This week, England’s National Health Service (NHS) threw up yet another roadblock to gender-affirming care for transgender youth in the UK.

On Monday, the NHS announced it was pausing new referrals for feminizing and masculinizing hormones for 16- and 17-year-olds suffering from gender dysphoria, citing a collection of studies commissioned by the health service after publication of the controversial Cass Report in 2024, the Guardian reports.

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That study recommended “extreme caution” initiating hormone treatments, including estrogen and testosterone, and a “clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.”

The new NHS report comes to a similar conclusion.

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“Following the Cass review, NHS England commissioned an in-depth review of all available clinical evidence for using estrogen or testosterone either alone or with other medications to treat gender incongruence and dysphoria,” the report states. “This review has established that the available evidence does not support the continued use of masculinizing or feminizing hormones to treat gender incongruence or dysphoria for young people under 18.”

The Cass Review, which contradicted long-established guidance around the efficacy of gender-affirming care for trans youth, has already prompted the health service to halt prescriptions of puberty-suppressing drugs for trans youth, with an indefinite ban for trans minors enacted by the UK government in December 2024.

The UK’s Health Secretary cited an “unacceptable safety risk” for halting new prescriptions of the drugs, though puberty blockers are still prescribed for early onset puberty and other conditions for children not suffering from gender dysphoria.

Puberty blockers, or GnRH analogues, slow down or halt the onset of puberty in young people taking them, and have preceded and been accompanied by the use of estrogen or testosterone for gender transition.

The positive effects of that combination therapy were all but ignored in the new NHS review, say critics of the decision to halt new prescriptions.

The Dutch Protocol, the “gold standard” for transition care, “involves prescribing GnRH analogues (puberty blockers) first to suppress puberty, then adding hormones later,” writes trans journalist Erin Reed in a story questioning the report’s findings.

“When hormones are introduced, the GnRH analogues are sometimes continued alongside them — the blocker keeps suppressing the body’s natural hormones while the prescribed estrogen or testosterone does its work. This overlap period means patients are on both GnRH analogues and hormones at the same time. That is the ‘combination therapy’ the reviews claim to examine.”  

But the reviews “inexplicably excluded every study” where GnRH analogues and feminising and masculinising hormones were taken in succession or combination. The review tossed out hundreds of such studies in favour of a “salami slicing” approach that examined the hormones in isolation.

NHS was explicit in its methodology.

“Any reference to GnRH analogues in the context of puberty suppression or used as puberty-suppressing hormones must be excluded,” the report states.

“NHS England’s own data, cited in the reviews themselves, confirms that 98% of its patients followed the very pathway every review was designed to exclude,” Reed writes.

She called the NHS evidence reviews “an extreme example of politically-manufactured science.”

Gender Plus, a leading private trans healthcare and education service in the UK, accused NHS England of ignoring clinical expertise and evidence provided by leaders in the field, including the Endocrine Society, which recommends introducing the hormones for trans youth once “persistence of gender incongruence has been confirmed and the young person has sufficient capacity to consent.”

“NHS England’s interpretation of the evidence is in contrast to every reputable expert body in the field of transgender healthcare,” said a spokesperson for the health group.

NHS said patients currently receiving hormone treatments can continue the therapy, “but this will need to be reviewed individually with their clinical team.”

“Banning new prescriptions of gender-affirming hormones for 16- and 17-year-olds is a profound attack on young people’s bodily autonomy,” said Tammy Hymas, policy lead at British advocacy organization TransActual, “with trans people yet again cruelly singled out by this government.”

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