The UK Government is signalling a significant shift in its approach to healthcare for transgender and non-binary young people, with a minister suggesting a move away from medical interventions such as puberty blockers.
Speaking during a Commons debate on Tuesday, 13 January, Health Minister for Secondary Care Karin Smyth said the Government supports transitioning away from a “medical intervention model” in favour of a more comprehensive, evidence-based framework for care.
“The Government supports moving away from the medical intervention model towards a holistic approach to care based on the evidence,” Smyth told MPs. “That is the model with which we are progressing.”
The shift is grounded in findings from the Cass Review – an independent and controversial report into the UK’s gender identity services for young people. The review has been a cornerstone of the Government’s revised stance, favouring broader support strategies over immediate medical treatments.
Shortly after Labour’s victory in the 2024 General Election, Health Secretary Wes Streeting extended the ban on puberty blockers – a decision initiated by the previous Conservative administration. The ban remains in place indefinitely, with a final decision pending the outcome of an NHS-supported clinical trial into the use and impact of puberty blockers.
Despite the extension, critics argue that the approach is inconsistent. Labour MP Nadia Whittome highlighted in the debate that puberty blockers are still readily prescribed to cisgender children for conditions like precocious puberty. She also noted that even Dr Hilary Cass, author of the Cass Review, acknowledged that puberty blockers are effective for some trans youth and warned against an outright ban.
In response, Smyth stated that the Health Department is investing more than any prior government in youth health services across the board.
Further controversy surrounds the NHS PATHWAYS trial – currently the only legal avenue to access puberty blockers in the UK. Conservative MP Gregory Stafford raised concerns that young participants could be exposed to “sexually explicit questions,” referencing a questionnaire derived from the Avon longitudinal study.
The trial involves more than 13 hours of assessments for under-16s, including probing into romantic and personal development. This approach has drawn criticism from several global professional bodies, including the World Professional Association for Transgender Health (WPATH), which cautioned that the trial might breach ethical standards concerning voluntary informed consent.
In defence, Smyth assured Parliament that the trial is being conducted under strict ethical and clinical guidelines. Health Secretary Streeting also affirmed that policy decisions will not be based solely on the PATHWAYS trial but will draw on a broad range of domestic and international evidence.
Numerous peer-reviewed studies from countries including the US, Canada, and Australia have found puberty blockers to be safe, effective, and in many cases, life-saving. A soon-to-be-published study in the Journal of Paediatrics reports significant reductions in depression, anxiety, and suicidal thoughts among trans adolescents undergoing hormone therapy.
Additional 2024 research found that regret rates for gender-affirming care were remarkably low – lower even than for those undergoing knee surgery or childbirth.
