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NHS England has decided to temporarily halt new prescriptions of cross-sex hormones for 16 and 17-year-olds who are exploring their gender identity. This pause follows a recent review that criticized previous research into the effects of these medications as “really weak.” Cross-sex hormones, such as testosterone or oestrogen, are used to support transgender individuals in developing physical traits aligned with their gender identity rather than their biological sex. These treatments can induce irreversible changes, including deeper voices or breast development.
Only a small number of teenagers will be affected by this pause, and the health service has initiated a consultation process aimed at developing longer-term guidance regarding the use of hormone treatments in young people. Those already receiving hormone therapy will continue their prescriptions, but their clinical teams have been advised to reassess their care. Current guidelines stipulate that hormone treatment should not be prescribed to individuals under 16 years of age. For those unable to access these medications, NHS England promises alternative support through the three NHS gender clinics for children presently operating in England.
The decision arises after a major report published in April 2024 by Dr Hilary Cass, which highlighted the “remarkably weak evidence” supporting medical interventions for children with gender dysphoria. In response, NHS England commissioned ten independent evidence reviews to thoroughly examine various aspects of using testosterone and oestrogen, either alone or in combination with other drugs, for young people identifying with a gender different from their biological sex. These reviews did not find sufficient quality evidence to prove either benefits or harms conclusively. Consequently, NHS England will not authorize new hormone prescriptions while it continues to gather feedback from advocacy groups and healthcare professionals.
Professor James Palmer, National Medical Director for Specialised Services at NHS England, explained, “The NHS has exercised extreme caution when considering starting young people on this treatment.” He described the review as “exceptionally thorough and complex,” noting that it “established that the available evidence does not support the continued use of masculinising or feminising hormones to treat young people under 18 with gender dysphoria or gender incongruence.” The evidence is insufficient to determine whether these treatments are effective or harmful. A public consultation on the matter will launch soon, with NHS England hoping it will reveal any missing data before finalizing long-term clinical guidance.
In response to the NHS decision, trans advocacy group TransLucent voiced strong criticism, calling it “yet another blatant act of discrimination against transgender youths’ healthcare, which has been systematically eroded since the Cass Review.” They announced plans to “critically assess the NHS’s evidence before responding” and hinted at possible legal action due to the human rights implications. The guidance change applies only within the NHS and does not affect private healthcare providers. Notably, the Gender Plus hormone clinic, the only private gender clinic registered with the UK’s Care Quality Commission and rated outstanding, expressed disappointment with the NHS move. Paul Carruthers, the clinic’s nurse consultant and manager, remarked that their hormone prescribing protocols are rigorous and conform to international standards, contrasting with what NHS England concluded, and that they intend to review the NHS policy thoroughly.
The Department of Health and Social Care emphasized that “the safety and wellbeing of children and young people is paramount,” adding that NHS England bases clinical policy decisions on expert scientific and clinical advice. This new NHS England stance follows a recent legal case brought by campaigners challenging the government’s prescription of cross-sex hormones to 16 and 17-year-olds. The case was led by Keira Bell, who had been prescribed testosterone during her teenage years but now regrets undergoing treatment that permanently changed her body. Although her case was dismissed in May 2025, at that time the health and social care secretary indicated he was “actively considering” banning or restricting hormone use in young people pending the outcome of the ongoing review
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