The NHS will create six new clinics and begin a clinical trial of puberty blockers next year in a review of children’s gender services.
It comes after prescriptions of the controversial drugs for new patients were banned in May due to safety concerns.
Health bosses have outlined plans to reform the controversial service for children and teenagers who think they are transgender.
They promised to “adopt a more cautious approach.”
But they still plan to test puberty blockers on a “substantial” number of young people – a measure considered by activists to be “ethically unjustifiable”.
Naomi Cunningham, chair of human rights charity Sex Matters, said: “We understand why the NHS and Dr Hilary Cass believe clinical trials of puberty blockers are necessary, but we urge them to reconsider.
“Such trials are ethically unjustifiable given the known risks of permanent harm to fertility, sexual functioning and general health.”
Leading doctors say not enough is known about the long-term impacts of puberty blockers — but many who use them switch to cross-sex hormones that have better-known consequences, such as potential loss of fertility.
The report appears on Wednesday, setting out the NHS’s plans for the future of gender care, addressing recommendations in a hard-hitting review by pediatric doctor Hilary Cass in April.
A network of regional clinics will be created by 2026.
They will replace the flagship Tavistock after it was closed for being too medicalised.
An official review of NHS gender identity services by Dr Hilary Cass last year concluded that England’s only clinic was too biased and too quick to get children on potent, life-changing medicines.
The new clinics will focus on overall mental health as well as gender.
Under new, stricter criteria, children must be referred by a mental health specialist or pediatrician, rather than just a family doctor.
NHS England directors Professor James Palmer and John Stewart said: “The primary clinical approach will be psychosocial and psychological rather than medical.”
The health service will also devise a new service for people who wish to “detransition” back to their original sex.
Dr Cass said: “I am pleased that NHS England is planning to fully implement the recommendations from my review.
“The next important step will be the most challenging – turning it into reality.”
Risk of puberty blockers ‘unknown’
Puberty blockers stop the physical changes of puberty, such as the development of breasts or facial hair, while those who take them consider their gender identity without additional distress.
An emergency ban on prescribing puberty-blocking drugs to new patients due to safety fears was due to expire at the end of September.
But Health Secretary Wes Streeting will prolong the restriction with a view to making it permanent, despite the Labor backlash.
The drugs will only be available as part of an NHS-led clinical trial, which is expected to begin early next year.
Children’s healthcare should always be guided by evidence.
Wes Street
Mr Streeting said last month: “We do not yet know the risks of disrupting puberty hormones at this critical stage of life. This is the basis on which I am making decisions.
“I am proceeding with caution in this area because the safety of children must come first.”
Dr Hilary Cass, in her landmark review, said there was “remarkably weak” evidence about such treatments, including that delaying puberty improved well-being.
However, a “substantial” number of participants are expected to be involved in the puberty blocker trial she recommends.
Ms Cunningham said: “This update suggests that children and young people with gender difficulties will finally achieve the professional and ethical standards expected in all other areas of healthcare.
“The worrying practice of treating children with dangerous, evidence-free treatments appears to be over.
“The commitment to collecting comprehensive and standardized data marks a radical improvement on the opaque and substandard practices of the past.”
Trans rights advocates lost their bid to overturn the ban after a High Court judge said the measure was legal.
What are puberty blockers?
The use of puberty blockers has been discussed internationally.
The goal of puberty blockers is to “buy more time” for young people with gender dysphoria who may be considering becoming transgender.
GnRH hormones (referred to as puberty blockers in treating young people) have undergone extensive testing for use in early-onset disease.
puberty (very premature puberty) and have met strict safety requirements to be approved for this condition.
“This is because puberty blockers are suppressing hormone levels that are abnormally high for the child’s age,” said the NHS gender identity services report, authored by Dr Hilary Cass, last year.
“This is different from stopping the normal surge in hormones that occurs during puberty.
“Puberty hormones are necessary for psychological, psychosexual and brain development, and there is not yet enough information about the risks of stopping the influence of puberty hormones at this critical stage of life.”
GnRH hormones are used off-label for gender dysphoria, meaning they can be prescribed for it, but manufacturers have not gone through the formal license application process.
Dr Cass concluded there was “remarkably weak” evidence on treatments such as puberty blockers, but said children taking them will be monitored in NHS trials “where there is clinical agreement that the individual can benefit from taking them”. .
It said: “The review found that not enough is known about the long-term impacts of puberty blockers for gender-nonconforming children and young people to know whether they are safe or not, nor which children may benefit from their use.”
Delay in gender care
A huge backlog is currently being addressed by the only two newly created clinics in London and Liverpool.
The next new clinic is expected to open in Bristol later this year, followed by East Anglia.
Figures show that 5,769 under-18s were on waiting lists for NHS gender clinics at the end of May.
The youngest was less than five years old.
The delay means the average wait for a first appointment is 100 days.
NHS England will also review adult gender services as part of the revamp.
The government estimates there are between 200,000 and 500,000 transgender people in the UK.
Professor Sir Stephen Powis, NHS medical director, said: “These plans set out in detail how we will establish a different, safer model of care for children and young people.”
Health Secretary Wes Streeting added: “Children’s healthcare should always be guided by evidence.
“I want trans people in our country to feel safe, accepted and able to live with freedom and dignity.”
Professor Palmer, NHS England’s medical director for specialist commissioning, said: “The rollout of new specialist centers across all regions of England will be key to improving and expanding NHS gender services for children and young people.
“There is still a lot of work to do, but we are already making progress.
“Clearly our adult services also need focus and our review needs to address bad experiences but also learn from good experiences of care.”
What are the plans set out by the NHS for gender clinics?
– Up to eight new gender clinics are expected to open by 2026, covering the seven NHS regions in England.
– Each will have a designated pediatrician or psychiatrist with overall clinical responsibility for patient safety within the service.
– Clinical trials into the potential benefits and harms of puberty blockers will begin early next year, subject to academic approval.
– One previously announced analysis in adult gender services will begin in the coming weeks and is expected to be completed within a few months.
– New patients – not including those currently on the waiting list – will first need to be referred by their GP to Children and Young People’s (CYP) mental health services or paediatrics and will then be referred to a gender clinic.
– The aim is to eventually have a target of 18 weeks from consultation with a GP to referral to a gender clinic.
– Clinical trials into the potential benefits and harms of puberty blockers will begin early next year, subject to academic approval.
– One previously announced analysis in adult gender services will begin in the coming weeks and is expected to be completed within a few months.
– The NHSE said there will be a new clinical policy on the use of gender-affirming hormones – testosterone and estrogen – sometime between August 2025 and July 2026.
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