third has not yet tried. Stephen Minger (King’s College London), who has held a licence for over a year, said, ‘What we have to work out now is whether it’s a good use of our scant resources to put our efforts into resubmitting a proposal - which is incredibly time-consuming.’ (nature.com 2009; 3 February, cmf.org.uk 2009; 3 February, news.bbc.co.uk 2009; 13 January)


gender reassignment for transsexual teens? Transsexual children should be given puberty- blockers from the age of twelve, say controversial draft guidelines from the International Endocrine Society. Preventing early pubertal changes would give children, who express a wish to change sex, time to make a decision.


The guidelines come amid news of the world’s youngest person to undergo a successful sex change. Kim Petras began treatment (in Germany under national health insurance) with hormone replacement therapy at the age of twelve, completing it with gender reassignment surgery at the legal age of 16.


Puberty-blocking treatment for this indication has not been approved in the UK for under-16s, although it is offered by some clinics in Canada, Australia, Germany and the US. Some doctors believe that children do not have the emotional maturity or understanding to make such a permanent life changing decision. Also, little is known about the long term affects of puberty-blockers if patients were to change their mind about therapy. Some teenagers with such feelings may find puberty repellent if they believe they are becoming the wrong sex. However studies show that 80% of boys who experience transsexual feelings as children change their mind in adulthood. (newscientist.com


nucleus easter ‘09


news review 4 2008; 10 December, dailymail.co.uk 2009; 5 February)


non-invasive fetal tests - coming soon The NHS should prepare for advances in non- invasive fetal DNA tests, recommends the Foundation for Genomics and Population Health. With no risk of miscarriage, these are safer than current invasive methods (such as amniocentesis), and can be used much earlier in pregnancy. The technology uses cell-free fetal DNA in maternal blood. They can potentially detect Y chromosomes for those at risk of sex-linked disease, or an abnormal ratio of chromosomes (eg Down’s syndrome).


A working group from the Foundation examined ethical and social issues raised; particularly the potential for sex selective abortions and determining paternity. They concluded, ‘Implementation of non-invasive prenatal diagnosis for clinically significant genetic disorders is desirable, both to improve the quality and management of antenatal care and to facilitate parental reproductive choice.’ Nevertheless, the greater ease with which abnormalities can be detected - and embryos discarded - is concerning for those who believe life to begin at conception.


The report recommends education of the public and healthcare professionals, to ensure that individuals are adequately informed. It cautions the NHS to ensure that the tests are thoroughly evaluated for reliability and effectiveness, as well as calling for auditing processes and best practice guidelines. Will these be enough? (BMJ 2009;338:b618)


Jenny Chui, Andrew Fergusson, Steve Fouch, Siôn Glaze, David Jack, Sarah MacLean


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