nationalisation. Why are this Government so keen to take us back to the 1970s?”
“The previous Secretary of State, the right hon. Member for Stalybridge and Hyde (Jonathan Reynolds), said that the Government would seek to find a buyer for British Steel, and several parties have expressed interest. Are discussions ongoing with those parties, and if not, why not?”
“I recently invited residents to vote for their favourite local businesses in my constituency. Will the Leader of the House join me in congratulating MLP Wealth Management in Banstead, which won best overall small business; the Chapel in Reigate, which won best independent café; Murray Designs in Reigate, which won best independent shop; a…”
“The Secretary of State will know that e-bikes do not require insurance, but we are seeing some pedestrians suffer catastrophic injuries due to the additional weight of these bikes compared with a normal bike. Is she giving any consideration to reviewing the rules on this issue?”
“I thank the hon. Member for Tooting (Dr Allin-Khan) for securing the debate. This is a really important topic, and I do not think there has been enough focus on it in the last few years. Her speech was very powerful, and the hon.”
“The problem was not down to their lack of commitment or compassion; it was down to a system that is operating without enough physical space to meet the excessive demand placed upon it. The previous Secretary of State, the right hon.”
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“Other indications remain unproven at this time.” I take that to mean that those drugs have been given to young girls, not because they benefit them specifically, but because they might benefit a very small group of males. Professor David Bell, a retired consultant psychiatrist at the Tavistock, and Dr Sinead Helyar, a clinical trial nurse, also warned of the potential harms in a recent article. “Current known and potential harms of puberty blockers are multi-fold and include a reduced bone density and early-onset osteoporosis, brain swelling and concerns around impairment of future sexual functioning and ability to form emotional relationships.”
“It was also found that, given that most children progress on to cross-sex hormones after starting puberty blockers, the main objective of pausing development is not achieved. No reduction in gender dysphoria or improvement in body satisfaction was demonstrated, and there was limited evidence of positive mental health outcomes. Worryingly, bone density in those taking puberty blockers was compromised, and height gain may lag behind normal. In the case of biological males, it can make vaginoplasty more difficult in future, due to insufficient penile growth, forcing the use of gut tissue instead. The Cass review reports: “There seems to be a very narrow indication for the use of puberty blockers in birth-registered males…in order to stop irreversible pubertal changes.”
“One would think that, in the absence of any evidence of benefit from puberty blockers, the NHS would have stepped back from using them after the trial. Furthermore, the high numbers of autistic, traumatised, mentally unwell and same-sex attracted youth in the group of children referred should have rung alarm bells loudly, but no; instead, puberty blockers and cross-sex hormones were routinely made available to an even broader group of children, including those with neurodiversity and complex mental health presentations. An independent systematic review of published studies on puberty blockers, of which there were 50, was undertaken by the University of York as part of the Cass review. It was found that puberty blockers do indeed suppress puberty effectively.”
“The preliminary results in 2015-16 did not demonstrate psychological benefits, with some of the females suffering a worsening of symptoms, including higher incidence of wanting to hurt or kill themselves. The results of the study, which were not formally published until 2020, demonstrated no statistically significant improvement in gender dysphoria or mental health outcomes. It is also important to remember the early studies that told us that in the majority of cases, going through puberty could relieve gender distress. It follows, therefore, that stopping or delaying puberty using medication could derail that natural desistence, essentially locking in or prolonging the gender distress, rather than allowing it to naturally resolve.”
“They are licensed for use in children with precocious puberty—when puberty starts much too early and it is beneficial to suppress it until a more normal developmental time and age—but in the case of gender dysphoria they are used to delay or even indefinitely stop natural pubertal development and maturation, and it is important to note that puberty blockers are not licensed for that purpose. The original rationale for using puberty blockers to treat gender dysphoria was to press pause on puberty and give children time to think, but for some the aim was also to increase the chances of a child passing as a member of the opposite sex in adulthood. GIDS started trialling puberty blockers in the UK after 2011.”
“Early studies from the 1980s showed that in around 85% of cases, the gender incongruence or distress ceased in the child after going through puberty. Later studies reached a similar conclusion, with between 67% and 90% desisting after puberty. Only a small cohort of children continued to experience gender dysphoria or incongruence after puberty, and it was that small group who would likely adopt a permanent trans identity in adulthood. Everything changed with the emergence of the Dutch protocol, which involved the use of puberty blockers from early puberty. Puberty blockers are gonadotropin-releasing hormone analogues, which supress oestrogen production in girls and testosterone in boys.”
“In 2009, only 51 patients were referred to GIDS—the NHS gender identity development service for children—of whom two thirds were male. In 2016, there were 1,766 referrals and two thirds of them were female. That is quite the change. There has been an overall surge in the number of children suffering gender distress, but the increase is especially notable among girls; we also see over-representation of neurodiversity, mental health issues and trauma in this group. To put it another way, these children are much more likely to have been in care, to suffer with anxiety and depression, to be autistic and to have been abused. It is a group of incredibly vulnerable children. GIDS was established in 1989. Its main approach to treatment at that time was therapeutic—referred to as watchful waiting.”
“It is speculated that the factors may include 24/7 internet access, increased acceptance of trans identities, or even peer, social and cultural influences. Over the last 20 years we have seen groups such as Stonewall and Mermaids call for better access to treatment and increased rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands, impactful TV dramas centring trans stories, such as “Butterfly”, have been widely viewed, and the public sector, from the NHS to the police, has been flying the progress flag at every opportunity. So it can be no surprise that gender identity is at the front of young people’s minds in a way that it simply was not when I was growing up.”
“I beg to move, That this House has considered the potential impact of puberty suppressing hormones on children and young people with gender incongruence. It is a pleasure to serve under your chairmanship, Ms Lewell. I am pleased to have the opportunity to shine a light on this important topic, one that impacts the health and wellbeing of some of the most vulnerable children in our country. This debate must be led by science, data and evidence, not by ideology, bias or belief. I will do my best to do that today. The number of children and young people presenting to the UK NHS with gender distress has increased year on year since 2009, with an exponential rise in 2014. What is behind the increase among Generation Z is unclear and the reasons are likely to be multifaceted.”
“I appreciate that some of the detail is not available yet, but will be forthcoming. Question put and agreed to . Resolved, That this House has considered the potential impact of puberty suppressing hormones on children and young people with gender incongruence.”
“Very vulnerable children are affected by the issue, so it is important that we get it right. I thank the spokespeople, the hon. Member for North Shropshire (Helen Morgan) and my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), for their contributions. I also thank the Minister, who has taken a huge number of questions from me. She and her Department were very constructive in advance of the debate. This debate is not political; it is about doing the right thing for our children. I am absolutely here to work with the Government and to support what they are doing to get us to that right position. If I can do anything to help, they should not hesitate to let me know. I thank the Minister for going through the questions, and I look forward to hearing the detail.”
“I will speak only briefly. I want to say a massive thank you to everyone who has spoken. To echo the words of the hon. Member for Macclesfield (Tim Roca), I appreciate the respectful and constructive tone. There have been some different ideas—not everyone is entirely on the same page—but we have all approached the debate in a way that is evidence-based and about sharing facts. It is very clear that everyone in this Chamber wants the best for our children. We absolutely share that objective. I thank the hon. Member for Strangford (Jim Shannon) for his thoughtful contribution. We always tend to be on the same page about such issues. My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) and I are also very much aligned in our thinking on this point. This is a really important debate.”