Gender-affirming hormone prescriptions for 16 and 17-year-olds paused by NHS

NHS England has paused the prescribing of gender affirming hormones for gender incongruence or dysphoria in 16 and 17-year-olds after a review found there was not enough evidence to support their use.

Young people already being prescribed the hormones will be able to continue if they and their parent or guardian and their lead clinician in the NHS Children and Young People’s Gender Service ‘agree in writing that continuation is in their best interests’.

It follows existing guidance, which states the hormones should not be prescribed to under-16s for gender treatment due to a scarcity of evidence on the subject. Furthermore, it comes after the PATHWAYS trial, a UK study examining the prescription of puberty blockers for those 16 years and younger, was paused in February – with the Medicines and Healthcare products Regulatory Agency citing safety concerns as the reason.

The pause in prescriptions is being put in place alongside a 90-day public consultation on halting use of the treatments on the NHS for those under 18 years.

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All feedback will be considered before the clinical policy is finalised, NHS England said.

A review of the evidence on masculinising and feminising (MAF) hormones for children and adolescents who have gender incongruence or dysphoria was set up following a recommendation in the Cass Report published in 2024.

NHS England commissioned a third party to carry out the independent evidence review including research published since NICE’s previous review of the evidence in 2021.

The review considered evidence on a range of outcomes including mental health and quality of life.

It reported there was ‘very limited and weak evidence’ to support the continued access to MAF hormones by children and young people under the age of 18 years.

NICE had also found limited evidence about the safety, risks, benefits and outcomes related to prescribing of the hormones in young people under 18 years of age.

Under the updated policy, young people who cannot access the treatment will be offered other forms of care at one of the three NHS gender clinics for children currently operating in England.

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Professor James Palmer, NHS England’s national medical director for specialised services, said the review had been thorough and complex.

‘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 16-17 year-olds.

‘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.’

Some advocacy groups reacted to the news with dismay and said it would discriminate against transgender young people.

TransLucent called the move was ‘yet another blatant act of discrimination against transgender youths’ healthcare, which has been systematically eroded since the Cass review.

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‘We will critically assess the NHS’s evidence before responding, but given the gravity of these human rights concerns, we will consider legal action.’

A version of this article was first published on our sister title, Pulse Today.