NHS England's decision to pause new prescriptions of cross-sex hormones for under-18s has sparked significant debate around the treatment of children and young people with gender dysphoria. The move comes as a direct result of a comprehensive review of clinical evidence, which highlighted concerns over the current approach to medical interventions in this area.
The policy change does not affect existing patients who are already receiving prescriptions for cross-sex hormones. These individuals will continue their treatment as planned, ensuring continuity of care for those who need it most. However, new patients under 18 will now only be considered for hormonal treatment within the context of a research protocol that is currently being developed. This shift underscores NHS England's commitment to evidence-based practice and a more cautious approach to future interventions.
The decision follows the interim report of the Cass Review, led by Dr Hilary Cass, which highlighted concerns over the lack of robust evidence supporting medical interventions in gender identity services for children and young people. The review recommended a more holistic and integrated approach to care, prioritising comprehensive support rather than rushing into medical pathways.
Against this backdrop, NHS England is restructuring its gender identity services for under-18s, replacing the former Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust with regional centres that offer more specialised and integrated care pathways. These new services aim to provide comprehensive support, including psychological, social, and medical assessments, to ensure individualised treatment decisions are made with careful consideration of long-term implications.
For patients and families, this pause in hormone prescriptions signifies a shift towards a more cautious approach to treating gender dysphoria in under-18s. While existing patients will continue their treatment as usual, new referrals will navigate a different pathway that involves more extensive psychological and social support before any consideration of hormonal treatment – and then only within a research framework. The ultimate goal remains the same: ensuring care is safe, effective, and in the best long-term interests of young people experiencing gender dysphoria.