Recently on December 11, the British government indefinitely banned puberty blockers for children with gender dysphoria. This step was taken after independent experts found that there was an unacceptable safety risk involved when prescribing this medication.

Before getting into the "why" of the ban, let's understand what gender dysphoria is and what puberty blockers do.

Gender Dysphoria

As per the National Health Service (NHS), UK, gender dysphoria is a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity. The NHS writes, "Most people identify as "male" or "female". These are sometimes called "binary" identities. However, some people feel their gender identity is different from their biological sex. For example, some people may have male genitals and facial hair but do not identify as a male or feel masculine."

NHS notes that children show their interest through the choice of toys and clothes that are often associated "societally" with the opposite gender.

Puberty Blocker

They are a type of medication that delays the changes of puberty in gender-diverse youth. They are called gonadotrophin-releasing hormone (GnRH).

How does it work?

Sex hormones get affected once you consume this medicine. Sex hormones determine the sexual organs present at birth, which are also known as the primary sex characteristics. They include the penis, scrotum and testicles, and the uterus, ovaries and vagina. In contrast, the secondary sex characters are the organs or physical changes that occur in our body after we hit puberty. For instance, facial hair, development of breasts, etc.

So what do puberty blockers do?

It delays puberty, which can combat the symptoms, as noted by NHS, which can occur if someone experiences gender dysphoria. The symptoms include:

• low self-esteem
• becoming withdrawn or socially isolated
• depression or anxiety
• taking unnecessary risks
• neglecting themselves

The puberty blocker by delaying the development of secondary sex character helps with the:

• improving mental well-being
• ease depression and anxiety
• improve social interactions with others
• lower the need for future surgeries
• ease thoughts or actions of self-harm

So, why is it banned?

The UK stated that this decision will be revisited in 2027, till then the ban remains effective. However, it goes against standards held by medical groups including the European and World Professional Associations for Transgender Health and American Medical Association and the American Academy of Pediatrics.

The ban was put in place by the Conservative government and has been extended by the Labour government too. The announcement comes after a judge upheld an emergency ban in a ruling that said this treatment could be potentially harmful. However, NHS also stopped prescribing puberty blockers at gender identity clinics stating that there was not enough evidence found for either benefits or harms.

However, in July, Justice Beverley Lang said that the review commissioned by the NHS found "very substantial risks and very narrow benefits” to the treatment. The confusion exists because the British Medical Association further noted that the NHS review was controversial and included patients, academics, scientists and legal experts among its critics. However, the group that challenged the court - TransActual criticized the decision and said that evidence of danger from 40 years of puberty blocker cannot be tracked.

Banning medicines with no evidence of serious harm, only for trans people … is discrimination plain and simple,” said Keyne Walker, the group’s strategy director. “Evidence of the harm of the temporary ban continues to emerge, and will grow now that it has been made permanent.”

Why the ban in Scotland?

The Scottish government also confirmed that as the medicine policy is reserved to Westminster, the ban would also apply across England, Scotland and Wales.

However, the ban is not on those who are already consuming the medicine for gender dysphoria, but on the "new children and young people aged under 18 years from beginning to take puberty blockers for the purposes of gender incongruence and/or gender dysphoria. under the care of private or non-UK prescribers".

The United States Food and Drug Administration has recently approved Qfitila (fitusiran) for routine prophylaxis to prevent or to reduce the frequency of bleeding episodes in adults and pediatric patients 12 years of age and older with hemophilia. It works on those with hemophilia A or hemophilia B, with or without factor VII or IX inhibitors which neutralizes antibodies.

While subcutaneous Qfitilia does not replace the missing coagulation factor VII or IX, it reduces the amount of protein antithrombin, which leads to an increase in thrombin. It is an enzyme critical for blood clotting. The dosing starts at once every two months and it is also based on the FDA-cleared Innovance Antithrombin companion diagnostic test.

However, as of now, there is no fixed doses of Qfitila is not approved mainly due the risk excessive clotting. It has also a boxed warning for thrombotic events and gallbladder disease.

One of the most common side effects reported were viral infection, nasopharyngitis, and bacterial infection.

How Was This Approved?

The approval came on the basis of two randomized clinical trials that had 177 adult and pediatric male patients with either hemophilia A or hemophilia B enrolled. Among the participants with inhibitors who received the antithrombin-based dosing regimen of Qfitlia, there was a 73% reduction in the estimated annualized bleeding rate. This was seen in comparison with those who received on-demand treatment with bypassing agents.

Among the participants without inhibitors receiving the antithrombin-based dosing regimen of Afitlia, there was a 71% reduction in the estimated annualized bleeding rate versus that seen in those who received on-demand treatment with clotting factor concentrates.

"Today's approval of Qfitlia is significant for patients with hemophilia because it can be administered less frequently than other existing options," Tanya Wroblewski, M.D., deputy director of the Division of Non-Malignant Hematology in the FDA Center for Drug Evaluation and Research, said in a statement.

What Is Hemophilia?

As per the Centers for Disease Control and Orevention (CDC) it is an inherited bleeding disorder in which blood does not clot properly. It can lead to spontaneous bleeding as well as bleeding following injuries or surgeries. Blood usually has proteins called clotting factors that can help one to stop bleeding. However, people with hemophilia have low levels of either factor VII or factor IX.

Hemophilia could also result in bleeding within joints which can then lead to chronic joint disease and pain. It could lead to bleeding in head and in brain, causing long term problems such as seizures or paralysis. In severe cases it can also lead to death if the bleeding cannot be stopped.

The most common types of hemophilia are inherited, thus it is a condition that is present from birth. There are rare cases where hemophilia happens later in life, which is known as acquired hemophilia.

Difference between Hemophilia A and Hemophilia B

As per the National Bleeding Disorders Foundation, hemophilia A, also called factor VIII (8) deficiency or classic hemophilia, is a genetic disorder caused by missing or defective factor VIII (FVIII), a clotting protein. Although it is passed down from parents to children, about 1/3 of cases found have no previous family history.

Hemophilia B, also called factor IX (FIX) deficiency or Christmas disease, is a genetic disorder caused by missing or defective factor IX, a clotting protein. Although it is passed down from parents to children, about 1/3 of cases are caused by a spontaneous mutation, a change in a gene.

Shingles, a painful viral infection due to the reactivation of the varicella-zoster virus (VZV), is primarily known for its blistering rash and nerve pain. New research indicates, however, that shingles vaccine can be significant in preventing dementia. This recent finding paves the way to new avenues to understand the association between viral illness and brain wellness, which might change preventive treatment against cognitive degeneration in aging individuals.

Once a person has had chickenpox, he or she carries the varicella-zoster virus for life. The virus lies dormant within nerve cells and may reappear years later as shingles, commonly because of compromised immunity with age, stress, or illness.

Shingles appears as a painful rash, typically on one side of the body, and may persist for weeks. Aside from the rash, the infection may cause severe complications like postherpetic neuralgia (PHN), a long-term nerve pain syndrome that lasts for months or even years. In rare instances, shingles may infect the eye, causing blindness.

The Centers for Disease Control and Prevention (CDC) estimates that approximately 1 in every 3 Americans will develop shingles at some time during their lifetime. Vaccines have been recommended to avoid the condition, but recent studies indicate they might also have an added bonus—prevention from dementia.

Shocking Link Between Shingles and Dementia

Dementia, such as Alzheimer's disease, is a rapidly increasing worldwide health issue, with millions of older adults at risk. Although the causes of dementia are still unknown, researchers have long suspected that some viruses, specifically those in the herpes family (which includes VZV), may play a role in cognitive decline.

A study recently published in Nature determined that getting the shingles shot lowered the risk of developing dementia dramatically. Scientists followed more than 280,000 elderly people in Wales who got the original shingles vaccine, Zostavax, and identified a 20% decrease in dementia incidence over the next seven years.

Lead author Dr. Pascal Geldsetzer of Stanford University said the results were "very robust" and added that women appeared to gain more benefit from the vaccine than men. Since women are at greater risk for dementia, these results could have important implications for future prevention efforts.

Can Shingles Cause Cognitive Decline?

Although no one knows the exact mechanisms, several theories discuss how the shingles virus might enhance the risk of dementia:

Inflammation and Brain Damage: The varicella-zoster virus has the ability to cause inflammation in the body, including the brain. Chronic inflammation is recognized to speed up cognitive decline and may play a role in neurodegenerative diseases such as Alzheimer's.

Vascular Effects: The virus has the ability to infect blood vessels in the brain, leading to clots or constricting blood flow. Decreased cerebral circulation is a well-documented risk factor for dementia and stroke.

Amyloid Protein Formation: A study by the University of Colorado Anschutz Medical Campus indicates that shingles can encourage the formation of amyloid plaques, a characteristic of Alzheimer's disease. These adhesive proteins clump together in the brain, interfering with normal function and speeding up cognitive decline.

Can Shingles Vaccination Protect Against Dementia?

The research suggests that shingles vaccination can lower the risk of dementia by inhibiting reactivation of the virus and triggering inflammation in the brain. It is unclear, however, whether the same protective mechanism works for the newer, more effective Shingrix vaccine, which supplanted Zostavax in 2020.

In contrast to Zostavax, which had a live but attenuated form of the virus, Shingrix is a genetically modified vaccine that consists of certain viral proteins to stimulate an immune response. Shingrix has been 97% effective in preventing shingles in clinical trials, versus 51% for Zostavax. Whether it can help prevent dementia, however, is an open question scientists are eager to investigate.

Who Should Receive the Shingles Vaccine?

The CDC advises Shingrix for people aged 50 and above, as well as younger adults with compromised immune systems. The vaccine is given in two doses, spaced a few months apart, and is very effective in preventing shingles and its complications.

With these advantages, however, vaccine acceptance continues to be low, with less than 40% of eligible Americans having gotten their shots. The most frequent side effects are mild flu-like symptoms and pain at the site of injection, but experts point out that the advantages far outweigh the risks.

Tips for Reducing Dementia Risk

Although shingles vaccination holds great potential for dementia prevention, it is not the only answer. Experts suggest an integrated approach to brain health that involves:

Living an Active Lifestyle: Physical exercise on a regular basis enhances circulation to the brain and averts cognitive loss.

Healthy Nutrition: A diet modelled on Mediterranean cuisine, featuring high intakes of fruits, vegetables, whole grains, and healthy fats, is supportive of brain function.

Social and Mental Stimulation: Mental activity with reading, puzzles, or social engagement may build cognitive reserve.

Control of Chronic Illnesses: Control of high blood pressure, diabetes, and cholesterol lowers the risk of dementia.

The association of shingles with dementia risk demonstrates the complex ways infectious illnesses affect overall well-being. Finding that shingles vaccination can decrease risk of dementia adds yet another persuasive argument to convince older people to be vaccinated. Although more study is necessary to validate the results, the study holds out hope that a straightforward vaccine has a key part to play in maintaining cognitive capacity and enhancing the quality of life among aging groups.

As scientists continue to investigate the link between viral infections and brain health, one thing is certain: guarding yourself against shingles might have advantages that reach far beyond the skin. With the increasing global burden of dementia, interventions such as vaccination could become a key part of the arsenal in the battle against cognitive decline.

Dr. Jayanta "Jay" Bhattacharya, has officially assumed office as the 18th Director of the National Institutes of Health (NIH), bringing a new era of leadership to the country's leading medical research agency. His confirmation, approved by the U.S. Senate on March 25, 2025, represents a major change in NIH's direction, in line with President Trump's Make America Healthy Again Commission.

Dr. Bhattacharya comes on board amid widespread federal health system reorganization. HHS Secretary Robert F. Kennedy Jr. just announced a comprehensive overhaul that involves firing about 1,200 NIH staff. In an all-staff letter, Dr. Bhattacharya accepted the challenges to come, promising staff that he will make changes with compassion and openness.

"I am aware that I am coming into NIH during a period of unprecedented change. Every corner of the federal government is being scrutinized — and NIH is no exception," he wrote. Grateful for the efforts of the affected employees, he went on to say, "Many of our good colleagues are losing their jobs, and that in no way reflects the quality of their effort.". I wish to thank most sincerely those who will be impacted for all that you have done for the mission of the NIH."

Promises to Restoring Trust in Science and Research Integrity

A leading Stanford health economist and physician, Dr. Bhattacharya has been a long-time advocate for scientific integrity and academic freedom. His mission is to reaffirm public faith in biomedical studies, with priority placed on maintaining integrity, being reproducible, and being innovative in NIH-sponsored research.

Most importantly, our findings will only be impactful if the public is confident in our results and believes that we are working on their behalf," said Dr. Bhattacharya. NIH will, under his leadership, focus research on solving directly the nation's most critical health priorities, especially chronic conditions like cancer, diabetes, heart disease, and obesity.

Funding Reforms and Research Priorities

NIH has experienced deep budgetary shifts over the last few months, with grant support suspended and restored, and indirect university research costs capped prior to the intervention of a federal judge. Dr. Bhattacharya is anticipated to negotiate these budget intricacies in order to secure ongoing support for innovative scientific discoveries.

Secretary Kennedy voiced his confidence in the new director, stating, “Under Dr. Bhattacharya’s leadership, NIH will restore its commitment to gold-standard science. I’m excited to work with him to ensure NIH research aligns with our Administration’s priorities — especially tackling the chronic disease epidemic and helping to Make America Healthy Again.”

Dr. Bhattacharya has been vocal about the importance of free speech in scientific discourse. In October 2024, he tweeted on X (formerly Twitter), "If you support government regulation of disinformation, you are an enemy of free speech." Now, as NIH Director, he has directed agency personnel to prepare a list of grants and contracts focused on fighting misinformation and disinformation, a step that could be evidence of a change in how government agencies handle scientific controversy and public messaging.

Prior to coming to NIH, Dr. Bhattacharya was a tenured professor at Stanford University, where he worked on population aging and chronic diseases, especially among vulnerable populations. He co-authored the Great Barrington Declaration in the COVID-19 pandemic, calling for a focused protection strategy instead of broad lockdowns.

As he enters this critical position, Dr. Bhattacharya is charged with guiding NIH through trying times, keeping research priorities in synch with public health needs, and reaffirming the agency's commitment to scientific integrity. His tenure will begin a new era for NIH, one that holds the promise of reforms to promote innovation, accountability, and reinvigorated faith in medical research.