NHS England pauses new prescriptions of cross-sex hormones for under-18s

In a significant development impacting gender-affirming care for young people, NHS England has announced a pause on new prescriptions of cross-sex hormones for individuals aged 16 and 17 who are questioning their gender identity. This decision follows a comprehensive review that concluded the existing evidence regarding the benefits and potential harms of these treatments in adolescents is "really weak." The move, which will affect a limited number of teenagers, has prompted the launch of a public consultation to inform longer-term guidance on the use of such medical interventions. While existing prescriptions will continue, clinicians will be tasked with reviewing the ongoing treatment of young people currently receiving hormones.

Cross-sex hormones, such as testosterone and oestrogen, are prescribed to facilitate the development of secondary sex characteristics aligned with a person’s affirmed gender, potentially leading to irreversible physical changes. Current NHS guidance already prohibits the prescription of these hormones to individuals under the age of 16 for gender-related treatment. For those 16 and 17-year-olds who will no longer be able to access new prescriptions, NHS England has stated that alternative forms of care will be offered through the three existing NHS gender clinics for children operating in England.

The impetus for this review stems from the publication of a pivotal report in April 2024 by Dr. Hilary Cass, which critically examined children’s gender care and highlighted the scarcity of robust evidence supporting medical interventions. In response, NHS England commissioned ten independent evidence reviews to scrutinize various aspects of testosterone and oestrogen use in young people who identify with a gender different from their biological sex. The findings from these reviews indicated insufficient high-quality evidence to definitively establish the overall benefit or harm of these hormones for this demographic. Consequently, NHS England will refrain from issuing new prescriptions while it carefully considers the feedback received from advocacy groups and healthcare professionals. The reviews specifically examined the impact of these hormones on a range of outcomes for young patients experiencing gender-related distress, including their quality of life and mental health.

Professor James Palmer, National Medical Director for Specialised Services at NHS England, emphasized the extreme caution the NHS has exercised in considering the initiation of these treatments for young individuals. He described the review process as "exceptionally thorough and complex," ultimately leading to the conclusion that the available evidence does not support the continued use of masculinising or feminising hormones for individuals under 18 diagnosed with gender dysphoria or gender incongruence. Professor Palmer clarified that this lack of conclusive evidence means the NHS cannot definitively assert whether these treatments are harmful or effective.

A 90-day public consultation on the revised policy and the findings of the review is scheduled to commence on Monday. NHS England anticipates that this consultation will help identify any overlooked evidence and expedite the process of establishing definitive long-term guidance.

The decision has drawn sharp criticism from the trans advocacy group TransLucent, which has labelled it "yet another blatant act of discrimination against transgender youths’ healthcare, which has been systematically eroded since the Cass Review." The group stated its intention to critically assess the NHS’s evidence and, given the profound human rights concerns, will consider legal action.

It is crucial to note that the revised guidance on cross-sex hormones applies exclusively to the NHS and does not extend to private healthcare providers. Currently, only one privately operated gender clinic, Gender Plus, is registered with the UK’s Care Quality Commission and holds an "outstanding" rating. Paul Carruthers, a nurse consultant and manager at Gender Plus, expressed dismay at NHS England’s decision, asserting that his clinic employs a rigorous, internationally standardized process before prescribing hormones. He 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."

The Department of Health and Social Care reiterated its commitment to the safety and well-being of children and young people, affirming that NHS England adheres to expert scientific and clinical advice when formulating clinical policies.

Helen Joyce, director of advocacy at the sex-based rights charity Sex Matters, described the prescription of cross-sex hormones to under-18s as "outrageous" and asserted that the pause to re-evaluate the evidence is "long overdue." She argued that individuals under 18 are too young to provide informed consent for treatments with such irreversible and life-altering consequences.

This development follows a high-profile legal case initiated by campaigners against the government concerning the prescription of cross-sex hormones to 16 and 17-year-olds. The case was spearheaded by Keira Bell, who underwent testosterone treatment as a teenager. Ms. Bell, who at the time identified as male, now expresses regret over the permanent physical changes induced by the medication. Although her case was dismissed in May 2025, the then Health and Social Care Secretary, Wes Streeting MP, indicated that he was "actively considering" a ban or restriction on these treatments for young people, pending the completion of a review. The current pause by NHS England represents a significant shift in the approach to gender-affirming medical care for adolescents in the UK.