NHS England has paused new referrals for masculinising or feminising hormone treatment for 16 and 17-year-olds after a review found insufficient evidence to support its continued use. The decision follows the Cass review, which recommended extreme caution in providing such treatment to minors.
The review, commissioned by NHS England, examined all available clinical evidence and concluded that it was too weak to determine whether the treatment was beneficial or harmful for young people with gender incongruence or dysphoria. The NHS is continuing to assess the evidence for adults.
Patients under 18 currently receiving cross-sex hormones may continue treatment, but their cases must be reviewed individually with clinicians. A 90-day public consultation on removing the treatment as a routine procedure has been launched, during which new referrals are paused.
The move comes after a clinical trial on puberty blockers for children as young as 10 was paused in November due to concerns about unquantified long-term biological harms. Use of puberty blockers for under-18s was banned in 2024.
Prof James Palmer, NHS England's national medical director for specialised services, stated that the evidence does not support continued use of these hormones for under-18s. He emphasised that the NHS is exercising extreme caution, in line with Dr Cass's advice.
Advocacy groups have reacted strongly. Tammy Hymas of TransActual called the pause a profound attack on young people's bodily autonomy, while Helen Joyce of Sex Matters said it comes too late and urged making the pause permanent.
