"NHS England has paused new prescriptions of cross-sex hormones for 16 and 17-year-olds, citing a ‘remarkably weak’ evidence base that fails to conclusively determine the drugs’ benefits or harms. This pivotal decision reflects a national shift towards extreme caution in gender-affirming medical interventions for minors, prompting a widespread public consultation."
NHS England has announced a significant policy change, immediately halting new prescriptions of cross-sex hormones for adolescents aged 16 and 17 who are questioning their gender identity. This decisive move follows an extensive review that concluded the existing research on the efficacy and safety of these drugs is "exceptionally thorough and complex," yet ultimately "really weak," failing to provide sufficient evidence to support their continued use in this age group. The decision underscores a growing national and international debate regarding the appropriate medical pathways for young people experiencing gender dysphoria or incongruence, prioritizing patient safety and the need for robust scientific understanding over established practices.
Cross-sex hormones, often referred to as masculinising or feminising hormones, are prescribed to facilitate the development of physical characteristics associated with an individual’s affirmed gender, rather than their biological sex. These treatments can induce profound and, in many cases, irreversible bodily changes, such as a deeper voice, facial hair growth, or breast development. The health service’s pause affects a small number of teenagers who might have been initiating this treatment, while those already receiving prescriptions will continue, though their care will undergo review by clinicians. Existing guidelines in England already prohibit the prescription of these hormones to individuals under 16 for gender treatment purposes.
The impetus for this policy shift originated from the landmark independent review into children’s gender care, led by Dr. Hilary Cass, which published its comprehensive report in April 2024. Dr. Cass’s findings critically highlighted the "remarkably weak evidence" underpinning many medical interventions in youth gender services, asserting that this deficiency was ultimately failing vulnerable children and adolescents. Responding to these concerns, NHS England commissioned 10 independent evidence reviews to meticulously examine various aspects of testosterone or oestrogen use, either in isolation or combined with other medications, for young people identifying as a gender different from their biological sex.
These rigorous reviews, as articulated by Professor James Palmer, National Medical Director for Specialised Services at NHS England, aimed to assess the impact of these hormones across a spectrum of outcomes for young patients distressed about their gender, including their overall quality of life and mental health. The collective conclusion was stark: there is insufficient high-quality evidence to definitively ascertain whether these drugs genuinely benefit or cause harm to young people. Consequently, NHS England has stated it cannot issue new prescriptions while it continues to process responses from diverse advocacy groups and healthcare professionals during a crucial consultation period.
Professor Palmer emphasised that the NHS has consistently "exercised extreme caution when considering starting young people on this treatment." He reiterated that the exhaustive review "established that the available evidence does not support the continued use of masculinising or feminising hormones to treat" individuals under 18 with gender dysphoria or gender incongruence. This means, as he plainly stated, "we cannot say if they are harmful or effective."
In response to this pause, young people who can no longer access new prescriptions for cross-sex hormones will be offered alternative forms of care. This care will be provided through the three specialised NHS gender clinics for children currently operating in England, focusing on comprehensive, holistic support tailored to individual needs without the immediate introduction of hormonal interventions.
A 90-day public consultation on the revised policy and the detailed findings of the evidence reviews commenced recently. This consultation period is designed to be an inclusive process, allowing NHS England to gather further insights, check for any overlooked evidence, and ensure a thorough and transparent decision-making process. The health service has committed to making a definitive decision about longer-term guidance as expeditiously as possible following the conclusion of this period.
The announcement has elicited strong reactions from various stakeholders across the spectrum of the gender identity debate. Trans advocacy group TransLucent voiced profound dismay, characterising the move as "yet another blatant act of discrimination against transgender youths’ healthcare, which has been systematically eroded since the Cass Review." The group indicated it would "critically assess the NHS’s evidence before responding" and, "given the gravity of these human rights concerns," would "consider legal action." This highlights the deep emotional and ethical complexities embedded within these policy decisions, with advocates arguing for access to medical pathways as essential healthcare.
It is crucial to note that this revised guidance on the use of cross-sex hormones applies exclusively to NHS services, not to doctors operating within the private healthcare sector. In the UK, only one privately run gender clinic, Gender Plus, is currently registered with the Care Quality Commission (CQC), the independent regulator of health and social care services, and holds an "outstanding" rating. Paul Carruthers, a nurse consultant and manager at Gender Plus, expressed his clinic’s dismay at the NHS decision. He affirmed that private clinics like his employ rigorous processes, adhering to international standards, before prescribing hormones. Carruthers stated, "NHS England’s interpretation of the evidence is in contrast to every reputable expert body in the field of transgender healthcare and, as such, we will assess their policy document and evidence-based review to better understand how they arrived at this decision." This divergence in interpretation underscores a significant philosophical and clinical divide on the best approach to youth gender care.
The Department of Health and Social Care (DHSC) offered a concise statement, reinforcing the government’s stance: "The safety and wellbeing of children and young people is paramount and NHS England follow expert scientific and clinical advice when making decisions relating to clinical policies." This statement aims to reassure the public that the decision is rooted in expert medical opinion and child protection principles.
Conversely, sex-based rights charities have welcomed the pause. Helen Joyce, director of advocacy at Sex Matters, described the previous prescription of cross-sex hormones to under-18s as "outrageous" and asserted that the "pause to take stock of the evidence is long overdue." She articulated a core concern for her organisation, stating, "Under-18s are simply too young to consent to such irreversible, life-changing consequences." This perspective highlights the ethical complexities surrounding informed consent for minors in medical treatments that carry permanent physical implications.
The backdrop to this latest development includes a notable legal case from last year, brought against the government by campaigners challenging the prescription of cross-sex hormones to 16 and 17-year-olds. This case was spearheaded by Keira Bell, an individual who was prescribed testosterone as a teenager but later expressed regret over the irreversible alterations to her body, having de-transitioned from identifying as male. Although her case was dismissed in May 2025, it significantly amplified the national conversation around youth gender care. At the time of the dismissal, then-Health and Social Care Secretary Wes Streeting MP indicated he was "actively considering" potential bans or restrictions on the use of cross-sex hormones for young people, pending the completion of a comprehensive review. The current NHS England decision appears to be a direct consequence of this sustained scrutiny and the findings of the subsequent expert reviews.
This policy shift by NHS England represents a pivotal moment in the landscape of gender-affirming care for young people in the UK. It signals a move towards a more cautious, evidence-based approach, prioritising long-term safety and well-being, even as it generates significant debate and concern among patient advocacy groups. The ongoing public consultation and future decisions will undoubtedly shape the trajectory of gender identity services for adolescents for years to come.