Update: Announcement by Tavistock & Portman NHS Foundation Trust on the 23rd September 2009, suggesting some relaxation of policy.
The Guidelines published by the British Society of Paediatric Endocrinolgy and Diabetes (BSPED) have been withdrawn. They did recommend that an adolescent should be left to experience his/her natural hormone environment until:
- Development of secondary sexual characteristics is complete
- Final height has been achieved
- Peak bone mass has been accrued (ideally)
After development of secondary sexual characteristics is complete, followed by a period of up to 15 months on the blocking medication, the authors of the BSPED Guidelines suggest 5-10 micrograms of ethinylestradiol per day for 6 months. However, their initial prescription is for 5 micrograms per day. The dose is increased to 15 then 20 micrograms over around 18 months. This is intended to mimic normal female puberty even though the adolescents now have fully masculinised bodies. Eventually, the patient might be put on what the clinicians say is an adult dose of 20-30 micrograms per day. They say that this is the normal dose of the oral contraceptive pill. It is not clear that it adequately feminises a fully masculine body.
Advice from NHS Direct
NHS Direct confirms that there is controversy about the treatment of children. The British practice differs from that in overseas centres. The British Society for Paediatric Endocrinology and Diabetes is reviewing its guidelines.