*Updated 16 May 2025*
Puberty blockers are banned in the UK to treat gender dysphoria in under-18s.
This decision follows independent, expert advice from the Cass Review and the Commission on Human Medicines
The below explains why this decision was made and what support is available for children and young people as the NHS reforms its gender services to provide all-round, holistic care.
What are puberty blockers?
- Puberty blockers are a type of medication called gonadotrophin-releasing hormone (GnRH) analogues. They are licensed only for use in young children (for precocious puberty) or older adults (for certain cancers).
- They are not licensed for use in adolescents and they are not licensed for gender incongruence or dysphoria.
- Licensing of medicines requires a robust assessment of safety and effectiveness data. These medications have not undergone that process, which means the safety and risk implications for use with gender dysphoria have not been assessed.
Why have you restricted puberty blockers indefinitely?
- In March 2024, NHS England took the decision not routinely use of puberty blockers for the treatment of gender incongruence - informed by an evidence review conducted by the National Institute for Health and Care Excellence (NICE).
- These findings were echoed in the Independent Review of Gender Identity Services for Children and Young People (the Cass Review), and accompanying systematic reviews, which found insufficient evidence to support the safety or clinical effectiveness of puberty blockers for adolescents.
- The Commission on Human Medicines (CHM), an independent expert body which advises ministers on the safety and efficacy of medicines, has also advised that the current prescribing environment is unsafe, and that an indefinite ban should be put in place until a safer prescribing environment can be established.
What is an ‘unsafe prescribing environment’?
- Through their review, CHM found poor medical and prescribing practice has taken place that goes against guidance of medical regulator, the General Medical Council.
- CHM reviewed evidence from a range of sources of private prescriptions, including examples of access to puberty blockers from different countries, and heard from organisations about how the standard of healthcare provided by some private healthcare providers may not be consistent with a UK NHS level.
- Overall, CHM saw evidence of poor-quality advertising, prescribing and communication by private practitioners to children and young people that would constitute unsafe practice.
- As an example, CHM found instances where children received prescriptions after filling out online questionnaires and a brief call with prescribers outside the UK.
- We are prioritising patient safety, which is why we accepted CHM’s recommendations.
What are you doing to support children and young people with gender dysphoria?
- NHS England has opened three new children and young people’s gender services in the North West, London and Bristol. These services operate under a fundamentally different model, embedding multi-disciplinary teams, including mental health support and paediatrics, within specialist children’s hospitals to provide all-round, holistic care to young people.
- A fourth service in the East of England is planned to open in spring 2025. By 2026, there will be a specialist children’s gender service in every region by 2026.
- These new services will increase clinical capacity and reduce waiting times, so patients can be seen sooner and closer to home.
- NHS England’s ambitious two-year action plan to implement the Cass Review sets out how they will continue to improve and transform services.
- The NHS has commissioned an additional support offer for young people who are waiting to be seen by the new gender services, through an assessment with their local Children and Young People Mental Health services.
- The NHS is also extending an offer of targeted support from local mental health services to anyone who is not on the NHS waiting list but has been affected by the banning order.
Is it true that toddlers are being treated for gender dysphoria?
- It is not true that toddlers are being treated for gender incongruence. As the Cass Review recommended, parents who have concerns about their child are offered specialist support and guidance.
- Any care received by families of children under the age of 7 focuses on providing support and guidance to the parents or carers, rather than a clinical assessment of the child.
Why has the NHS removed the age limit of 7 to access gender services?
- The Cass Review recommended removing the age limit on gender identity services so families can be seen as early as possible to receive support and advice.
Have NHS England instructed GPs to deny healthcare to trans patients?
- No – the NHS has published guidance to healthcare workers highlighting examples of inappropriate and unsafe prescribing of puberty blockers and hormones to children and young people from unregulated providers, like those abroad.
- The guidance makes clear that GPs should not be asked to support inappropriate prescribing with unregulated providers and it follows a request from GPs.
- However, GPs should continue to provide care and arrange for blood tests and other tests when there are concerns the child or young person is at risk of harm - for example from suspected blood clots.
- The advice in the guidance is in line with the other actions we have taken to protect children through the ban on puberty blockers.
Who did you engage with on the consultation when deciding to ban puberty blockers?
- The consultation engaged widely, including groups that represent the LGBT+ community and those representing patients and service users and their families, clinicians, pharmacists, charities, regulators and experts.
- Respondents also had the opportunity to make representations to the Commission on Human Medicines.
- The Health and Social Care Secretary, Wes Streeting, has also personally engaged with a range of stakeholders on this issue, including with children and young people, and their families, with lived experience of gender incongruence.
- This government will continue to engage with, and listen to, the trans community.
When is the clinical trial launching?
- NHS England and the National Institute of Health and Care Research (NIHR) are working together to set up a study into the potential benefits and harms of puberty suppressing hormones as a treatment option for children and young people with gender incongruence.
- Better-quality evidence is critical if the NHS is to provide reliable, transparent information and advice to support children and young people, and their parents and carers, in making potentially life-changing decisions.
- All NIHR-commissioned research must go through robust scientific and ethical approval processes. Once these have completed, the trial will begin recruiting patients.
Why have you continued this ban whilst still allowing puberty blockers to be prescribed for other conditions?
- While the medicine may be the same, they have not been licensed for gender incongruence or dysphoria.
- Licensing of medicines requires a robust assessment of safety and efficacy data. These medications have not undergone that process, which means the safety and risk implications for use with gender dysphoria have not been assessed.
- In particular, licensed uses of the medicine are for much younger children (precocious puberty) or older adults (certain cancers). For adolescents, the interaction with all the different processes of puberty may be very significant, which is why more evidence, and a better understanding of their impact, is needed in this patient group.
- That is why the clinical trial will measure a range of potential treatment benefits and harms (for example whether puberty suppressing hormones impact in a meaningful way on levels of anxiety or depression, on body image, or brain development) using a range of validated tools, questionnaires and user feedback.
Was there an increase in suicide amongst young gender dysphoria patients at the Tavistock clinic?
- No. Professor Appleby’s report makes clear the data does not support the claim of an explosion of suicides of children and young people at the Tavistock GIDS service. Anything said to the contrary is a complete misrepresentation of the facts and is dangerous.
- The review also noted the way this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide.
Why weren’t cross-sex hormones included as part of the original puberty blocker indefinite ban?
- The Cass Review made differing findings and recommendations about cross-sex hormones and puberty blockers.
- On puberty blockers, the review recommended to the NHS that these products should only be given in the context of a clinical trial.
- On cross sex hormones, it recommended that NHS England should review its policy on such hormones. It noted that the option to provide cross sex hormones is available for patients aged 16 and over, but extreme caution was recommended along with a “strong clinical rationale for providing hormones before the age of 18”. Every case for treatment should be discussed by a national multi-disciplinary team as part of the new NHS gender services.
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