Hormone treatments for children and young people: Clinical trial and consultations

Until April 2024, NHS-commissioned gender identity services were able to prescribe hormone treatments, known as ‘puberty blockers’ as a treatment for children with gender incongruence/dysphoria to suppress puberty. The medicines are not licensed for that purpose but may be prescribed where the prescriber judges their use to be in a patient’s best interests based on the available evidence.

Following a review of gender identity services for children and young people published in April 2024, the government banned the use of these treatments. The NHS and the government are funding research into the safety and effectiveness of these treatments (the PATHWAYS research programme). However, the main clinical trial in this programme was paused in February 2026, before it had recruited participants, because of concerns over safety.

Health services are devolved. Unless stated otherwise, the policy in this briefing applies to England only.

What is gender incongruence?  

Gender incongruence/dysphoria occurs when a person’s gender identity markedly and persistently does not match their experienced gender and sex registered at birth. It is defined in international medical guidelines published by the World Health Organization.

The Cass Review

An independent review of NHS gender identity services for children and young people (the Cass Review), raised concerns about the efficacy, safety and long-term outcomes of the use of hormone treatments in children with gender dysphoria.

In response to the Cass Review’s interim report (2022) and its final report (2024):

• In March 2024, the NHS stopped the routine prescription of puberty blockers for treatment of gender dysphoria in children under 18 years of age and recommended that gender-affirming hormones for young people with continuing gender incongruence / dysphoria, not be prescribed to children under 16 years of age,
• In December 2024, legislation was passed to place an indefinite ban on both NHS and private prescriptions of puberty blockers for gender dysphoria in children under 18 years of age. This position is to be reviewed in 2027.
• In March 2026, NHS England began a consultation on stopping the routine prescription of gender-affirming hormones to all children and young people.
• In December 2024, the PATHWAYS research programme began with the aim of generating more evidence about the use of hormone treatments in the care of children and young people with gender incongruence.

The PATHWAYS research programme

The PATHWAYS research programme consists of five related studies of gender identity interventions for children and young people. It is funded by the Department of Health and Social Care and NHS England.

One of the studies in the programme is the PATHWAYS TRIAL, a clinical trial that will consider the use of gonadotrophin-releasing hormone analogue (GnRHa) medicines (often referred to as puberty blockers) to manage gender incongruence in children and young people. The trial will recruit 226 children and young people aged under 15 years and 11 months who are experiencing gender incongruence. It will run for two years. The trial aims to assess the benefits and risks of using GnRHa medicines to suppress puberty, including effects on quality of life, mental health, gender identity, body satisfaction, cognition and brain development, and physical health, including bone density.

In February 2026, the Department of Health and Social Care issued a press release explaining that the PATHWAYS clinical trial had been paused, following safety concerns raised by the Medicines and Health Regulatory Agency.

Terminology

The terminology used in this area is complex and evolving. Definitions of some of the key terms referred to in this briefing are explained in section 1 of this briefing.