NHS Ends Cross-Sex Hormone Prescriptions for Under-18s Following Evidence Review
The National Health Service (NHS) has announced it will stop prescribing powerful cross-sex hormones to trans-identifying children under the age of 18. This decision comes after a comprehensive review found insufficient evidence to support the continued use of such treatments for this age group. The move marks a significant shift in healthcare policy, aligning with recommendations from the recent Cass Review, which urged extreme caution in providing hormonal interventions to minors.
Background and Current Policy
For the past 16 years, oestrogen and testosterone have been available on the NHS for 16 and 17-year-olds diagnosed with gender dysphoria, provided they met specific clinical criteria. However, from Monday, new referrals for these treatments will be paused. This pause coincides with the launch of a short public consultation to determine whether cross-sex hormones should be removed as a routine procedure for under-18s. Medical experts are reportedly firmly behind this ban for new patients, citing concerns over the lack of robust evidence regarding both benefits and harms.
Health Risks and Evidence Gaps
An internal NHS document, recently disclosed, highlights serious health risks associated with injecting oestrogen and testosterone in young people. These risks include blood clots, breast cancer, heart disease, stroke, and impaired sexual function. Additionally, the long-term effects of these powerful hormones on teenage brain development remain unknown, raising further safety alarms. The 2024 Cass Review, led by Baroness Hilary Cass, recommended extreme caution and a clear clinical rationale for providing hormones before age 18, rather than waiting until adulthood.
NHS England's subsequent review concluded that the evidence is too weak to ascertain whether such treatment is beneficial or harmful for children with gender dysphoria. This finding has prompted the health body to reconsider its approach, focusing on patient safety and evidence-based care. It is understood that the NHS continues to examine evidence for masculinising and feminising hormones for adults, indicating a more nuanced stance across age groups.
Immediate Actions and Consultation Process
NHS England has clarified that 16 and 17-year-old patients currently receiving cross-sex hormones can continue their treatment, but each case must be reviewed individually by clinicians. The upcoming consultation on plans to remove the treatment will last 90 days, during which the NHS expects to review thousands of responses from the public and stakeholders. This process aims to gather diverse perspectives before finalising any policy changes.
Professor James Palmer, national medical director for specialised services at NHS England, stated: 'Following the Cass Review, NHS England commissioned an in-depth review of all available clinical evidence for using oestrogen or testosterone to treat gender incongruence and dysphoria. This review has established that the available evidence does not support the continued use of masculinising or feminising hormones for young people under 18. We are now launching a public consultation on a revised policy which would see the NHS remove this treatment as a routine intervention.'
Broader Context and Campaigner Reactions
This decision follows a recent pause in a clinical trial investigating the impacts of puberty blockers on children as young as 10, due to concerns over unquantified long-term biological harms. In 2024, the use of drugs to delay or prevent puberty was banned for under-18s, reflecting a growing trend towards caution in paediatric gender care. Over the last decade, the number of children identifying as trans has increased significantly, making this policy shift particularly impactful.
Any ban on cross-sex hormones is likely to be viewed as a victory for campaigners who argue that the harms caused by these drugs outweigh any potential benefits. Dr Alice Hodkinson, a GP from the campaign group Biology in Medicine, commented: 'This has been a long time coming given the evidence of the harms these hormones cause.'
Physical Effects and Side Effects
The physical changes induced by cross-sex hormones can be profound and, in some cases, permanent. Boys taking oestrogen often experience smoother skin, thicker hair, softening facial features, and a redistribution of body fat. Girls on testosterone may develop facial hair, deeper voices, and some face male-pattern baldness. For girls and young women, long-term use of testosterone can lead to permanent changes, such as incontinence and vaginal atrophy, which involves thinning of the vaginal walls, resulting in bleeding and discomfort.
Other serious side effects associated with these hormones include dyslipidaemia, polycythaemia, hypercalcaemia, and elevated liver enzymes. These risks underscore the importance of careful clinical evaluation and the need for robust evidence before prescribing such treatments to minors.
Ongoing Support and Future Directions
Despite the pause on new hormone prescriptions, the NHS continues to offer specialist support for under-18s managing gender incongruence. This includes mental health support and referrals to specialist children and young people's gender services where appropriate. The health service emphasises a patient-centred approach, ensuring that those currently receiving treatments are not abruptly cut off but are reviewed on a case-by-case basis.
As the consultation progresses, the NHS will assess whether any key evidence needs further review before publishing a final policy. This cautious and evidence-driven approach aims to balance patient safety with the need for effective care, reflecting broader shifts in medical practice regarding paediatric gender services.
