NHS England has paused the initiation of new prescriptions of cross-sex hormones for 16- and 17-year-olds experiencing gender distress, following a review that concluded the existing evidence base for the benefits and risks of the treatment is insufficient.
Cross-sex hormones, such as testosterone or oestrogen, are used to induce physical characteristics associated with a person’s identified gender rather than their biological sex. These medications can produce significant and sometimes irreversible physical changes, including voice deepening, breast development, and altered body fat distribution.
The decision by NHS England follows the publication of the Cass Review, led by paediatrician Hilary Cass in April 2024. The review concluded that the clinical evidence supporting medical interventions for children and adolescents experiencing gender dysphoria was “remarkably weak” and that existing research often lacked long-term follow-up, control groups, or sufficient sample sizes.
In response, NHS England commissioned ten independent evidence reviews examining the effects of masculinising and feminising hormones, both as standalone treatments and in combination with other interventions. These reviews assessed outcomes including mental health, quality of life, and physical health impacts among young people seeking gender-related medical care.
The findings indicated that there was not enough high-quality evidence to determine whether the treatments consistently benefit young patients or pose significant harms. As a result, NHS England announced it would not begin new hormone prescriptions for patients under 18 while further consultation and evaluation take place.
Young people already receiving the medications will continue treatment, though clinicians will review their care plans. NHS England also stated that adolescents unable to access hormone therapy will be offered alternative psychological and support services through the three NHS gender clinics currently operating for children and young people.
Professor James Palmer, National Medical Director for Specialised Services at NHS England, said the health service had taken “extreme caution” in reviewing the evidence. According to Palmer, the comprehensive review concluded that existing research does not support the continued routine use of cross-sex hormones for individuals under 18 with gender dysphoria or gender incongruence, noting that the available data cannot clearly establish whether the treatments are harmful or beneficial.
A 90-day public consultation has been launched to review the findings and allow medical professionals, researchers, advocacy groups, and members of the public to submit additional evidence before long-term policy decisions are made.
Trans advocacy organisation TransLucent criticised the decision, describing it as discriminatory and suggesting that it may pursue legal action. The group argues that restricting access to hormone therapy could negatively affect transgender young people’s mental health and wellbeing.
The policy change applies only to the NHS. Private providers remain able to prescribe hormone therapy, subject to regulatory oversight by the Care Quality Commission. One such provider, Gender Plus, which operates a private hormone clinic, stated that it follows a rigorous assessment process aligned with international guidelines before prescribing medication.
Debate over youth gender medicine is not limited to the United Kingdom. Across Europe, several countries have also re-evaluated clinical practices in light of emerging research.
In Germany, medical guidelines have increasingly emphasised cautious, multidisciplinary assessment for adolescents seeking gender-affirming treatments. German paediatric and psychiatric associations have called for more robust longitudinal research before expanding medical interventions for minors, highlighting similar concerns to those raised in the UK about the limited quality of existing evidence.
Meanwhile, in Spain, the debate has taken place within a different legislative framework. Spain’s Ley Trans expanded legal gender recognition rights and improved access to gender-affirming healthcare. However, Spanish clinicians and medical ethicists have also raised questions about appropriate clinical safeguards for adolescents, particularly regarding the long-term effects of hormone therapy and the need for careful psychological assessment.
These differing approaches across Europe reflect an ongoing international discussion about how best to balance access to gender-related healthcare with the need for strong clinical evidence and safeguards for minors.
Within the UK, the issue has also been shaped by legal and political developments. A high-profile legal challenge was brought by Keira Bell, who had been prescribed testosterone as a teenager and later expressed regret about the treatment. Although the case was dismissed in 2025, it contributed to increased scrutiny of clinical practices.
At the time, the UK Health Secretary Wes Streeting said the government was considering whether further restrictions on the use of cross-sex hormones for minors might be necessary, pending the outcome of ongoing reviews.
The Department of Health and Social Care reiterated that the safety and wellbeing of children remain the central priority, stating that NHS policy decisions are based on expert scientific and clinical advice.
