Hormone treatments and age consent: Government policy

Approximate read time: 15 minutes

The House of Lords is scheduled to consider the following question for short debate on 22 October 2026:

Baroness Deech (Crossbench) to ask His Majesty’s Government at what age they consider it appropriate for an individual to be able to consent to the administration of puberty blockers and cross-sex hormones.

This briefing focuses on the government’s position on these treatments for children and young people and recent policy changes. As health policy in the UK is devolved, this briefing focuses on treatments available in England.

1. Key points

• Until April 2024, NHS-commissioned gender identity services were able to prescribe hormone treatments, known as ‘puberty blockers’ as a treatment for children with gender incongruence/dysphoria to suppress puberty. Following a review of gender identity services for children and young people published in April 2024, NHS England confirmed it would end the routine use of puberty blockers as a treatment for children. The then government introduced a temporary limit on private prescriptions which came into effect in June 2024. The Starmer government introduced a permanent ban which came into effect from January 2025.
• NHS England has paused new prescriptions of cross-sex hormones for under-18s while a revised clinical policy is being consulted upon. This revised policy states cross-sex hormones should no longer be available as a routine commissioning option for treatment.
• The independent Cass review into gender identity services for children and young people, commissioned by NHS England, concluded there was no reliable evidence base to support clinical decision-making on treatments for children and young people with gender incongruence or dysphoria. The review recommended there should be a programme of further research, including a clinical trial of puberty-blockers.
• NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA) commissioned the ‘Puberty suppression and transitional healthcare with adaptive youth services (PATHWAYS)’ programme to investigate the benefits and risks of puberty blockers. The trial was temporarily paused following regulatory concerns raised by the MHRA in February 2026. It was subsequently approved in June 2026 with a revised protocol.

2. Terminology

2.1 Hormone treatments and gender incongruence or dysphoria

Puberty blockers and cross-sex hormones are terms used to refer to hormone treatments for people experiencing gender incongruence or dysphoria. Gender incongruence is defined by the World Health Organisation as “a marked and persistent incongruence between an individual’s experienced gender and the assigned sex”.^[1] NHS England defines gender dysphoria as the distress or discomfort someone experiences because the gender they feel they are is different from their sex registered at birth.^[2] Gender incongruence or dysphoria have been identified by NHS England as being potentially more distressing in adolescence “due to the pubertal development of secondary sex characteristics and increasing social divisions between genders”.^[3]

The treatment for gender incongruence or dysphoria for adults offered by NHS England currently consists of hormone therapy as well as other forms of treatment, including talking therapy and counselling.^[4] Treatment for people aged 17 or under usually includes talking therapy and counselling.

2.2 Puberty blockers

Puberty blockers refer to gonadotrophin-releasing hormone analogue (GnRHa) medicines. These control hormones produced by the body and can be used in order to stop the progress of puberty.^[5] These are also referred to as puberty-supressing hormones (PSH) by the NHS.^[6] GnRHa medicines are licenced for use in young children for precocious puberty.^[7] They are also used for the treatment of certain cancers. As explained in section 4 of this briefing, the use of puberty blockers as a treatment for gender incongruence or dysphoria in people under the age of 18 is currently banned in the UK. An exception to this ban can be made in order for people under the age of 18 to participate in medical trials.

2.3 Cross-sex hormones

Cross-sex hormones refer to hormone treatments when used with the intention to masculinise the female body or to feminise the male body.^[8] The aim of such treatment is to induce the sex characteristics congruent with the individual’s experienced gender. These are referred to by the NHS as gender-affirming hormones or masculinising and feminising hormones.^[9] As discussed in section 6 of this briefing, NHS England has paused the prescribing of cross-sex hormones to treat gender incongruence or dysphoria for people under 18 and has launched a consultation on a revised commissioning policy.^[10]

2.4 Further information on terminology

NHS England has described the language used in this area as “evolving” and has noted the terminology used is “different depending on the stakeholder’s perspective”.^[11] Further discussion of the terminology used is provided in the following briefings:

• House of Commons Library, ‘Hormone treatments for children and young people: Clinical trial and consultations’, 19 March 2026
• Parliamentary Office of Science and Technology, ‘Puberty-suppressing hormones for children and young people accessing gender identity services’, 14 September 2026

3. Cass review

Puberty blockers could be prescribed as a treatment for young people with gender incongruence or dysphoria until April 2024. In September 2020, NHS England commissioned an independent review of gender identity services for children and young people.^[12] This was led by the former president of the Royal College of Paediatrics and Child Health, Hilary Cass, now Baroness Cass (Crossbench). The interim report of the Cass review, published in February 2022, noted there had been a rapid increase in recent years in the number of children requiring support from gender identity services and argued that the existing clinical model was not “sustainable in the longer term”. One of the challenges the interim report identified was a lack of data and evidence on appropriate clinical assessment and treatment. It also stated there was a:^[13]

[…] lack of consensus and open discussion about the nature of gender dysphoria and therefore about the appropriate clinical response.

The interim report said there needed to be a “transformation” in gender identity services to ensure children and young people with gender incongruence or dysphoria received an equivalent standard of clinical care, assessment and treatment as that provided by other health services.^[14] It also said that, at this stage of the review, it was not able to provide advice on the use of hormone treatments due to “gaps in the evidence base”.^[15]

The final report of the Cass review, published in April 2024, confirmed the view of the independent review was that there was no “reliable evidence base upon which to make clinical decisions” concerning the care and treatment of children and young people with gender incongruence or dysphoria.^[16] On hormone treatments specifically, the overview to the report summarised the review’s findings as follows:^[17]

• The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.
• The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

The final report made several recommendations, including that there should be a “full programme of research” to consider the “characteristics, interventions and outcomes of every young person presenting to the NHS gender services”.^[18] The report noted that a trial of puberty blockers which the government had already started to develop should form part of this research programme.^[19]

The then Conservative government welcomed the recommendations of the Cass review.^[20] The then health secretary, Victoria Atkins, noted its conclusions concerning gaps in the evidence and she argued the report highlighted what she described as “a culture of secrecy and ideology that was allowed to trump evidence and [patient] safety”.^[21] The then opposition health secretary, Wes Streeting, also welcomed the report, saying it presented an “evidence-led framework” which might be used to ensure children received “the best possible healthcare”.^[22]

4. Ban on puberty blockers

In March 2024, NHS England published a new clinical policy ending the routine use of puberty blockers in most cases for children experiencing gender incongruence or gender dysphoria.^[23] A statutory order temporarily limiting private prescriptions came into effect in June 2024.^[24] Regulations extending this ban indefinitely were introduced in December 2024 and came into effect from January 2025.^[25] Separate regulations were introduced restricting NHS primary care in England prescribing puberty blockers.

The ban only applies to new patients. It does not apply to patients who were already on a course of treatment before the ban was put in place. It also allowed for the use of puberty blockers as part of an authorised clinical trial.

5. PATHWAYS clinical trial

In October 2025, in response to the Cass review’s recommendation and a separate consultation on permanently banning puberty blockers, the Starmer Labour government confirmed NHS England would launch clinical trials to assess the potential benefits and harms of their use.^[26]

In November 2025, NHS England and the National Institute for Health and Care Research (NIHR) commissioned and funded the PATHWAYS research programme, led by King’s College London.^[27] This programme includes a clinical trial of puberty blockers.^[28] The aim of the trial is to explore the impact of puberty suppressing hormones on the physical, social and emotional wellbeing of young people with gender incongruence or dysphoria. The trial will involve young people being treated in NHS Children and Young People’s Gender Services with a formal diagnosis of gender incongruence.^[29] As the participants are below the age of 16, they must provide “appropriate informed assent, alongside the consent of their parent/legal guardian”.^[30] More detailed information about the criteria for inclusion in the PATHWAYS trial is available in the protocol of the trial.^[31] The Health Research Authority (HRA) also publishes guidance on consent in medical trials involving children more generally.^[32]

The trial was submitted for approval by the MHRA and the HRA.^[33] In February 2026, the Department of Health and Social Care (DHSC) announced the PATHWAYS trial had been paused following concerns raised by the MHRA.^[34] A letter from the MHRA to the trial sponsors set out several recommendations for how the protocol for the trial should be amended, including that the minimum age limit for eligibility should be at least 14 years old.^[35] It also said future trials may consider lowering the threshold depending on the findings of the initial trial.

In June 2026, King’s College London published an updated protocol for the PATHWAYS trial which stated the minimum age for participation would be 11 years old for birth-registered females and 12 years old for birth-registered males.^[36] A spokesperson for the PATHWAYS trial research team told the British Medical Journal this was agreed following a series of meetings with the MHRA from February to April 2026 to discuss the design of the trial.^[37] The MHRA has approved the updated protocol.^[38]

In a statement confirming the reopening of the trial, the then health secretary, James Murray, told the House of Commons the PATHWAYS programme fulfilled the government’s commitment to implement the recommendation of the Cass review.^[39] He said the revised protocol contained “significantly strengthened” safeguards for children participating in the trial.^[40] The Starmer government said subsequently the minimum entry ages set out in the updated protocol reflected “a balanced approach to ensure the treatment is studied at the point it is most clinically relevant while maintaining appropriate safeguards for participant safety”.^[41] The opposition has criticised the trial, arguing that it may risk the health of young people participating.^[42]

On 25 June 2026, Baroness Deech asked the government an oral question concerning the participation criteria in the puberty blockers trial.^[43] She criticised the government’s support for the trial and argued that it would not be possible for participants below the age of 16 to give meaningful consent. Responding, parliamentary under-secretary of state at the Department of Health and Social Care, Baroness Merron, said the Burnham government supported the trial and said this approach had been led by the clinical evidence and by the advice of experts. She said eligibility for the trial would be “tightly controlled”.^[44]

6. Consultation on cross-sex hormone treatment

In March 2026, the Starmer government announced that NHS England would be consulting on a revised clinical policy on the prescribing of cross-sex hormones to treat gender incongruence or dysphoria for young people.^[45] It also announced that NHS England would pause prescribing cross-sex hormones to people under the age of 18. Young people with existing prescriptions for cross-sex hormones would continue to receive their prescriptions. The revised clinical policy being consulted on states that cross-sex hormones should no longer be available as a routine commissioning option for treatment.

NHS England’s national medical director for specialised services, James Palmer, said the decision to pause new prescriptions had been taken because available evidence did not support the continued use of masculinising or feminising hormones for people in this age group.^[46] He said the NHS would continue to provide specialist support for under-18s including mental health support and referral to specialist children and young people’s gender services where appropriate.

The consultation on the revised commissioning policy ran from 9 March to 7 June 2026.^[47] At the time of writing, the response to this consultation has yet to be published. NHS England has said the finalised policy is expected to be published later in autumn 2026.^[48]

7. Read more

• Parliamentary Office of Science and Technology, ‘Factors shaping gender incongruence and gender dysphoria, and impact on health services’, 2 August 2023
• Parliamentary Office of Science and Technology, ‘Puberty-suppressing hormones for children and young people accessing gender identity services’, 14 September 2026
• House of Commons Women and Equalities Committee, ‘Oral evidence: Evidence base on the safety and effectiveness of puberty blockers’, 22 January 2025, HC 503 of session 2024–26, Q1–58

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This briefing was updated on 15 October 2026 to include additional information on the guidance on research involving children published by the HRA.

Image from Magnific.