Letter to Ministry of Health Officials regarding peer review position of Dr Bagshaw

Tēnā koutou,

I write to you regarding the choice of Dr (Dame) Sue Bagshaw as the peer reviewer of the puberty blockers evidence brief. I laid a puberty blockers research misrepresentation complaint against Dr Bagshaw in 2021 which resulted in the Otago University removing a false claim about the recovery of bone density after puberty suppression from the Otago website in 2022. Dr Bagshaw is also a highly prolific prescriber of puberty blockers, possibly one of the highest in the world, and certainly prescribes at a rate many times higher than recently seen in England. These two factors make the choice of Dr Bagshaw to review the evidence brief highly questionable. In response to an OIA request, you state that Dr Bagshaw has been chosen as a reviewer because she is “clinically active”, but it will be difficult for clinicians who have prescribed extensively for this usage, and with the possibility that they may have harmed vulnerable young people with uncertain benefit, to provide a dispassionate peer review of the clinical outcomes literature.

In the summer of 2020/2021 Drs Bagshaw and Spittlehouse of Otago University enlisted a student to review the literature on puberty blockers and published a media statement on the 1st of March 2021. Some of the claims are false. For example, that “psychosocial outcomes were very positive”. As I’m sure you are now aware from reading the Cass report and the associated systematic reviews, psychosocial outcomes actually have “insufficient and/or inconsistent evidence”. The original article also made the claim that “research shows” that:

“...use of puberty blockers does result in a decrease in bone mineral density, but this normalises when GnRH analogues are stopped and either a return to self-produced or cross-sex hormones are started.”

This claim is also false; there is no literature on the recovery of bone density after puberty suppression when returning to “self-produced” hormones and this part is pure speculation. There is literature demonstrating an incomplete recovery of bone density on cross-sex hormones, but it does not “normalise” as the statement puts it. The issue has been addressed in systematic review by Ludvigsson and colleagues who find that some bone health measures only partially recover under cross-sex-hormone treatment and remain below pre-treatment levels (emphasis added): 

“After a median [CSH] duration of 5.4 years in in female-to-male and 5.8 years in male-to-female, the lumbar spine…z-score was still significantly lower than at the start of GnRH therapy…In another study, female-to-male receiving testosterone replacement therapy for 1–2 years had not regained their group mean [bone mineral density] z-score registered at the start of GnRHa therapy.”

After I laid a complaint of breach of Otago’s research ethics with Vice Chancellor of Research Professor Blaikie, he eventually agreed to remove the bone density recovery statement because of “ambiguity” –though of course the false claim is straightforward and not in fact ‘ambiguous’. In addition, and in breach of standard journalistic and academic practices, no notice of correction appears – the claim has been ‘memory-holed’ creating a further misrepresentation. I also appealed a decision to redact emails requested via the OIA between Drs Bagshaw and Spittlehouse to the Ombudsman citing the notable public interest. The Ombudsman found in my favour, and the emails were released –demonstrating that Dr Spittlehouse knew their claims had shaky foundations. Ultimately, despite later removing one of the false claims, Professor Blaikie dismissed my complaint of research misrepresentation. 

I also intend to appeal Professor Blaikie’s decision to the Ombudsman once the Ministry of Health has published their own long-awaited puberty blockers evidence brief, but Dr Bagshaw’s position as a reviewer of this same brief now complicates the situation. 

In 2020 it was reported that Dr Bagshaw had 65 out of 100 gender questioning young people on puberty blockers at the Youth 298 clinic in Christchurch where she was until recently the medical director (rebranded as Te Tahi Youth). This is a remarkably high treatment rate given the size of the Canterbury catchment, and may not represent the total prevalence of puberty blocker prescriptions for gender dysphoria in this region. In comparison, 378 gender questioning children and young people in England and Wales were on puberty blockers in 2022 with a catchment population about 100 times larger. The entire state of Western Australia also had about the same number of children on puberty blockers in 2024 as Dr Bagshaw’s clinic in 2020, despite a catchment population at least 4 times larger. 

Dr Bagshaw’s high prescription rate might be attributed to her commitment to the medical intervention model and an overconfidence in the capacities of adolescents to self-diagnose. When asked to explain the use of puberty blockers Dr Bagshaw was reported to say that blockers are the “standard treatment”  and that “most kids know what they want, most kids know who they are ''. The statements contrast with the view of retired psychiatrist and former President of the British Psychoanalytic Society, Dr David Bell writing in The Guardian and summarising his perspective on the Cass Review:

“The policy of “affirmation” – that is, speedily agreeing with a child that they are of the wrong gender – was an inappropriate clinical stance brought about by influential activist groups and some senior gender identity development service (Gids) staff, resulting in a distortion of the clinical domain”

“Characterising a child as ‘being transgender’ is harmful as it forecloses the situation and also implies that this is a unitary condition for which there is unitary ‘treatment’.”

I hope the Ministry will investigate the substantially higher puberty blocker prescription rates in New Zealand, including those of Dr Bagshaw.

I look forward to the Ministry affirming its commitment to scientific integrity when it publishes similar conclusions on long-term clinical outcomes of puberty suppression as the Swedish, Finnish, NICE, and University of York systematic reviews. However, in the unlikely event that the Ministry’s conclusions were to differ, alongside the involvement of a prolific prescriber with a history of misrepresenting the scientific literature, it might raise questions as to the trustworthiness of the Ministry’s medical information –an outcome which I am sure you want to avoid. 

Best wishes,

Simon Tegg