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Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
I beg to move,
That this House has considered e-petition 751839 relating to the clinical trial into puberty blockers.
It is always a pleasure to speak under your chairmanship, Mr Mundell. I sincerely thank everyone I met in preparation for this debate: the legal and medical professionals who shared their expertise and the individuals with deeply personal, lived experience on both sides of this discussion. It goes without saying that this is a complex topic. I am grateful for the time and care that people have taken to help inform this debate.
I also thank the petition’s creator, James Esses, and petition supporter and campaigner Keira Bell. I had the pleasure of meeting them ahead of this debate, and they are watching today. Their petition asks that the clinical trial for the use of puberty blockers be cancelled. They believe that medical intervention in this area is dangerous, poorly evidenced and ethically questionable. They have asked Parliament to ensure that children are protected from potential harm.
I want to make it crystal clear that this debate is not about trans rights or whether people who identify as transgender have the right to exist and live free from discrimination. This discussion focuses on a clinical and ethical issue: whether puberty blockers should be prescribed to children experiencing gender dysphoria, and specifically whether a new NHS-backed clinical trial into their use should proceed.
Puberty blockers are medicines that suppress the production of sex hormones. They press pause on puberty, delaying changes like periods, breast development, voice changes and facial hair growth. Historically, they have been prescribed to children who enter puberty unusually early and, in some cases, for the treatment of cancers or endometriosis. Importantly, they are distinct from gender affirmation or cross-sex hormones. Blockers temporarily pause development, while cross-sex hormones actively induce the physical changes of the opposite sex and are generally irreversible.
The petition raises two main areas of concern: the possible long-term medical side effects of puberty blockers, and whether meaningful consent can ever be obtained from a child or adolescent.
Tonia Antoniazzi (Gower) (Lab)
The hon. Gentleman is making a very good start to his speech. I appreciate that this is very contentious, but I am concerned about the manner in which young people—children—are asked questions. The KIDSCREEN-10 index is a primary outcome measure for the PATHWAYS trial, and when I look at the questions, I wonder how my son would have answered them aged 11. One of them asks:
“Have your parent(s) treated you fairly?”
The truth is that any child at that age would probably say, “No.” Does the hon. Gentleman share my concern that these questions are not fit for purpose?
Jamie Stone
I thank the hon. Member for her intervention, but she will understand that it is my job as Chairman of the Petitions Committee to present a fair description of both sides of the discussion, which is what I hope to do.
James Esses, who started the petition, is a psychotherapist, and he impressed on me the benefit that good psychiatric intervention could have, without medicalisation. Puberty, he argued, is rarely a picnic for anyone—it can be confusing, uncomfortable, and sometimes miserable—but it is an essential developmental stage, and suppressing it pharmacologically could alter physical and cognitive development in ways we do not yet fully grasp. His argument is not to remove care for children experiencing gender incongruence, but to focus efforts on careful psychological support.
Others question the trial’s purpose, noting that puberty blockers have already been paused for new NHS patients with gender incongruence, following concerns about safety. They fear that authorising a new trial implies a level of confidence that the evidence base does not yet justify, arguing that enough data exists to recognise the potential harms, from reduced bone density to uncertain impact on brain development. Continuing could erode the safeguards that protect young people.
Graham Stringer (Blackley and Middleton South) (Lab)
The hon. Member is making great efforts to be balanced in his presentation on behalf of the Petitions Committee. He says this is a complex area, but surely it is actually quite simple: we should not be experimenting on children, particularly as we cannot do double-blind experiments. Those are two fundamental reasons why these so-called experiments should not go ahead.
Jamie Stone
I note the sincerity with which the hon. Gentleman makes his remarks. There is the legal and ethical question of whether a child can ever truly consent to something like this.
Stuart Anderson (South Shropshire) (Con)
I have five children, and have watched half of them go through puberty. They continually change their minds about things. Ethically, I can see no justification for allowing children to be experimented on. What might be a short-term solution could become a permanent solution that people often grow to regret.
Jamie Stone
I thank the hon. Member for his intervention, which was, I believe, made with as much sincerity as the previous intervention.
Sir Julian Lewis (New Forest East) (Con)
I believe many children were treated with puberty blockers, among other drugs, before the Gender Identity Development Service programme was closed down. Does the hon. Member know what has happened to all the data from those children who were previously treated, or why it should be necessary to treat any more children with these drugs until enough time has elapsed to enable that data, and the treatment’s consequences, to be verified?
Jamie Stone
What I am about to say relates to the right hon. Member’s intervention. It is not unusual in medicine for children to participate in clinical trials, provided that there are robust safeguards, clear parental consent and proper oversight. But can a distressed teenager and a family desperate to help truly grasp these long-term implications? The legal experts I consulted spoke about the delicate ethics at play. Medical research always involves balancing competing risks: the risks of harm from an intervention versus the risks of harm from withholding it.
Puberty blocker trials pose unusual challenges as they cannot include placebos, so the design requires special scrutiny to ensure that informed consent is meaningful. There is still work to do to ensure that children and parents fully understand what entering a study means. On the other hand, opponents of the petition—those who support the new trial—say that the only way to reach clear conclusions about safety and efficacy is through rigorous, carefully monitored research. We do not yet know about the potential harms of puberty blockers for treating gender dysphoria, but we do know that the effects of cross-sex hormones can be irreversible.
Following the Cass review, NHS England proposed a very different approach from the old Tavistock model, focusing on smaller numbers and much stricter controls. The new design would have national oversight, tight eligibility criteria and a multidisciplinary team around each young person, and only about 5% of participants might receive puberty blockers compared with around 27% who were prescribed them while at Tavistock.
Also important is that cancelling the NHS trial would not prevent young people from accessing puberty blockers. In some gender clinics, clinicians report that between 10% and 20% of clients are obtaining them privately or online, outside regulated healthcare systems. Those unmonitored routes carry greater risks because dosages, purity and outcomes are not tracked or supported. Proponents of the trial point out that without direct research we remain in a state of uncertainty, which carries its own risks. If puberty blockers help some young people to avoid serious distress, we need to understand that better.
If the evidence ultimately shows that the risks outweigh the benefits, that too must be established through high-quality data. Without such evidence, none of us—doctors, parents or policymakers—can make sound judgments. Of course, participation in any trial is voluntary. Families will continue to have the right to decline. The aim of the study is not to push young people towards any one outcome, but to understand what support is appropriate for different individuals.
I want to end my speech by returning to the people at the heart of this issue. I have spoken to individuals who feel deeply harmed by medical intervention, such as Keira Bell, whose story has been widely discussed. Her experience matters, as do the experiences of all those who regret the care they have received. I have also had the pleasure to speak with Maxine Heron, whose experience with puberty blockers was profoundly positive. Having the option to pause puberty spared her immense distress, and she has experienced no negative health outcomes. For her, being forced to undergo male puberty would have been the greater trauma. She is one of many who report that their lives have been significantly improved by timely support.
We must hold both kinds of stories with equal seriousness. Regret exists, but so does gratitude. The aim of research is not to erase one side of the story, but to understand why experiences differ, and crucially, how best to help every child who is struggling. Without doubt, this is one of the most challenging questions before us: how to protect young people, respect autonomy and uphold scientific integrity. I, for one, do not pretend that it is easy.
I hope today’s debate will help to address some of the challenges, and reassure those who have signed the petition that their concerns are being taken seriously. I can see with my own eyes that many colleagues wish to contribute. I will therefore draw my remarks to a close. I look forward to the contributions to this debate, especially the reply from the Government, which I believe will be instructive.
David Mundell (in the Chair)
Order. I remind Members that they should bob if they wish to be called. As the debate is heavily subscribed, I am afraid that I will have to impose a two-minute speech limit from the start, and even that will not guarantee that everyone will be called.
David Smith (North Northumberland) (Lab)
It is a pleasure to serve under your chairship, Mr Mundell. Any debate in which we are talking about the health and wellbeing of children and young people requires us all to be measured in our remarks, not least in the context of a debate that has been so toxic at times.
Our focus in clinical studies and in any treatment that we offer anyone, let alone children, should be: “First, do no harm.” It is that axiom that seems to be at the heart of the Medicines and Healthcare products Regulatory Agency intervention that has paused the puberty blocker trial. To summarise where we have got to with the PATHWAYS trial, parents are being asked to consent to a potentially life-altering intervention to their children in the absence of a life-threatening condition, based on an unreliable diagnosis with an unknown trajectory.
I urge the Government to go one step further and cancel the trial altogether, not least because there are alternative approaches for us to establish the facts regarding the use of puberty blockers, and to do so with an approach that is compassionate, understanding and holistic. The only question we should be asking in relation to gender dysphoria is: what is the best approach to support those who experience it?
Dr Cass said in her review:
“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.”
In the context of that really good review, the PATHWAYS trial was a mistake. I welcome the trial being paused, because there is so much else that we can do.
The MHRA has said that ultimately puberty blockers can be very dangerous for bone health and cognitive development, with other long-term effects. We must move from a pause of the trial to its cancellation. There are other types of studies that we can do; I suggest we focus on a data linkage study.
David Mundell (in the Chair)
Thank you, Mr Smith, for keeping to time, which I am sure Rebecca Paul will do as well.
Rebecca Paul (Reigate) (Con)
The use of puberty blockers on healthy children is deeply wrong. Children given those drugs are being locked into their discomfort and put on a one-way pathway to cross-sex hormones and surgeries. All of that leads to a lifetime of sexual impairment, fertility issues, bone density loss and other catastrophic psychological and emotional impacts. No child put on puberty blockers at the earliest stage of puberty and whose natural puberty is blocked will ever have an orgasm or be fertile. That is what anyone in this room cheerleading this trial is supporting.
In December, the Health Secretary said at the Dispatch Box:
“Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that.”—[Official Report, 17 December 2025; Vol. 777, c. 929.]
However, on 20 February, we found out that the MHRA had U-turned and was expressing serious concerns about the current trial. The issues it raised were not new, though, having been raised from the outset by many in this room. Making children infertile and harming bone structure are not minor points of detail, but fundamental safety flaws. That last-minute intervention raises questions about the rigour and diligence of the overall approval process. How did a trial with such potentially catastrophic health impacts make it through the research ethics committee approval process?
Having looked through the minutes of the meetings, I can see that the committee members met three times over Zoom; nine out of 12 attended the first, only five attended the second and only three attended the third. What stands out most to me is the REC’s delegation to a sub-committee of approval responsibilities for such a profoundly dangerous trial. Section 4.2.24 of the REC governance policy document indicates that sub-committees can be used when
“research proposals…present no material ethical issues”.
I am therefore staggered that it took the decision to delegate approval responsibilities in this case.
Josh Newbury (Cannock Chase) (Lab)
It is a pleasure to see you in the Chair, Mr Mundell. At the outset, I want to acknowledge the strength of feeling on all sides of this debate, and our responsibility in this House to provide clarity that is grounded in evidence and centred on the wellbeing of the young people we are talking about.
The petition calls for the cancellation of the planned clinical trial of puberty-suppressing hormones, describing them as unsafe and inconsistent with safeguarding. However, the reality is that Dr Cass was clear in her review that we are lacking evidence, and that one of the scenarios where she believed that puberty blockers should be prescribed for gender incongruence is a clinical trial. A trial is a response to uncertainty, focused on ensuring that clinical decisions are made on a foundation of robust evidence.
I find it a little more than ironic that, when the Cass review was published, many of the voices now telling us that a trial should not go ahead were saying that the Cass review should be accepted and implemented in full. They have gone from saying, “We need the evidence,” to, “This trial should be stopped.” If someone can show me another way of properly gathering clinical evidence other than a full clinical trial, then I am all ears, but, in reality, we are talking about shutting down options for trans people. With waiting times for a first appointment for a gender identity service currently standing, in many cases, at more than five years, it is not as if there are copious alternatives out there for this group of young people. Many are waiting the entirety of their adolescence just to start treatment. Would we tolerate that for any other group of patients? I doubt it.
Josh Newbury
In the interest of time, I will not.
Although I respect the concerns that have led many to sign the petition, I urge colleagues to reflect on the consequences of the course of action it proposes. Cancelling research does not resolve uncertainty, but entrenches it. In doing so, it risks leaving vulnerable young people without the evidence base needed to support safe, informed and compassionate care. As someone who is proud to be an ally of the trans community, I believe that we have a duty to ensure that trans young people hear a clear message from this House: they are supported, respected, cared for and never alone.
Rosie Duffield (Canterbury) (Ind)
It is always a pleasure to serve under your chairship, Mr Mundell. First, I should acknowledge that, having been steeped in this issue for many years, I know James Esses, the therapist who organised this petition. He, the formidable Keira Bell and the Bayswater Support Group have managed to halt this trial, so no children are to be recruited until the High Court makes its decision, until at least July.
It is clear that we are talking about an extremely vulnerable cohort of children. Recently, James told MPs and peers that, first and foremost, most of his patients—almost all of them, in fact—are autistic. As recognised by the Cass review, children or adolescents on the autism spectrum experience difficulties with social belonging and can be particularly sensitive to seeking affirmation from others. James explained to us that many of his patients rely on rigid and regressive stereotypes, including the trope that a preference for activities or even friendships associated with the opposite sex must mean that they actually are that sex. That is the basic foundation for the so-called gender critical movement: a rejection of labelling, and the pigeonholing or aggressive stereotyping of what constitutes boy or girl behaviours, clothes preferences or activities.
For over 20 years, medical professionals voicing their sound judgment and concern about ethics and child safeguarding at the Tavistock were ignored, their concerns buried and they themselves punished, sidelined and vilified for challenging an entirely ideological project. It is thanks to medical professionals such as Sue and Marcus Evans, Dr David Taylor, Dr David Bell and Sonia Appleby, to name just a few brave medics, and the committed reporting of journalists such as Hannah Barnes and Julie Bindel that we are having this debate today. In all the years I have been actively campaigning against the impossible notion that anyone is born in the wrong body, I have been labelled far-right, bigoted, transphobic and all kinds of other ridiculous slurs that would be unparliamentary to repeat here. We must stop this trial because of the incredibly vulnerable cohort of children as young as 12 who cannot possibly give consent.
Jonathan Hinder (Pendle and Clitheroe) (Lab)
It is a pleasure to serve under your chairmanship, Mr Mundell. The proposed puberty blockers trial on children is not just badly designed; it is profoundly unethical. It proposes that vulnerable children who are struggling with their identity, but medically healthy, be given drugs that risk permanent damage. We know that this group of children is deeply vulnerable. They deserve proper care and treatment. The medicalising of gender identity risks underlying conditions being overlooked, meaning that children will not get the support they really need.
Children in this trial would be at what is called Tanner stage 2 of puberty. For children at Tanner stage 2 who proceed to cross-sex hormones—basically, all of them—infertility is not a risk, but an expected outcome. I repeat: once they are locked into this medicalised pathway, infertility is expected. Let us be absolutely clear that this trial would mean the British state sterilising healthy little children in plain sight—not by accident, but consciously and deliberately. How could we do that to children? It would be the most appalling state scandal imaginable. These medically healthy children need love, compassion and support. They should not be given powerful drugs to stop their body from developing as normal.
The truth is that puberty can be very distressing for any child, not least those who do not conform to aggressive gender stereotypes or who will grow up to be same-sex attracted. Puberty is a natural and essential part of becoming a fully grown human being. I say to those children: you are perfect just the way you are and you do not need to be somehow corrected with these drugs.
Children of primary school age cannot possibly give consent to these life-changing decisions. When they become adults, many of them will look back on what was done to them and ask, “How did this happen to me? How did the Government do this to me?”
Carla Denyer (Bristol Central) (Green)
It is a pleasure to serve under your chairmanship, Mr Mundell. As an MP, I hear far too often from young trans and gender-questioning people and their families who are unable to get the treatment they need. It is important in this debate to start by being clear what puberty blockers are and are not. They do not, on their own, make any permanent changes to a young person’s gender. Some people who start puberty blockers will go on to further treatments, and some will not. Puberty blockers can give young people time to explore their gender without the added distress of unwanted physical changes. That gives them the time and space to decide if they want to take more permanent steps. Puberty blockers alone do not lock young people into any permanent decision.
New prescriptions for puberty blockers were banned indefinitely in November 2024, meaning that the PATHWAYS trial has been the only legal way to get a prescription. The Green party opposes the ban on puberty blockers and always has, because they are a safe and reversible way of reducing gender dysphoria that is recognised by international research and advisory bodies. The list is too long to give in the time we have, but it includes the European Society for Paediatric Endocrinology, the American Association of Clinical Endocrinologists, the European Society for Sexual Medicine, and so on.
My concern is that the PATHWAYS trial has not been paused because of genuine concern about young people’s safety or because the Government have listened to the constructive concerns of the trans community about how the trial will be run. It now looks like a political decision. If further research on puberty blockers is needed—I understand that most medical treatments benefit from ongoing research—that research must be carried out in a way that does not exclude or disadvantage one patient cohort over others. It should centre the needs of the young people involved. There should not be a cap on participants or an unmedicated control group, and it should take account of all uses of puberty blockers, including on cis children experiencing premature puberty. We so often talk about trans people without including them in decisions made about them. I ask the Minister to reconsider the Government’s path.
Dr Scott Arthur (Edinburgh South West) (Lab)
I believe that a trial for puberty blockers is necessary, and I am hopeful that the issues raised between the MHRA and King’s College can be resolved to allow the PATHWAYS trial to go ahead. If not, I hope an alternative trial can be proposed. I believe that if we accept that trans people exist and have rights, which I think—or at least hope—everyone here does, such trials are a natural consequence.
I understand the concerns the people here and outside this place have about the long-term medical impacts of puberty blockers. That is why we should act cautiously and it is why a trial is needed. We cannot possibly understand the short or long-term impacts without studying puberty blockers properly. The PATHWAYS trial came about because of a lack of conclusive evidence on the use of those drugs. The answer is not to allow their legal use again, but to undertake a trial into their benefits and consequences.
Not long ago in my constituency, I met the parents of a trans woman. Their daughter struggled significantly with her mental health during her teenage years. At one point, she was hospitalised due to complications from a severe eating disorder, which was driven by her decision to reduce her calorie intake because she thought that would delay puberty. Her parents have told me that they believe a big cause of her issues was her inability to express her true gender identity. They have no doubt that puberty blockers would have saved her from some of the anguish that she has experienced. While I know life is not always easy for her, my constituent’s daughter has since medically and socially transitioned; she lives openly as a woman and is happier as a result.
That story shows the profound impact that a struggle with gender identity can have on a young person. It is offensive to talk about young people simply needing love, to talk about trials being experiments, or to suggest that taking part would be an impulsive decision by anyone. People talk about trying to moderate language; we have a duty to bring people together on this topic, not create division.
Tom Tugendhat (Tonbridge) (Con)
It is a pleasure to serve under your chairship, Mr Mundell. We should start off by recognising that the life choices that adults make, in whatever way they make them, are to be respected and not criticised. This matter is not in any way a criticism of anybody who chooses a trans identity or who identifies as trans, or who chooses any other identify or identifies in any other way. It is simply about the experimentation on children.
Let us be clear: we would not tolerate any form of medical experimentation on children in such an uncertain category with any other treatment. We would, quite rightly, put forward the Hippocratic oath to do no harm. To change that, particularly for a group of children who are often already suffering from some other element of potential harm, including autism, as the hon. Member for Canterbury (Rosie Duffield) mentioned, would be to re-victimise children who are already vulnerable. This issue must be treated delicately and carefully, but the truth is that it is getting wrapped up in identity politics and being played with politically by those who wish to advertise their progressive credentials but who are forgetting that it is fundamentally about one thing: the protection of children.
Tom Tugendhat
I will not. Whatever the views of people in this room, there is a second element that this Government must consider. We are already seeing honourable individuals like Keira Bell who have raised the problem of detransitioning, and we are seeing the legal costs of their actions against the state. What money has the Government set aside for legal action for those who are too young to consent because they are not 18 years old and who will therefore able to bring legal action against the state for any experimentation that was done on them, as would have happened in this circumstance?
Emily Darlington (Milton Keynes Central) (Lab)
It is a pleasure to serve under your chairmanship, Mr Mundell. I want to start with the expression, “Do no harm.” To be clear for the people who have come to speak to me—parents and young people themselves—we are doing them harm by not giving them the treatment they need, with the wait times of six years, and potentially in respect of puberty blockers, where that is agreed with their healthcare professionals.
My overarching concern is that the clinical trial was suggested in the Cass review. It was proposed and designed in conjunction with the MHRA, but then the MHRA changed its mind. Why was that? Dr Hilary Cass said:
“There are no new research findings and the MHRA hasn’t presented any new evidence. It feels to me like they are responding to political pressure rather than to science.”
That is what she said; I was quoting her verbatim. It was her review that the people around this Chamber wanted us to listen to and to make changes in response to, so we have to listen to her in this instance as well.
The MHRA should operate without any political interference or fear of legal action, yet the MHRA itself referenced potential legal action in relation to the trial as one of the reasons why it changed its mind. That is a problem. The MHRA is there to make sure that anything from clinical trials to medical technologies and new drugs are dealt with on the basis of science and science alone.
Tonia Antoniazzi
The problem is that the MHRA lead, Professor George, is being hounded and scapegoated after recusing himself. It is really sad to see a professional in such a situation. I urge my hon. Friend to use words with caution, because he recused himself. He is a great man who is being hounded.
Emily Darlington
I am not for hounding any particular individual. The only person I have referred to by name is Hilary Cass and she has been on the public record. I have been hounded for my views as well—
Emily Darlington
Exactly, and that is completely inappropriate. A leader of a political party shouted “Traitor” at me when I said we should watch our language around this issue. I do not know who they think I am a traitor to, but I am certainly not one to the human race. The hon. Member for Canterbury (Rosie Duffield) has said she has received death threats; I get death threats too. This is not unique to the hon. Member.
The MHRA should not be in an environment where it has any fear of any legal action; it should only look at the science. Many in the community feel that the trial has now become too political for anybody to touch and that we have forgotten about those children who, quite frankly, if we do not do anything for them, we are doing harm.
Carla Lockhart (Upper Bann) (DUP)
Children deserve protection, not experimentation. In Upper Bann alone, 1,300 people signed the petition—more than twice the number of signatories in any other constituency. Their message is clear and I stand with them.
Animal testing on mice and monkeys shows that puberty blockers cause irreversible damage to brain development. If these hormones are unfit for animals, why on earth are we about to inject them into our children? Children are once again being used as lab rats for a dangerous medical experiment. It is wrong. We should not be experimenting on a fresh cohort. Instead, we should be prioritising a data-linkage study of the hundreds of children who were given puberty blockers at the now discredited and closed Tavistock clinic.
It is reckless to allow minors to take certain risks while they are still maturing. All trial participants will be under 16. We do not allow teenagers to drive, get married, buy alcohol or own a gun. We should not put them on a medical pathway with such life-altering consequences. In fact, for most children who are questioning their gender, going through puberty will naturally resolve their gender dysphoria. We should offer vulnerable young people support and stability, not give them life-altering drugs.
It should send a shiver down our spines when we look at the documentation relating to safeguarding. Participants are warned against getting pregnant while taking puberty blockers; there is no mention of the fact that the legal age of consent is 16. Even more concerningly, girls will be advised to consider getting their eggs harvested, which is normally a procedure for in vitro fertilisation or cancer treatment. Complications include ovarian hyperstimulation syndrome, which can cause severe abdominal pain and even death. There is no mention of those risks in the document.
I have met Keira Bell. She is sounding the alarm for anyone who will listen. Doctors did not give her holistic care; instead, they affirmed her false belief that hasty medical intervention was the answer. My constituents and I need a total ban, not just a temporary pause to this dystopian medical trial.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
It is a pleasure to serve under your chairmanship, Mr Mundell. Over the past year, the public debate has become often heated and personal and, at times, deeply harmful. The rhetoric has consequences, and we in this House must take responsibility for the climate that we help to create.
The Cass review’s recommendations were so important, and among them was a clear call for carefully designed clinical trials to build the evidence base around puberty blockers. Those trials would allow clinicians, patients and families to make informed decisions grounded in robust data rather than speculation or ideology. Those who argued that puberty blockers should be restricted due to insufficient evidence are now opposing the very research that would provide that evidence. That does not suggest a commitment to scientific rigour; it suggests a shifting position driven by political ideology. I am not a clinician, and I do not pretend to be. On matters such as these, we must be guided by medical evidence.
Rachel Taylor
For the sake of time, I will not.
The need to be guided by evidence is precisely why the current situation is so troubling. It is concerning that the MHRA initially raised no objections to the trial when it was approved but has since changed that position. As Dr Cass made clear, no new evidence has been presented to justify that shift. That raises serious questions about the basis of the decision, and whether an independent regulator has buckled to pressure from a well-funded lobbying campaign. As a consequence, vital research is now at risk, and that matters. The trials are not an optional extra; they are the mechanism through which we build the evidence base that critics say is lacking.
Rachel Taylor
No, I am not giving way.
We cannot afford to sacrifice the future of vulnerable young people on the altar of ideology. The trials received ethical approval and were recommended by one of the country’s foremost experts in child health. It is vital that they go ahead so that we can build the evidence we need to support safe, effective healthcare for young trans people.
Sarah Pochin (Runcorn and Helsby) (Reform)
It is a pleasure to serve under your chairmanship, Mr Mundell. I am concerned about the motivation behind the trials. I went to the initial meeting hosted by the Secretary of State for Health and Social Care, where we met the panel of so-called experts, and came away with the impression that this was nothing more than a spine-chilling, state-sponsored experiment on our children, with no regard to safeguarding them.
In the main Chamber, I asked the Secretary of State to introduce statutory legislation to access the extensive data that is already available from Tavistock; yet again, I was not provided with an answer as to why he could not do that. I am concerned about the profile of the children being used. I asked at the initial meeting for a lower age limit, but I was refused. I asked whether the Government would consider not including vulnerable children, children in care, or children on drugs for anxiety or attention deficit hyperactivity disorder, but I was refused.
We have all talked about the long-term damage that seems to be ignored, but one of the most important things that has not really been covered is parental consent. We have heard that consent would be needed from only one parent, if a parent was present in a child’s life. This can cause irreversible damage to families. Last week, I hosted a roundtable about the indoctrination of our children in schools on this very subject, and I heard horrific stories from isolated parents whose children were lost to them because of brainwashing and the fantasy world they had been taught about at school.
Sarah Pochin
No, I will not.
Overall, we are creating a generation of lost, anxious young people who are confused about their identity, socially insecure and physically scarred.
Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)
Many of my constituents have spoken or written to me because they are anxious about the pausing of the trial. In the words of one of my constituents,
“to be a true ally you must support all trans people and their needs, not just adults”.
As a matter of principle, politicians should not meddle in medical decisions. If we accept that trans people exist, and if they are to be accepted, they need to have access to healthcare. We must listen to the experiences of trans young people and take action to protect their wellbeing by opposing restrictions on gender-affirming care for trans youth. All children need access to safe and timely healthcare in line with international best practice. The pausing of the trial is causing deep anxiety among many of my constituents.
International best practice, as laid out by the World Professional Association for Transgender Health, emphasises that decisions around hormones should be made on a case-by-case basis. Puberty-suppressing hormones have long been used by children who experience early-onset puberty, and significant international research and advisory bodies already support their use by trans adolescents as a safe, reversible means of alleviating gender dysphoria and improving psychological functioning and wellbeing. They are used in Canada, Belgium, the Netherlands and many other European countries.
I have four asks of the Minister. Will the Department engage legitimately with the widest range of advocacy groups, including groups such as TransActual, to understand the real human impact of the ban and ensure that future policy is informed by those who are directly affected? Will the Department reinstate the trial, while ensuring that those who do not wish to take part in research can continue to access appropriate healthcare? Will the Department revise its policy on the prescription of gender-affirming hormones to remove arbitrary age limits, in line with international best practice? Will the Department do more to bring down waiting lists, which are more than six years for a first appointment at a young person’s gender service?
Like many, I am concerned about the erasure of the trans community. Today, we need to heed the many arguments they are making. In the words of the trans community, “Nothing about us without us.”
Joy Morrissey (Beaconsfield) (Con)
It is a pleasure to serve under your chairmanship, Mr Mundell. The truth is that this clinical trial is flawed, and we should not be experimenting on children. We should be protecting children from many harms, such as alcohol and nicotine. We have things such as the age of consent for sexual intercourse and for marriage, to protect children. It is important to remember that a child’s prefrontal cortex does not fully develop until their mid-20s, so even their ability to grasp the long-term effects of any decision is limited.
Although a diagnosis is necessary for participation in the trial, it is not sufficient in determining whether medical intervention should take place. Cass directly makes this point:
“Although a diagnosis of gender dysphoria has been seen as necessary for initiating medical treatment, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them.”
The PATHWAYS trial uses the ICD-11—the 11th edition of the “International Classification of Diseases”—diagnosis of gender incongruence, which simply requires a desire to transition. The diagnosis is subjective, based on how the child feels. Can the long-term risk of medical intervention be justified by such a vague diagnosis? If the core diagnostic tool cannot predict outcomes with confidence, the trial would expose children to harm without a sound basis for believing that medical intervention is in their best interest.
The trial has been framed as a pathway to clarity, yet it is flawed before it has even begun. Proceeding is not neutrality but a decision with consequences. The trial would see harmful, long-term and irreversible damage to children, and should be cancelled.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
It is a pleasure to serve under your chairship, Mr Mundell. This is a Government who have shown that they care for the safety and welfare of children. They supported the Online Safety Act 2023 to counteract harmful digital content and removed, albeit eventually, the punitive two-child benefit cap to reduce poverty. The Government have committed to halving violence against women and girls, and have banned the pre-watershed advertising of junk food on TV.
However, the trial flies in the face of the Government’s explicit mission to protect children from harm. It would expose children to severe and irreversible harm when viable, less harmful alternatives are available. Despite that, the Government are happy to permit a clinical trial that would give puberty blockers to 226 children. Research has shown that over 95% of children who start out on puberty blockers continue on to cross-sex hormones, while other research has shown that between 60% and 98% of children with gender dysphoria will outgrow that feeling and go on to live a normal, natural, healthy life in their born body.
Iqbal Mohamed
I am going to continue, given the lack of time.
The numbers are important. They mean that the Government are choosing to prioritise the interests of between five and 90 of the 226 children involved in the clinical trial at the expense of deliberately harming between 135 and 203 children, who will eventually come to terms with their birth sex. I ask the Minister, will the Government now confirm that the current pause—which I welcome and am grateful to the Government for—will remain in place unless and until all safety, ethical and scientific concerns are fully and transparently resolved?
Jim Allister (North Antrim) (TUV)
As politicians, we all profess to be interested in protecting the vulnerable. If we are, surely one of the most vulnerable in our society are those going through adolescence. If anyone needs protecting, it is the adolescents.
Feelings and behaviours fluctuate during adolescence. I am sure that is the experience of all of us who are parents. More often than not, gender dysphoria resolves naturally during puberty. That is the reality. Yet for too long in our society, we have had this laissez-faire attitude to puberty blockers. Until 2024, there was no restraint whatsoever. What damage was done to those children who were given puberty blockers before the pause was imposed? Does no one care about the damage that was done to those children? Whether one likes the word or not, it is experimentation on children, and without a due process of consent. The trial is incapable of having a due process of consent.
When we endorse puberty blockers, we are turning a blind eye to the fact that they might have medical consequences on children’s bone density and on the development of their brains. Do we not care about that? If we care about that we need to cancel, not just pause, the programme.
Rebecca Smith (South West Devon) (Con)
It is a pleasure to serve under your chairmanship, Mr Mundell. I have strong concerns about artificially delaying puberty, but at the same time, I also want high quality, holistic support for young people who question their gender. The Cass review recommended psychological care as the first port of call for managing gender distress, yet the NHS trial shows a worrying bias towards medicalisation.
As a former corporate parent, I am alarmed that looked-after children were over-represented in referrals to the NHS Gender Identity Development Service. At the time, they made up just under 0.6% of the general population, but 5.9% of referrals. For children in care, the transition to adulthood is already a challenging time. They are often more vulnerable to the suggestion that puberty blockers could solve their problems. Despite that, children in care will still be allowed to enrol in any trial. Who will consent to their treatment? The state itself, represented by a corporate parenting board. That blurs the line between child safeguarding and institutional interest. The state is wearing two hats: legal guardian and trial sponsor.
Another serious issue is that the trial risks treating young lesbians as if they were born in the wrong body. Shortly before GIDS closed, 74% of teenagers referred to the clinic were girls. Most identified as lesbian or bisexual. Almost 70% said that they were attracted only to other girls, and 20% that they were attracted to both sexes. Yet in recent years, some young women have been encouraged to identify as trans rather than lesbian, and my view is that the trial will only reinforce that belief.
Lastly, at least 64 patients from the Tavistock clinic returned to living as their birth sex between 2010 and 2020. Detransitioners face huge social pressure to stay silent about their experiences, so I conclude by quoting the brave detransitioner Keira Bell, who said:
“The state assisted me in destroying my body during a period of distress. I was a tomboy who came out of an abusive, neglectful environment with a lack of positive role models, and I struggled with my sexuality. Stopping children’s brains and bodies from developing is not a solution, nor is it healthcare. It’s like giving Ozempic to an anorexic or alcohol to an alcoholic.”
We need a permanent end to the trial, not just a pause. Otherwise, even more young people will be left asking the same question: why did no one stop me?
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship, Mr Mundell. My constituents have a clear expectation that we proceed with caution when it comes to children’s healthcare, but there is a fundamental contradiction at the heart of this trial: the Government have already restricted these drugs due to what they described as an “unacceptable safety risk”, but those same drugs are now being made available through a clinical trial.
We must also look squarely at the evidence. There is no robust proof that puberty blockers deliver the benefits often claimed. In fact, the evidence suggests that, for many children, gender-related distress resolves naturally through puberty. The risks, however, are very real—to bone density, brain development and fertility. There are also serious ethical concerns. We are talking about administering powerful drugs to young children with no reliable way to predict who will benefit. This is not a targeted intervention; it is a gamble with children’s futures.
The design of the trial only adds to those concerns. It compares immediate treatment with delayed treatment, rather than examining long-term outcomes, and relies heavily on subjective measures rather than clinical evidence. It risks answering the wrong questions while exposing children to the well-rehearsed risks. Even more concerning is the sequencing—clearly, we should understand past outcomes first, and yet the trial presses ahead before we do.
The process itself also gives us pause. The trial received ethical approval and £10.7 million of public funding, and yet within months it has been paused following intervention by the regulator over concerns about safety and design. If a trial collapses under scrutiny before it begins, that tells us it is not ready and raises a serious question about why it was pushed forward in the first place.
I urge the Minister to explain why, given the known risks, the trial should proceed at all. When the evidence is weak, the risks are real and the patients are children, pressing ahead is not leadership, but recklessness.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve with you in the Chair, Mr Mundell. I thank my hon. Friend the Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for his opening speech, as well as the compassionate and balanced nature with which he introduced the debate.
Liberal Democrats have been arguing for many years that improved access to better specialist healthcare services for children and young people struggling with their gender identity is extremely important. These young people have been badly let down by low care standards, extremely long waiting lists and an unacceptably toxic public debate.
Up front, I want to be clear that my party’s position is that any treatment and the approval of a trial must always be led by clinical, expert evidence, and not by personal belief, however sincerely that belief is held. For these reasons, we welcomed and continue to welcome the call in the Cass review for a clinical trial.
Following the closure of the GIDS clinic, which was rated inadequate by the Care Quality Commission, it is clear that change is needed. Under the previous system, more than 5,000 young people were stuck on a waiting list for a single clinic, each waiting an average of three years for just their first appointment.
We have consistently campaigned for real action to tackle the shocking waiting times across the NHS, whether for cancer patients or mental health referrals, and the importance of cutting these wait times is equally pressing for gender identity services. We have been pressing for new services with more specialist clinicians who can provide children and young people with the appropriate and high-quality care that they need. Liberal Democrats welcome the NHS’s move to create new regional centres to offer this healthcare to the young people who need it. However, as far as I am aware, only two have opened so far—one in London and one in the north-west. We would like confirmation of when more centres will open.
Young people who are stuck on these waiting lists will still have to wait a very long time. At such a distressing point in their lives, the three-year average wait for someone to see a specialist must feel like an eternity—for them and their family. The Government must show true urgency in opening these services to prevent more children being further denied the care that they need.
It is right that treatment should first be based on talking therapies. That gives those receiving treatment and their families the time, space and clarity to make informed decisions about their future. However, young people must be able to start talking therapy when they need it as a matter of urgency, not after languishing for years on waiting lists.
Following the Cass review, the Secretary of State for Health and Social Care announced the launch of an NHS clinical trial to investigate the impact of puberty blockers, alongside an indefinite ban on puberty blockers as treatment for gender dysphoria or gender incongruence. That trial has now been paused. It is crucial that decisions on treatment are made by expert clinicians and based on the best possible evidence, but we need the NHS to build up that evidence base effectively and safely.
In that vein, we are supportive of the Secretary of State’s decision to pause the trial while the concerns raised by the MHRA are thoroughly assessed. I am calling on the Government to publish how the MHRA arrived at its decision to pause the trial, so there can be confidence that the decision was led by clinical evidence. As with any medical treatment, it is crucial that decisions are led by expert clinicians following the evidence on safety and effectiveness. Research should also take into account the personal experiences of those who have previously used these services.
This debate should not be an ideological one; it is a debate about the quality of healthcare we provide to people who are in desperate need. All trans and non-binary people should be able to access the high-quality healthcare they deserve. The Liberal Democrats call on the Government to make tackling the unacceptable waiting times a priority. To take the urgent action that is needed, the Government must commit to NHS trials and adult services for trans and non-binary people that will expand the timely provision of appropriate specialist healthcare.
The Government must ensure trans people can access high-quality healthcare in the manner we expect for all patients. Medical decisions should be made by patients and doctors together and informed by the best possible evidence. The Government must support research through effective and safe methods using international best practice to improve our evidence on the safety and efficacy of potential treatments.
One thing is certain: in a debate where the wellbeing of many young people is at risk, decisions should not be led by ideology. We cannot let a toxic public debate threaten the wellbeing of vulnerable individuals. The Government must prioritise clinical evidence and put the interests of patients at the heart of the decision-making process, as we do in all areas of healthcare.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship this afternoon, Mr Mundell. I must first declare an interest as an NHS consultant paediatrician. I thank James Esses for the petition and the thousands of people who have signed it, including many of my constituents, for enabling today’s important debate. I also thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for leading the debate so well.
The petition asks the Government to cancel the puberty blockers trial and to safeguard vulnerable children. Perhaps it is worth considering whether clinical trials in children are a good idea in principle. The answer, of course, is yes. Children are not just small adults; they have different illnesses from adults, they present with different symptoms and respond differently to medication, and they require different doses at different ages. Properly designed clinical trials ensure that children’s medicines are safe and effective for them.
However, today we are discussing one particular trial: a proposal to give puberty blockers—gonadotrophin-releasing hormone analogues—to children, specifically for gender incongruence. Perhaps at this point it is worth considering why doctors and others prescribe medication; we do it to treat or cure disease, to treat or lessen symptoms and to aid in diagnosis.
What does this trial seek to do? On the face of it, it seeks to establish whether puberty blockers are a safe and effective treatment for gender incongruence. ICD-11 defines gender incongruence as:
“A marked and persistent incongruence between an individual’s experienced gender and the assigned sex”.
To suggest persistent incongruence with gender stereotypes is wrong could undo years or decades of rolling back gender norms. If it is not causing the person any distress, why would we want to treat it, especially when we know that most children, even those with gender dysphoria who do have distress, will get better without any puberty blockers?
Currently, there is no way to identify which children will persist with a trans identity as adults and which will not. The much-delayed data linkage study could help with that. It could enable more targeted interventions and may also provide information on the long-term outcomes for people who have taken puberty blockers in the past. However, the Government insist on pushing on with the puberty blockers trial anyway, before the data linkage study is complete. Why? In written parliamentary questions, Ministers have said that they expect the data linkage study to be finished by April 2027, so what is the rush?
What is the point of the treatment? It has been suggested that it helps transgender adults pass more easily as the opposite sex and potentially avoids surgical operations in adulthood, but how on earth can it be ethically, morally or medically right to treat a large group of children with risky medication to give cosmetic benefits to a much smaller number of adults?
There are also cosmetic risks to the treatment. The penis grows very little between the ages of three and 10 years. The use of puberty blockers restricts growth, meaning those with a persistent trans identity may struggle with having enough tissue for a vaginoplasty surgery, and those who do not have a persistent trans identity may struggle with normal intimate relationships.
As mentioned earlier, the Secretary of State has said that he has confidence in this trial. Now it has been paused, we can presume that he is not quite so sure. But can we, patients and the general public have confidence in this trial? There are certainly causes for concern. In fact, there are so many that I cannot speak of them all today, but I would like to speak of a few in the time I have available.
First, on the selection of patients, we have had a dramatic change in the demographic. There has always been a small number of children uncomfortable in their own bodies, but there has been a rapid increase, which is not fully understood, particularly among girls. Many of them are in care, some have autism spectrum disorders and many are same-sex attracted. We need to understand this before prescribing irreversible treatments.
We do prescribe—and I have prescribed—drugs that are high risk or potentially harmful to children. An easy example would be chemotherapy, but that is being given to save a child’s life; it is not used to pause a perfectly normal physiological process in a physically healthy child. The risks of these treatments have been listed today, but I will list just a few: fertility problems; idiopathic intracranial hypertension; demineralisation of bone density, leading to fractures; in some studies, an increase in depression and anxiety; and the long-term loss of sexual function in some patients. We have discussed consent. How do you get consent from a parent of a child—a boy or a girl at Tanner stage 2—about long-term sexual function and fertility?
On the design of the trial, it is said to be a randomised controlled trial. Well, it is, but that is a bit of a fudge, because instead of an actual randomised controlled trial where some patients receive puberty blockers and some do not, it has given some now and some slightly later, with a very short difference in the timing. The comparison group that does not have any puberty blockers at all is taken from a slightly different population, which introduces an unnecessary bias. The trial’s organisers have said that they are doing that because they think the children would get the drugs from elsewhere or from abroad, but that is not how we do medical trials. When I have raised this issue, Ministers have responded that it cannot be blinded, but blinding and randomisation are not the same thing. The trial is also far too short to provide data on long-term outcomes.
On the process of the trial, the hon. Member for Gower (Tonia Antoniazzi) raised questions about what children are being asked as part of this trial. Why is the trial proposing to ask children about their sexual experiences? Why is this helpful to the trial?
Dr Johnson
I will not because I am aware of the time.
The Commission on Human Medicines’ report heard that, because trials of puberty blockers have been blocked, some clinicians are trying to use other drugs to limit puberty, such as spironolactone and cyproterone acetate. There have been reports that the number of prescriptions for spironolactone in 10 to 17-year-olds is going up. Could the Minister confirm whether that is the case and what the Government are doing to look into it?
The MHRA was happy with the process; now it is not. What has changed? None of the issues raised seem to have not been raised before. The Government are being secretive about it: in February, Ministers brought forward a written statement referencing an MHRA letter in November, but the Minister is refusing to publish it. I have asked Ministers whether they talked to MHRA officials about the trial before February 2026, and they will not answer the question. There was a letter between the MHRA and KCL; I asked when it was received, when the Department became aware of it and when Ministers became aware of its contents. They will not tell me.
What about the people controlling the trial? As has also been mentioned during this debate, Professor Jacob George has been recused from further involvement. According to the MHRA’s statement, this is “a precaution”, because of social media posts made before his involvement. Why have those who have made the opposite type of comment not been recused too? This will inevitably make members of the public think there is bias involved.
There is an oversight board. What has the Minister done to ensure that the clinicians and scientists on that board are impartial, and that it is balanced between both perspectives? The Tavistock trial was supposed to report to the MHRA, but it did not, seemingly with no consequence. There will be lay members on the board with lived experience; will one of those be a detransitioner, or will they all be people on one side? That would increase the perception of bias in this trial.
In summary, this is a trial of risky medication on healthy children, most of whose features of gender incongruence will resolve in time, given normal puberty. What is particularly worrying is that, at the end of this treatment, the trial has so many flaws that it is bound to be disputed, whatever the result.
To give this treatment, the lead clinician will need to think that there is a reasonable prospect of a patient benefiting from puberty blockers. Given all that has been said, how can any clinician believe that that is the case? I hope we can all agree that we do not need a clinical trial to know that helping a child to be at peace with themselves and their body is infinitely preferable to a lifetime of harmful medical intervention.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Mr Mundell. I thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) of the Petitions Committee for the way in which he introduced the debate. In his usual style, he made sure that he had talked to a range of people and experts to inform this debate.
I want to start by recognising that the thousands of signatures on the petition show the real strength of feeling on this issue. I thank everyone for taking part. I am acutely conscious of the young people, their families and people in the Public Gallery today and outside who are paying close attention to this debate and what is being said. I hope to address all the issues that have been raised—I have kept notes and listened carefully—as I know people want to get this on the record. I will say now that I will not take any interventions; I will just set out where I think we are. If I do not answer particular questions, I will get back to people.
I want to assure colleagues and the signatories to the petition, particularly young people and their families, and those who are waiting for, have had or have been concerned about gender services, that this Government will always be led by science and not ideology. We are proceeding carefully in line with clinical advice and we will always put the interests of vulnerable children first, because their health and wellbeing are not negotiable. That is our position.
Let me start, briefly, with some of the context. In 2020, NHS England commissioned Dr Hilary Cass to undertake a review of NHS children and young people’s gender services. Like others, I am sure, I have taken time over the weekend to re-read her interim report and her full report; I commend both to people with an interest in the subject.
Dr Cass is one of the most pre-eminent clinicians in her field, and her review is the most definitive assessment of its kind. It laid bare the inadequacy of the now decommissioned Tavistock Gender Identity Development Service. The interim review and final report made it clear that we needed better data and a stronger evidence base to design the right services for children and young people presenting with questions around gender dysphoria or gender incongruence, given the poor evidence base for services and treatment against rapidly increasing and, as we have heard, changing demand.
Dr Cass recommended a new model of care based on holistic assessment and psychosocial support, with further research into puberty blockers, specifically where they are not provided in isolation. The Labour party in opposition welcomed her report and accepted her findings, and we continue to do so in government. Many of the recommendations in her report are being implemented, including opening new NHS children and young people’s gender services while building the evidence base in parallel through a national research programme.
As the hon. Member for Caithness, Sutherland and Easter Ross outlined, the rationale for the clinical trial is part of the recommendations to gather robust, contemporary and comparative evidence on the relative benefits and harms of puberty-suppressing treatments in children. That is how we can decide whether puberty suppression can be an option in NHS gender care in future.
The PATHWAYS trial has undergone thorough scientific, clinical, ethical and regulatory safeguards. Following academic peer review, it was supported by the independent National Institute for Health and Care Research funding committee. It was endorsed by a multidisciplinary and multi-agency national research oversight board, and was then subject to formal regulatory approvals via the Medicines and Healthcare products Regulatory Agency; the Health Research Authority, including a review by an independent research ethics committee; and finally, the Commission on Human Medicines, which made considered recommendations to the study team that were adopted in full.
As with all complex clinical trials, the top priority of each of those organisations is the safety of the trial participants. The MHRA in particular is maintaining a high level of scrutiny and taking a cautious and measured approach. Where appropriate, after initial approvals have been granted, there can be ongoing dialogue between the sponsors of clinical trials and the MHRA. That is part of the process—I want to stress that point.
The MHRA has raised concerns relating to some elements of the trial design, and those questions obviously need answering. Rigorous and constructive discussions are accordingly under way between the MHRA and the trial sponsor.
Karin Smyth
I am not going to give way; I am going to get through these points.
The safety and wellbeing of children and young people have always been the driving consideration in every decision we have made regarding this trial, and always will be. That is why the trial sponsor has paused recruiting until these issues can be resolved. There have been calls today to cancel the pause, to continue with the pause and to cancel the trial, but the position is that the trial is paused until the issues are resolved, because we will not compromise an inch on safety. The trial will proceed only if the regulatory approval is reconfirmed. We will provide an update on the outcome of those discussions as soon as we can.
David Mundell (in the Chair)
Order. I think the Minister has made it clear that she is not taking interventions.
Karin Smyth
Thank you, Mr Mundell.
Dr Cass also recommended that we take forward the data linkage study as part of the wider national research programme. The linkage study is not a clinical trial, and as such it will not in and of itself provide the type of evidence that can demonstrate cause and effect for any particular treatment. It is observational in nature, linking and analysing existing routinely collected data for adults who were referred as children to the Tavistock before it was decommissioned. The study requires no active patient participation; instead, it relies on an analysis of digital information held within health records and other databases.
Data linkage studies have faced difficulties that are a matter of public record, but since then there have been great efforts to improve the collaboration of the adult clinics and other organisations. Important final steps are currently being taken to enable the study to begin. We expect the study analysis to then take around one year to complete. On 26 February, we laid an order before the House to make it lawful for people and organisations to share or process data that could be subject to protections under the Gender Recognition Act 2004 where it is for the purpose of the study. That order came into force last week.
The PATHWAYS clinical trial is a key step that we are taking to build an evidence base to prove whether puberty blockers are safe and effective in treating gender incongruence and gender dysphoria. As we speak, the new clinical model is collecting a consistent and comprehensive core clinical dataset while we develop a supporting national registry.
In the meantime, hormone medications are not being prescribed. NHS England now prevents the routine use of puberty-suppressing hormones in the NHS children and young people’s gender services, and the Government have indefinitely extended restrictions that prevent them being supplied privately. Last year, NHS England issued guidance to GPs that strongly advised against supporting prescribing agreements with unregulated providers, who do not always have children’s best interests at heart. That includes online overseas providers who are known to have supplied puberty suppressants and cross-sex hormones to children in the past without any proper safeguarding. NHS England issued that warning because of the serious safety risks that unregulated providers continue to pose to children in this country. In some cases, we are talking about puberty blockers being prescribed following a questionnaire or a brief Zoom call.
I will come on to other issues around future services, although I think I have answered most questions. All clinical trials have appropriate insurance to cope with the issues outlined by the right hon. Member for Tonbridge (Tom Tugendhat). The trial sponsor is King’s College, so my understanding is that the issue raised by the hon. Member for South West Devon (Rebecca Smith) with regard to the state having conflicts does not arise. The hon. Member for Bristol Central (Carla Denyer) cited regulations that were mainly from overseas, but the UK has its own regulatory independent network: the MHRA, which we work with. The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), who I respect in her role as a paediatrician, asked a number of questions about timing and process. She will be aware that there is a judicial review, but I will make sure that she gets an answer on some of those issues.
I want to update the House that since April 2024, NHS England has opened three new services in the north-west, London and the south-west. I can confirm that a fourth service will become operational at Cambridge University hospitals NHS foundation trust very shortly. Those are important services for young people and their families who are awaiting treatment and who want to understand when and how they will receive care.
Karin Smyth
I am not going to give way.
Those services operate under a fundamentally different clinical model from the Tavistock clinic. Children and young people will get comprehensive, tailored assessment and support from multidisciplinary teams made up of experts in paediatrics, neurodiversity and mental health.
Under this Government, mental health spending has gone up in real terms, and we are putting specialist mental health teams in every school to support those young people. However, I know there are still families who are desperately worried by some of the debate and are concerned about the future, often to the detriment of their own mental health. They want clarity on the options open to them. I want to end by assuring hon. Members that we will update the House on all these issues as soon as possible. I urge all hon. Members to continue to engage with the evidence that best supports our young people. That is what we, as a Government, continue to be focused on.
Jamie Stone
I trust that this evening’s debate has given a flavour of what life on the Petitions Committee is like—it brings its challenges and informative debate. I want to thank all those who have spoken; they have done so with sincerity. Opinions differ, but there is no doubt that hon. Members feel very strongly about the issue. I also thank those in the Public Gallery. At the end of the day, the work of the Petitions Committee is about ensuring that an issue is properly aired in this place and that petitioners are heard. I believe that has been done tonight, and I thank everyone.
Question put and agreed to.
Resolved,
That this House has considered e-petition 751839 relating to the clinical trial into puberty blockers.