UK Pauses Prescribing Cross-Sex Hormones to Children Following Review

The UK’s National Health Service launched a 90-day consultation on proposals to permanently remove the treatment as a routine procedure for under-18s.

Dr. Hilary Cass, independent pediatrician, speaks about the publication of the Independent Review of Gender Identity Services for Children and Young People (The Cass Review) in west London, on April 9, 2024. Yui Mok/PA Wire

Prescribing cross-sex hormones to 16- and 17-year-olds has been paused in the UK after a review by national health authorities found that evidence does not support their use.

Masculinizing or feminizing hormones have been available for more than a decade for young people aged 16 to 18 with a diagnosis of gender dysphoria who meet certain criteria, but all new referrals have been paused since March 9.

NHS England said that patients in this age group who are already taking cross-sex hormones can continue to receive them, but the prescription must be reviewed with doctors.

Taking these hormones can cause irreversible changes, including breast development in males taking estrogen, or deepening of the voice and muscular development in females taking testosterone, according to NHS England. They can also cause temporary or permanent infertility.

In her wide-ranging review of the care of children who present with gender dysphoria, Baroness Hilary Cass, a medical doctor, called for “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 separate review by NHS England has since found that the evidence is too weak to conclude whether cross-sex hormone treatment is either beneficial or harmful to children with gender dysphoria.

The NHS has started a 90-day consultation on proposals to permanently remove the treatment as a routine procedure for under-18s, which will remain paused throughout the consultation period and while the responses are considered.

Puberty Blockers Trial Concerns

A planned clinical trial into the effects of puberty blockers on children as young as 10 was paused in February amid concerns about the “unquantified risk” of “long-term biological harms” on vulnerable youngsters.

The use of the drugs to delay puberty was banned indefinitely for under-18s across the whole of the UK in December 2024.

Professor James Palmer, national medical director for specialized services at NHS England, said in a statement that following Cass’s 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,” he said. “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.”

Palmer added that 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.”

He said the NHS will continue to provide specialist support, including mental health support and referrals to specialist children and young people’s gender services, “where appropriate.”

Tammy Hymas, policy lead at advocacy group TransActual, told the Press Association, “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.”

Campaign groups opposed to placing children on medical pathways welcomed the announcement and urged the government to scrap the puberty blockers trial, which is currently subject to a judicial review.

Transgender Trend pointed to findings by Cass that almost all children who are prescribed puberty blockers progress to taking cross-sex hormones.

“And yet a puberty blockers trial was given the go-ahead knowing that this was the likely outcome, and before the review of hormones,” the campaign group wrote in a post on X.

The Bayswater Support Group (BSG), which helps the families of children with gender dysphoria, welcomed the decision to pause prescribing the hormones but said in a post on X that it raises “more questions than answers.”

The group stated that families “have paid a heavy price for years of inaction on cross-sex hormones.”

“Reports about the lack of evidence and potential harms go back many years and were confirmed by the 2020 [National Institute for Clinical Excellence] systematic evidence reviews that informed Cass,” it stated.

BSG called on the government to clamp down on private online clinics, which may still be selling the hormones to children, and raised the question of what provision the NHS will make for children who have been harmed by the treatment.

The group said if the planned puberty blocker trial eventually goes ahead, it will “generate a new cohort of patients for a treatment now confirmed to lack an evidence base.”

BSG also stated that the NHS now needs to provide evidence that cross-sex hormones are safe for over-18s.

Serious Side Effects

Studies, such as a 2016 Nature paper, have shown that cross-sex hormones affect the functioning of the brain in ways that are not yet fully understood.

Multiple papers have highlighted serious side effects of testosterone-blocking drugs, including an increased risk of blood clots, cardiovascular disease, and slow-growing tumors affecting the brain and spine. Over time, these drugs can increase the risk of Type 2 diabetes, high blood pressure, and osteoporosis in men.

With the estrogen-suppressants given to women desiring a more masculinized appearance—usually prescribed in conjunction with testosterone—known and common side-effects include high blood pressure, weight gain, acne, male pattern baldness, increased risk of cardiovascular disease, osteoporosis, and Type 2 diabetes. They also decrease levels of cholesterol in the brain, which is believed to be linked to the development of Alzheimer’s disease.

NHS England has confirmed to The Epoch Times that it is separately reviewing the prescription of cross-sex hormones for adults, following the proposal of the previous Conservative government.

Keira Bell previously took action against the NHS trust that prescribed her testosterone when she was a 17-year-old girl suffering gender incongruence. Bell underwent a double mastectomy as a 20-year-old and later came to regret the irreversible damage to her body.

Keira Bell outside the Royal Courts of Justice in central London, where a landmark case to stop the NHS prescribing "experimental" puberty blockers and cross-sex hormones to children who wish to undergo gender reassignment reached the High Court, in London on Jan. 22, 2020. Sam Tobin/PA

Bell applied for a judicial review into the government’s decision to approve the puberty blocker trial, along with psychotherapist James Esses and BSG.

The Department of Health and Social Care announced that the trial was paused on Feb. 20 following concerns raised by the Medicines and Healthcare products Regulatory Agency.

“This trial will only be allowed to go ahead if the expert scientific and clinical evidence and advice conclude it is both safe and necessary,” a spokesperson for the department said.

The NHS does not separate the cost of treatment for so-called gender-affirming care for children in publicly available figures, but documentation submitted to a court shows that planned NHS spending on all gender dysphoria services in England in 2023–2024 for adults and children combined came to 78.17 million pounds (roughly $100 million)—up from 33.4 million pounds (roughly $43 million) in 2018–2019.

Over the past decade, the number of children who say they suffer from gender dysphoria has soared, along with the number of children presenting with mental health conditions and neurodiversity.

Ritchie Herron began taking cross-sex hormones in his mid-20s, before undergoing surgery at 30, which he has since said he regretted. He said in a 2024 interview with The Epoch Times that there could be a raft of future claims against the NHS by people who were prescribed cross-sex hormones and later developed serious health problems.

Ritchie Herron in undated photos. Courtesy Ritchie Herron

“The big [side effect] I’m worried about is the cognitive decline. You hear a lot of trans people talking about like brain fog and [that sort of thing],” he said at the time. “Now, I think the next big thing is claimants [of] this generation. Alzheimer’s impacts women more than men at the scale of two to one. Alzheimer’s research shows [the disease] in males is highly linked with low testosterone and high estrogen levels.”

A debate by British lawmakers on a petition calling for the permanent cancellation of trials of puberty blockers is scheduled for March 23.

The Epoch Times reached out to the Department of Health and Social Care for comment but did not receive a response.