NHS Pauses Hormone Treatment for Under-18s with Gender Dysphoria

The National Health Service (NHS) in England has paused new referrals for masculinising or feminising hormone treatment for 16 and 17-year-olds diagnosed with gender incongruence or dysphoria, following a review that found insufficient evidence to support its continued use. The move comes after the recommendations of the Cass Review, which called for “extreme caution” in providing such treatment to young people.

What Led to the Pause?

An in-depth review commissioned by NHS England examined all available clinical evidence regarding the use of oestrogen or testosterone, either alone or in combination with other medications, to treat gender incongruence and dysphoria in young people under 18. The review concluded that the evidence base was too weak to demonstrate whether the treatment is beneficial or harmful. Source

Baroness Hilary Cass, in her review of children’s gender care, had advised a “clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.” Source

What Happens Now?

New referrals for hormone treatment for 16 and 17-year-olds have been paused while NHS England launches a 90-day public consultation on plans to remove the treatment as a routine procedure. During this consultation period, NHS England will review responses and consider whether any key evidence needs further examination before finalizing a policy. Source

Patients currently receiving cross-sex hormones will be able to continue treatment, but their cases will be reviewed individually with their clinical teams. Source

Treatment Options for Children and Young People

For children and young people experiencing gender dysphoria, treatment options typically begin with psychological support, including family therapy, individual child psychotherapy, parental support or counselling and group work. Source Referral to local Children and Young People’s Mental Health Services (CYPMHS) is also an option for more serious emotional issues. Source

Hormone therapy for children and young people is not currently available due to insufficient evidence on its clinical safety and effectiveness. Source

Adult Hormone Treatment

NHS England continues to examine the evidence for masculinising and feminising hormones in adults. Source

Reactions to the Pause

Tammy Hymas, policy lead at advocacy group TransActual, stated that banning new prescriptions is “a profound attack on young people’s bodily autonomy.” Source Helen Joyce, director of advocacy at Sex Matters, argued the pause “comes too late” for many children and should be made permanent. Source