Gender-affirming hormone treatment for children halted by NHS

Gender-affirming hormone treatment for 16 and 17-year-olds has been paused after an NHS review found evidence does not support its continued use.

The treatment, prescribing masculinising or feminising hormones, has been available on the NHS for 16 and 17-year-olds with a diagnosis of gender dysphoria who meet certain criteria, but new referrals have been paused from Monday.

Taking such hormones can cause irreversible changes, such as breast development when taking oestrogen, or deepening of the voice caused by taking testosterone.

In the 2024 Cass Review into children’s gender care, Baroness Hilary Cass recommended “extreme caution” in providing such treatment, and a “clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18”.

A review by NHS England has since found that the evidence is too weak to show whether such treatment is either beneficial or harmful to children with gender dysphoria.

It is understood the NHS is continuing to examine evidence for masculinising and feminising hormones for adults.

NHS England said 16 and 17-year-old patients currently receiving cross-sex hormones can continue to receive treatment but it must be reviewed individually with clinicians.

It is launching a 90-day consultation on plans for the NHS to remove the treatment as a routine procedure.

The treatment will be paused throughout the consultation period and while NHS England reviews the expected thousands of responses before reaching a final decision.

A clinical trial into the impacts of puberty blockers on children as young as 10, launched in November, was paused last month – before anyone had been recruited – amid concerns about the “unquantified risk” of “long-term biological harms”.

Use of the drugs to delay or prevent puberty happening was banned for under-18s in 2024.

Professor James Palmer, national medical director for specialised services at NHS England, said: “Following the Cass Review, NHS England commissioned an in-depth review of all available clinical evidence for using oestrogen or testosterone either alone or with other medications to treat gender incongruence and dysphoria.

“This review has established that the available evidence does not support the continued use of masculinising or feminising hormones to treat gender incongruence or dysphoria for young people under 18.

“We are now launching a public consultation on a revised policy which would see the NHS remove this treatment as a routine intervention for young people under 18. As part of the consultation NHS England will want to determine whether any key evidence may need to be reviewed before a final policy is published.

“The NHS has exercised extreme caution when considering starting young people on this treatment – in accordance with the advice from Dr Cass – and as part of this action will now be pausing any new referrals for this treatment for 16 and 17-year-olds.

“Patients currently receiving these treatments on the NHS can continue but this will need to be reviewed individually with their clinical team.

“The NHS continues to offer specialist support for under-18s managing gender incongruence, including mental health support and referral to specialist children and young people’s gender services where appropriate.”

Tammy Hymas, policy lead at advocacy group TransActual, said: “Banning new prescriptions of gender-affirming hormones for 16 and 17-year-olds is a profound attack on young people’s bodily autonomy with trans people yet again cruelly singled out by this government.”

Helen Joyce, director of advocacy at Sex Matters, said the pause “comes too late” for many children.

“Under-18s are simply too young to consent to such irreversible, life-changing consequences,” Ms Joyce said.

“This pause now needs to be made permanent, as part of the long road back to sanity on gender issues for the NHS.”