NHS England Suspends New Hormone Referrals for Under-18s Following Evidence Review
NHS England has announced a temporary pause on new referrals for masculinising or feminising hormone treatment for individuals under the age of 18. This decision comes after a comprehensive review of clinical evidence, which found insufficient support for the continued use of such treatments in 16 and 17-year-olds diagnosed with gender incongruence or dysphoria.
Review Findings and Clinical Rationale
The NHS England review, commissioned in response to the Cass review, examined all available clinical evidence regarding the use of oestrogen or testosterone, either alone or in combination with other medications. The review concluded that the evidence base was too weak to determine whether these treatments are beneficial or harmful for young people with gender dysphoria. Professor James Palmer, national medical director for specialised services at NHS England, stated, "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."
Impact on Current Patients and Consultation Process
Patients under 18 who are currently receiving cross-sex hormone treatments may continue their regimens, but these will now require individual reviews with clinicians. NHS England has launched a 90-day public consultation on plans to remove the treatment as a routine procedure for under-18s. During this consultation period, new referrals for the treatment will be paused. Professor Palmer emphasized, "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."
Broader Context and Advocacy Responses
This development follows recent pauses in related clinical trials, including a trial on puberty blockers for children as young as 10, which was halted due to concerns about unquantified long-term risks. The use of puberty blockers was banned for under-18s in 2024. Advocacy groups have expressed mixed reactions to the NHS decision. Tammy Hymas, policy lead at TransActual, criticized the move as "a profound attack on young people’s bodily autonomy with trans people yet again cruelly singled out by this government." In contrast, Helen Joyce, director of advocacy at Sex Matters, argued that the pause "comes too late" for many children and should be made permanent, stating, "Under-18s are simply too young to consent to such irreversible, life-changing consequences."
Ongoing Support and Future Steps
NHS England continues to offer specialist support for under-18s managing gender incongruence, including mental health services and referrals to specialist children and young people’s gender services where appropriate. The NHS is also examining the evidence for hormone treatments in adults. The final policy on hormone treatment for under-18s will be determined after the consultation period, with a focus on ensuring patient safety and evidence-based care.
