NHS England Halts New Cross-Sex Hormone Prescriptions for Teenagers Under 18

NHS England Suspends New Cross-Sex Hormone Prescriptions for Under-18s

NHS England has officially paused the issuing of new cross-sex hormone prescriptions to 16 and 17-year-olds who are questioning their gender identity. The decision follows an extensive evidence review that concluded the existing body of research supporting such treatments is significantly lacking in quality and reliability.

Teenagers who are currently receiving these hormones will not have their treatment interrupted, though their healthcare providers will be asked to conduct formal reviews of each individual case.

What Are Cross-Sex Hormones and Why Do They Matter?

Cross-sex hormones — typically testosterone or oestrogen — are prescribed to help individuals develop physical characteristics aligned with their preferred gender rather than their biological sex. These treatments can trigger permanent bodily changes, such as a deeper voice or breast tissue development, making the decision to prescribe them particularly consequential for young patients.

Existing NHS guidance had already prohibited the prescription of these hormones to anyone under the age of 16 for gender-related treatment. The latest pause now extends additional scrutiny to 16 and 17-year-olds as well.

The Evidence Review That Triggered the Decision

The suspension was set in motion following the landmark Cass Review, a comprehensive report into children's gender healthcare published in April 2024 by Dr Hilary Cass. The report raised serious concerns, stating that the evidence underpinning medical interventions for gender dysphoria in young people was "remarkably weak."

In response, NHS England commissioned ten independent evidence reviews examining the effects of testosterone and oestrogen — used alone or in combination with other medications — on young people who identify as a gender different from their biological sex. The reviews assessed a wide range of outcomes, including mental health, quality of life, and overall wellbeing.

The conclusion was clear: there is insufficient high-quality evidence to determine whether these treatments are ultimately beneficial or harmful to young patients.

Professor James Palmer, National Medical Director for Specialised Services at NHS England, described the review process as "exceptionally thorough and complex." He stated that the findings "established that the available evidence does not support the continued use of masculinising or feminising hormones" to treat gender dysphoria or gender incongruence in under-18s, adding that the NHS "cannot say if they are harmful or effective."

Public Consultation Now Open

A 90-day public consultation on the revised policy launched on Monday, inviting responses from advocacy groups, healthcare professionals, and members of the public. NHS England stated it hopes the consultation process will help identify any overlooked evidence and that longer-term guidance will be issued as promptly as possible.

Young people who can no longer access the treatment through this route will be directed to one of three NHS gender clinics for children currently operating across England, where alternative forms of care will be made available.

Reactions From Advocacy Groups and Healthcare Professionals

The decision has drawn sharply divided responses from different corners of the debate.

Trans advocacy group TransLucent condemned the move, calling it "yet another blatant act of discrimination against transgender youths' healthcare, which has been systematically eroded since the Cass Review." The group announced it would critically assess NHS England's evidence and is actively considering legal action over what it described as a serious human rights concern.

Paul Carruthers, nurse consultant and manager of Gender Plus — the only privately registered gender hormone clinic in the UK rated outstanding by the Care Quality Commission — expressed dismay at the decision. He noted that his clinic follows a rigorous process aligned with international standards before prescribing hormones, and argued that "NHS England's interpretation of the evidence is in contrast to every reputable expert body in the field of transgender healthcare."

In contrast, Helen Joyce, Director of Advocacy at sex-based rights charity Sex Matters, welcomed the move. She described the prescription of cross-sex hormones to under-18s as "outrageous" and called the pause "long overdue," arguing that young people are "simply too young to consent to such irreversible, life-changing consequences."

Legal and Political Background

This decision arrives against a backdrop of ongoing legal and political pressure. Last year, a legal challenge was mounted by campaigners — led by Keira Bell, who was prescribed testosterone as a teenager and later expressed deep regret over the permanent physical changes it caused — against the government's approach to prescribing cross-sex hormones to 16 and 17-year-olds. Although that case was dismissed in May 2025, Health and Social Care Secretary Wes Streeting MP indicated at the time that he was "actively considering" banning or restricting hormone use in young people, pending the outcome of the very review whose findings have now prompted this pause.

It is important to note that this revised guidance applies exclusively to NHS prescribers. Private doctors operating outside the NHS are not bound by this policy change.

The Department of Health and Social Care reaffirmed its position, stating: "The safety and wellbeing of children and young people is paramount, and NHS England follows expert scientific and clinical advice when making decisions relating to clinical policies."