NHS England pauses new referrals for masculinising or feminising hormone treatment in under-18s

The NHS is pausing new referrals for masculinising or feminising hormone treatment for 16 and 17-year-olds after an in-depth review found there was insufficient evidence to support its continued use.Prescriptions for hormones had been available in England for under-18s with a diagnosis of gender incongruence or dysphoria who met certain criteria.But after the Cass review, NHS England commissioned its own review of all the available clinical evidence. That review has now concluded and found the evidence did not back the continued use of the treatment for 16 and 17-year-olds.In her review of children’s gender care, Hilary Cass had recommended “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”.The NHS England review found the evidence was too weak to show whether such treatment was beneficial or harmful to children with gender dysphoria. The NHS is continuing to examine the evidence for masculinising and feminising hormones in adults, the Guardian understands.NHS England said patients under 18 currently receiving cross-sex hormones may continue to receive treatment. However, that treatment must now be reviewed individually with clinicians.On Monday, NHS England launched a 90-day consultation on plans to remove the treatment as a routine procedure. New referrals for the treatment will be paused during the consultation period.The development comes after a clinical trial into the impacts of puberty blockers on children as young as 10, launched in November, was paused last month – before anyone had been recruited – amid concerns about the “unquantified risk” of “long-term biological harms”.Use of the drugs to delay or prevent puberty was banned for under-18s in 2024.Prof James Palmer, national medical director for specialised services at NHS England, said: “Following the Cass 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 the NHS was conducting a public consultation on the removal of the drugs as a routine treatment for under-18s before a final policy was published.Palmer added: “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.“Patients currently receiving these treatments on the NHS can continue but this will need to be reviewed individually with their clinical team.“The NHS continues to offer specialist support for under-18s managing gender incongruence, including mental health support and referral to specialist children and young people’s gender services where appropriate.”Tammy Hymas, policy lead at advocacy group TransActual, said: “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.”Helen Joyce, director of advocacy at Sex Matters, said the pause “comes too late” for many children.“Under-18s are simply too young to consent to such irreversible, life-changing consequences,” Ms Joyce said.“This pause now needs to be made permanent, as part of the long road back to sanity on gender issues for the NHS.”