Thread by @hannahsbee

(🧵) NEW: Today’s news that NHS England has paused new prescriptions of cross-sex hormones for under 18s a) seems a bigger deal than being suggested, b) raises several questions, c) has potentially significant consequences for any forthcoming trial of puberty blockers...

England has - for a period at least - ended the medical transition of children on the NHS. This puts a stop to 20+ years of practice. (The former Tavistock Gender Identity Development Service [GIDS] referred 16 year olds for puberty blockers from around the year 2000.)

The precise trigger for the pause seems unclear. What is the “in-depth review of all available clinical evidence” referred to by NHSE in their statement? I have asked NHSE. NHSE's statement says it was triggered by Dr Hilary Cass’s 2024 major report into children's gender care...

But one of the systematic evidence reviews that informed that final report and its recommendations had already looked at CSH use in under 18s. It pointed to a "lack of high-quality research assessing the outcomes of hormone interventions in adolescents [with] gender dysphoria..."

The review noted that few studies undertook long-term follow-up. "No conclusions can be drawn about the effect on gender-related outcomes, body satisfaction, psychosocial health, cognitive development or fertility."
adc.bmj.com/content/109/Su…

Maybe the new 'review' refers to the findings of the expert ‘Working Group’ – asked to look into this by Wes Streeting in April 2025? (and which put a stop to legal action – see my copy below)? If so, that was completed in June 2025. Why the delay?
newstatesman.com/politics/healt…

Expert evidence provided to the High Court last year, and which triggered the NHSE group, outlined multiple serious concerns about under 18s' use of hormones. One expert explicitly criticised NSHE's prescribing to 16- and 17-year-olds, saying there was no evidence behind it.

Prof James Palmer, national medical director for NHSE specialised services at NHSE says, “the available evidence does not support the continued use of masculinising or feminising hormones... for young people under 18.”
If so, why are private providers not included in the pause?

Finally, were the pause to be made permanent (after consultation), it has profound implications for any future trial of puberty blockers. The MHRA's recent request for a minimum age of 14, was in part because of fears of being on PBs for too long before hormones were available

That observation was when hormones were available at 16. What if they're unavailable until adulthood? If the trial goes ahead with unchanged age criteria, it could mean children remaining blocked for up to eight years, with all the risks that brings.
assets.publishing.service.gov.uk/media/6998b06d…

A 90-day public consultation on a permanent policy of the NHS no longer routinely prescribing hormones for under 18s starts later today. Young people already receiving these treatments can continue, but will have to be reviewed individually by their clinical team. (ENDS)

Consultation and supporting documents now published:
engage.england.nhs.uk/consultation/p…