PATHWAYS Study: Puberty Suppression

Debate between Baroness Barker and Baroness Cash

Wednesday 24th June 2026 Lords Chamber

[Baroness Cash (Con)]

My Lords, the proposed PATHWAYS puberty blockers trial for 226 children as young as 11 risks becoming a medical scandal unfolding in real time. Gender-incongruent children include some of the most vulnerable children in society, with disproportionate numbers of that cohort having autism or mental disorders or being children in care. There is an unknown and inestimable correlation with social media that is yet to be uncovered. The challenges for these children and their families, and the difficulties they face, are not to be underestimated, but gender-incongruent and gender non-conforming behaviour is also often characteristic of children who grow up simply to be gay. Surely the Minister does not truly agree with a trial which will place children who would otherwise simply grow up to be healthy gay and lesbian adults on a pathway that may impair their fertility and their sexual development.

The data shows, and the Cass review accepted, that a very large majority of children presenting with gender incongruence will resolve without medical intervention. I assume that the Minister accepts this. That being the case, this trial will be subjecting many physically healthy young children to completely unnecessary medical risks. Let us be clear. The medical risks inherent in taking puberty blockers at such a young age are truly life-altering. They include possible lifelong consequences for brain development, including IQ, bone health, fertility and adult sexual function.

Shockingly, 2,000 children have already been treated with puberty blockers in this country. They were treated at the now closed Tavistock clinic. More scandalously, they went on to adult clinics and we are entirely in the dark about how they are today. The data linkage study to analyse the information about those children has not yet been done. A shocking six out of seven of those adult clinics they went on to have not released the data, despite Parliament legislating for it.

So, what are Ministers doing to require adult gender clinics receiving public money to provide that data? What is the current status of that process? And, when the Government still do not know what happened to the 2,000 children already treated, why and on what grounds are they exposing another cohort of healthy children to medical harm before that question has been answered? It is no good to point to the fact that the noble Baroness, Lady Cass, recommended a trial. Government cannot and should not outsource such decisions and it will be no defence to the litigation coming down the line, as it already is in the US, that the noble Baroness told the Government to do it.

In any case, there are major issues about consent, particularly given the nature of the trial as currently put together. I am deeply troubled by how the informed consent of children can possibly be obtained when they are too young to appreciate what they stand to lose: as young as 11. It is important to set out what they stand to lose. Commencing puberty blockers at an early age may make fertility preservation for these children impossible. Studies show that puberty blockers may affect brain development, including their IQ and memory function, as well as their bone density and organ development. There is currently no long-term data sufficient to quantify those risks. Then, of course, there is a risk that normal adult sexual function—let us call a spade a spade; we are talking about the ability to ever experience sexual pleasure—does not develop when puberty is interrupted at such an early stage.

In these circumstances, it is inexplicable that the Government have rejected the MHRA’s recommendation that children under 14 should not be included in any trial. This trial is for children from the age of 11. How does the Minister justify that children under 14 are to be included in the trial? And how does she argue that any child can give informed consent to such risks? Please can the Minister confirm that these risks and all others will be expressly communicated to the children and families concerned? If this trial goes ahead, it is inevitable that irreversible, unnecessary harm will be done to at least some of these children.

Finally, could the Minister confirm that the Government have carried out an assessment of the future liability coming down the tracks to the NHS, and therefore to the taxpayer? Have the ongoing treatment costs, the treatment-related harms and the future litigation risks been assessed? What is the estimated cost to the NHS and the taxpayer of those, and how will that be funded?

Polling in December 2025 showed that almost 70% of the public was against giving puberty blockers to children and 63% wanted this trial to be stopped. As the Government consider a fresh start in other ways, I beg the Minister to think again and stop this trial.

[Baroness Barker (LD)]

My Lords, this Statement takes place in the context of a relentless campaign against trans people that started among right-wing politicians in the United States of America but has been seized on here: the bandwagon has been jumped upon by politicians in this country. That is the context.

We on these Benches have a policy towards trans people that is based on our belief that trans people not only exist but have a right to exist, and they have a right to exist with the same dignity as the rest of us—and part of that is having access to appropriate healthcare. I ask the Government, as, I hope, they seek to defend this test against the kind of political campaigning that we have just heard, to bear in mind that the use of puberty inhibitors is not the harmful intervention that has just been characterised. It is a safe medical intervention that has been used for different conditions since the 1980s, and there is already a lot of data on it. However, as the noble Baroness, Lady Cass, identified in her review, an absence or at least an insufficiency of data about the use of inhibitors in relation to people who have gender dysphoria. That is why this trial, consisting of 226 people, in a highly regulated period of group activity, has been allowed to go ahead in order to generate the data that she says we need.

It is true that last week the independent MHRA approved an update to the basis on which the trial is going to happen, in order to make sure that the safeguards were increased. It is not unusual for that to happen in a medical trial. It is not unusual for trials to stop and take note of what has happened initially and then for revisions to be made to the basis on which they are run.

We on these Benches believe very strongly that medical treatment should be based on science and evidence, not on belief and ideology. This trial has been under sustained attack from political organisations such as Sex Matters which do not believe that trans people should exist or should exist with the dignities that they currently do. This trial is currently the only legal route for anybody to access puberty blockers, so in the interests not just of accurate scientific evidence but of children who need this treatment, will the Minister ensure that the people who have undertaken this research are protected from the relentless political attacks against trans people?