Question to the Department of Health and Social Care:

To ask His Majesty's Government, in light of the finding of the Levy Review that adult Gender Dysphoria Clinics collect no systematic data on benefits, harms, regret, or detransition, what assessment they have made of the treatment offered by those clinics.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The information requested in HL3448, HL3450, and HL3451 is not centrally held by the Department.

With regard to HL3449, patients can complain directly to the provider that treated them or to NHS England, as the commissioner of adult gender services. They can also raise concerns with the Care Quality Commission or Healthwatch. If they remain unhappy after completing the National Health Service complaints process, they can ask the Parliamentary and Health Service Ombudsman to investigate. Information regarding the number of complaints received is not held centrally.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps NHS England takes to establish the clinical status and outcomes of patients who cease to attend an adult Gender Dysphoria Clinic before treatment is recorded as complete.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The information requested in HL3448, HL3450, and HL3451 is not centrally held by the Department.

With regard to HL3449, patients can complain directly to the provider that treated them or to NHS England, as the commissioner of adult gender services. They can also raise concerns with the Care Quality Commission or Healthwatch. If they remain unhappy after completing the National Health Service complaints process, they can ask the Parliamentary and Health Service Ombudsman to investigate. Information regarding the number of complaints received is not held centrally.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what complaint mechanisms exist for patients who consider themselves harmed by treatment received at an adult Gender Dysphoria Clinic to raise concerns; and whether any such complaints have been received in the last three years.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The information requested in HL3448, HL3450, and HL3451 is not centrally held by the Department.

With regard to HL3449, patients can complain directly to the provider that treated them or to NHS England, as the commissioner of adult gender services. They can also raise concerns with the Care Quality Commission or Healthwatch. If they remain unhappy after completing the National Health Service complaints process, they can ask the Parliamentary and Health Service Ombudsman to investigate. Information regarding the number of complaints received is not held centrally.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what estimate they have made of the number of patients who have discontinued treatment, expressed regret, or detransitioned following care at an adult Gender Dysphoria Clinic in the NHS.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The information requested in HL3448, HL3450, and HL3451 is not centrally held by the Department.

With regard to HL3449, patients can complain directly to the provider that treated them or to NHS England, as the commissioner of adult gender services. They can also raise concerns with the Care Quality Commission or Healthwatch. If they remain unhappy after completing the National Health Service complaints process, they can ask the Parliamentary and Health Service Ombudsman to investigate. Information regarding the number of complaints received is not held centrally.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the reliance of the NHS adult gender service specification on the World Professional Association for Transgender Health's standards of care; and whether they consider that reliance remains appropriate.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England has committed to implement the Cass Review's recommendation for a dedicated detransition service, and will hold a public consultation on a proposed service specification in the autumn of 2027, for adoption in 2027/28.

The NHS service specification for adult gender services was published in 2019, following an extensive public consultation in 2017, respondents to which included United Kingdom professional medical bodies and health regulators. A similar process of public consultation on a proposed new service specification will be held later in 2027/28 building on the findings and recommendations of the report of the National Operational and Delivery Review of Adult Gender Services published in December 2025.

The arrangements for referral for surgery, and the funding of that surgery, are consistent with those for other specialised services. Upon a confirmed diagnosis of gender dysphoria, an NHS-commissioned specialist multi-disciplinary Adult Gender Service may make a referral to a specialist surgical team who will assess the patient's suitability for surgery and communicate that decision to the Adult Gender Service. Processes are in place to ensure that patients are fully informed of potential risks and benefits in order to give informed consent both to the initial referral for surgery and to the surgical intervention.

The following table shows the number of NHS referrals for chest reconstructive surgery which were made in each of the last three years, broken down by age group. Please note that the number of referrals that were assessed as suitable for surgery will be lower and that these numbers include patients from England, Northern Ireland, Wales, and Scotland:

The following table shows the number of NHS referrals for genital surgery which were made in each of the last three years, broken down by age group:

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether providers of gender surgery receive funding from a national budget separate from standard commissioning arrangements; and what assessment they have made of any financial incentives this creates.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England has committed to implement the Cass Review's recommendation for a dedicated detransition service, and will hold a public consultation on a proposed service specification in the autumn of 2027, for adoption in 2027/28.

The NHS service specification for adult gender services was published in 2019, following an extensive public consultation in 2017, respondents to which included United Kingdom professional medical bodies and health regulators. A similar process of public consultation on a proposed new service specification will be held later in 2027/28 building on the findings and recommendations of the report of the National Operational and Delivery Review of Adult Gender Services published in December 2025.

The arrangements for referral for surgery, and the funding of that surgery, are consistent with those for other specialised services. Upon a confirmed diagnosis of gender dysphoria, an NHS-commissioned specialist multi-disciplinary Adult Gender Service may make a referral to a specialist surgical team who will assess the patient's suitability for surgery and communicate that decision to the Adult Gender Service. Processes are in place to ensure that patients are fully informed of potential risks and benefits in order to give informed consent both to the initial referral for surgery and to the surgical intervention.

The following table shows the number of NHS referrals for chest reconstructive surgery which were made in each of the last three years, broken down by age group. Please note that the number of referrals that were assessed as suitable for surgery will be lower and that these numbers include patients from England, Northern Ireland, Wales, and Scotland:

The following table shows the number of NHS referrals for genital surgery which were made in each of the last three years, broken down by age group:

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the practice of referrals for irreversible surgery being made by non-surgical clinicians in gender services; and in what other areas of NHS medicine this practice occurs.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England has committed to implement the Cass Review's recommendation for a dedicated detransition service, and will hold a public consultation on a proposed service specification in the autumn of 2027, for adoption in 2027/28.

The NHS service specification for adult gender services was published in 2019, following an extensive public consultation in 2017, respondents to which included United Kingdom professional medical bodies and health regulators. A similar process of public consultation on a proposed new service specification will be held later in 2027/28 building on the findings and recommendations of the report of the National Operational and Delivery Review of Adult Gender Services published in December 2025.

The arrangements for referral for surgery, and the funding of that surgery, are consistent with those for other specialised services. Upon a confirmed diagnosis of gender dysphoria, an NHS-commissioned specialist multi-disciplinary Adult Gender Service may make a referral to a specialist surgical team who will assess the patient's suitability for surgery and communicate that decision to the Adult Gender Service. Processes are in place to ensure that patients are fully informed of potential risks and benefits in order to give informed consent both to the initial referral for surgery and to the surgical intervention.

The following table shows the number of NHS referrals for chest reconstructive surgery which were made in each of the last three years, broken down by age group. Please note that the number of referrals that were assessed as suitable for surgery will be lower and that these numbers include patients from England, Northern Ireland, Wales, and Scotland:

The following table shows the number of NHS referrals for genital surgery which were made in each of the last three years, broken down by age group:

Question to the Department of Health and Social Care:

To ask His Majesty's Government how many NHS referrals for (1) mastectomy, and (2) genital surgery as treatment for gender dysphoria, were made in each of the last three years, broken down by age group.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England has committed to implement the Cass Review's recommendation for a dedicated detransition service, and will hold a public consultation on a proposed service specification in the autumn of 2027, for adoption in 2027/28.

The NHS service specification for adult gender services was published in 2019, following an extensive public consultation in 2017, respondents to which included United Kingdom professional medical bodies and health regulators. A similar process of public consultation on a proposed new service specification will be held later in 2027/28 building on the findings and recommendations of the report of the National Operational and Delivery Review of Adult Gender Services published in December 2025.

The arrangements for referral for surgery, and the funding of that surgery, are consistent with those for other specialised services. Upon a confirmed diagnosis of gender dysphoria, an NHS-commissioned specialist multi-disciplinary Adult Gender Service may make a referral to a specialist surgical team who will assess the patient's suitability for surgery and communicate that decision to the Adult Gender Service. Processes are in place to ensure that patients are fully informed of potential risks and benefits in order to give informed consent both to the initial referral for surgery and to the surgical intervention.

The following table shows the number of NHS referrals for chest reconstructive surgery which were made in each of the last three years, broken down by age group. Please note that the number of referrals that were assessed as suitable for surgery will be lower and that these numbers include patients from England, Northern Ireland, Wales, and Scotland:

The following table shows the number of NHS referrals for genital surgery which were made in each of the last three years, broken down by age group:

Question to the Department of Health and Social Care:

To ask His Majesty's Government when NHS England will decide whether to commission a dedicated service for patients who detransition; and what criteria will inform that decision.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England has committed to implement the Cass Review's recommendation for a dedicated detransition service, and will hold a public consultation on a proposed service specification in the autumn of 2027, for adoption in 2027/28.

The NHS service specification for adult gender services was published in 2019, following an extensive public consultation in 2017, respondents to which included United Kingdom professional medical bodies and health regulators. A similar process of public consultation on a proposed new service specification will be held later in 2027/28 building on the findings and recommendations of the report of the National Operational and Delivery Review of Adult Gender Services published in December 2025.

The arrangements for referral for surgery, and the funding of that surgery, are consistent with those for other specialised services. Upon a confirmed diagnosis of gender dysphoria, an NHS-commissioned specialist multi-disciplinary Adult Gender Service may make a referral to a specialist surgical team who will assess the patient's suitability for surgery and communicate that decision to the Adult Gender Service. Processes are in place to ensure that patients are fully informed of potential risks and benefits in order to give informed consent both to the initial referral for surgery and to the surgical intervention.

The following table shows the number of NHS referrals for chest reconstructive surgery which were made in each of the last three years, broken down by age group. Please note that the number of referrals that were assessed as suitable for surgery will be lower and that these numbers include patients from England, Northern Ireland, Wales, and Scotland:

The following table shows the number of NHS referrals for genital surgery which were made in each of the last three years, broken down by age group:

Question to the Home Office:

To ask His Majesty's Government what assessment they have made of the decision of the Upper Tribunal (Immigration and Asylum Chamber), issued earlier this year, to allow the appeal of a Gaza-born family of 18 to enter the United Kingdom on human rights grounds; who provided the mental health evidence relied upon by the Tribunal; how that evidence was assessed; and what weight should be attached to that evidence.

Answered by Lord Hanson of Flint - Minister of State (Home Office)

The Government has noted the Upper Tribunal’s decision and sought permission to appeal from the Court of Appeal. As the case remains subject to further judicial scrutiny, it would not be appropriate to comment on the specific circumstances of the case, the evidence before the Tribunal, or the weight attached to that evidence while proceedings are ongoing.

On 30 June, the government introduced The Immigration and Asylum Bill, which will deliver a fundamental reset of the balance between individual Article 8 rights and the public interest in maintaining an effective immigration system that promotes economic wellbeing and alleviates pressures on stretched public services.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what guidance is in place for NHS general practitioners asked to enter shared-care or monitoring arrangements for patients receiving gender-related prescriptions from private or overseas providers; and whether general practitioners are under any obligation to do so.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Further to the answer provided on 28 September in response to question HL3452, since 1 January 2025, fulfilment of private prescriptions for puberty blockers for people under 18 years old with gender incongruence or gender dysphoria has been banned under the provisions of section 62 of the Medicines Act 1968. This includes prescriptions issued by prescribers in the European Economic Area (EEA) or Switzerland.

While United Kingdom pharmacies can otherwise dispense prescriptions issued by appropriately regulated prescribers in the EEA or Switzerland, they can refuse to dispense a prescription if they have concerns about whether it is genuine, clinically appropriate, or safe. The Government is currently considering the findings of our recent call for evidence on non-National Health Service prescribing, including on the recognition of EEA and Swiss prescriptions in the UK.

The regulatory oversight of clinics operating outside the England, and not providing regulated activities in England, is a matter for the governments in the jurisdiction in which those clinics are based.

The General Medical Council is clear that a decision about whether to enter into a shared care agreement is for the general practitioner (GP) to make. NHS England has provided specific guidance advising GPs against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 years old as a response to gender incongruence or gender dysphoria.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the adequacy of current arrangements for cross-border prescribing to UK patients by clinicians not registered with the General Medical Council.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Further to the answer provided on 28 September in response to question HL3452, since 1 January 2025, fulfilment of private prescriptions for puberty blockers for people under 18 years old with gender incongruence or gender dysphoria has been banned under the provisions of section 62 of the Medicines Act 1968. This includes prescriptions issued by prescribers in the European Economic Area (EEA) or Switzerland.

While United Kingdom pharmacies can otherwise dispense prescriptions issued by appropriately regulated prescribers in the EEA or Switzerland, they can refuse to dispense a prescription if they have concerns about whether it is genuine, clinically appropriate, or safe. The Government is currently considering the findings of our recent call for evidence on non-National Health Service prescribing, including on the recognition of EEA and Swiss prescriptions in the UK.

The regulatory oversight of clinics operating outside the England, and not providing regulated activities in England, is a matter for the governments in the jurisdiction in which those clinics are based.

The General Medical Council is clear that a decision about whether to enter into a shared care agreement is for the general practitioner (GP) to make. NHS England has provided specific guidance advising GPs against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 years old as a response to gender incongruence or gender dysphoria.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the prescribing of masculinising and feminising hormones to people under 18 for gender dysphoria or gender incongruence by providers based outside the UK; and whether they intend to bring such prescribing within statutory restrictions.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Further to the answer provided on 28 September in response to question HL3452, since 1 January 2025, fulfilment of private prescriptions for puberty blockers for people under 18 years old with gender incongruence or gender dysphoria has been banned under the provisions of section 62 of the Medicines Act 1968. This includes prescriptions issued by prescribers in the European Economic Area (EEA) or Switzerland.

While United Kingdom pharmacies can otherwise dispense prescriptions issued by appropriately regulated prescribers in the EEA or Switzerland, they can refuse to dispense a prescription if they have concerns about whether it is genuine, clinically appropriate, or safe. The Government is currently considering the findings of our recent call for evidence on non-National Health Service prescribing, including on the recognition of EEA and Swiss prescriptions in the UK.

The regulatory oversight of clinics operating outside the England, and not providing regulated activities in England, is a matter for the governments in the jurisdiction in which those clinics are based.

The General Medical Council is clear that a decision about whether to enter into a shared care agreement is for the general practitioner (GP) to make. NHS England has provided specific guidance advising GPs against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 years old as a response to gender incongruence or gender dysphoria.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what regulatory oversight applies to online gender clinics that provide services to patients in the UK but are based and registered outside the UK and therefore fall outside the remit of the Care Quality Commission.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Further to the answer provided on 28 September in response to question HL3452, since 1 January 2025, fulfilment of private prescriptions for puberty blockers for people under 18 years old with gender incongruence or gender dysphoria has been banned under the provisions of section 62 of the Medicines Act 1968. This includes prescriptions issued by prescribers in the European Economic Area (EEA) or Switzerland.

While United Kingdom pharmacies can otherwise dispense prescriptions issued by appropriately regulated prescribers in the EEA or Switzerland, they can refuse to dispense a prescription if they have concerns about whether it is genuine, clinically appropriate, or safe. The Government is currently considering the findings of our recent call for evidence on non-National Health Service prescribing, including on the recognition of EEA and Swiss prescriptions in the UK.

The regulatory oversight of clinics operating outside the England, and not providing regulated activities in England, is a matter for the governments in the jurisdiction in which those clinics are based.

The General Medical Council is clear that a decision about whether to enter into a shared care agreement is for the general practitioner (GP) to make. NHS England has provided specific guidance advising GPs against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 years old as a response to gender incongruence or gender dysphoria.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they are taking to prevent puberty-suppressing hormones supplied directly to patients from outside the UK from being dispensed or used within the UK.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Further to the answer provided on 28 September in response to question HL3452, since 1 January 2025, fulfilment of private prescriptions for puberty blockers for people under 18 years old with gender incongruence or gender dysphoria has been banned under the provisions of section 62 of the Medicines Act 1968. This includes prescriptions issued by prescribers in the European Economic Area (EEA) or Switzerland.

While United Kingdom pharmacies can otherwise dispense prescriptions issued by appropriately regulated prescribers in the EEA or Switzerland, they can refuse to dispense a prescription if they have concerns about whether it is genuine, clinically appropriate, or safe. The Government is currently considering the findings of our recent call for evidence on non-National Health Service prescribing, including on the recognition of EEA and Swiss prescriptions in the UK.

The regulatory oversight of clinics operating outside the England, and not providing regulated activities in England, is a matter for the governments in the jurisdiction in which those clinics are based.

The General Medical Council is clear that a decision about whether to enter into a shared care agreement is for the general practitioner (GP) to make. NHS England has provided specific guidance advising GPs against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 years old as a response to gender incongruence or gender dysphoria.

Question to the Department of Health and Social Care:

To ask His Majesty's Government how many suspected breaches of the Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024 (SI 2024/1319) have been (1) reported to, and (2) investigated by the medicines and healthcare products regulatory agency since 1 January 2025; and what enforcement action has resulted.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

In August 2025, the Government launched a call for evidence on private, non-National Health Service prescribing, which included an invitation for views on online prescribing, hormone prescribing, and prescribing by practitioners based in the European Economic Area. We are considering the evidence and next steps.

Since 1 January 2025, the Medicines and Healthcare products Regulatory Agency has received three reports of suspected breaches of the Order cited by the Noble Baroness. All three reports were investigated, but no offences were identified and no criminal enforcement action was taken. In one case, the agency referred safeguarding concerns to the relevant local multi-agency safeguarding team, notified the relevant European regulatory authority about the prescribing doctor’s activities, and passed information about a possible breach by a registered pharmacy to the General Pharmaceutical Council.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of online telemedicine services providing hormones and adult gender clinic services, considering some are based outside of the UK and so are not subject to the Care Quality Commission.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

In August 2025, the Government launched a call for evidence on private, non-National Health Service prescribing, which included an invitation for views on online prescribing, hormone prescribing, and prescribing by practitioners based in the European Economic Area. We are considering the evidence and next steps.

Since 1 January 2025, the Medicines and Healthcare products Regulatory Agency has received three reports of suspected breaches of the Order cited by the Noble Baroness. All three reports were investigated, but no offences were identified and no criminal enforcement action was taken. In one case, the agency referred safeguarding concerns to the relevant local multi-agency safeguarding team, notified the relevant European regulatory authority about the prescribing doctor’s activities, and passed information about a possible breach by a registered pharmacy to the General Pharmaceutical Council.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the extent to which people under 18 are continuing to obtain puberty-suppressing hormones for gender dysphoria or gender incongruence from providers based outside the UK despite current restrictions.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

I refer the Noble Baroness to the answer I gave her on 2 October in response to Question HL3714, which, for ease of reference, is reproduced below:

“Further to the answer provided on 28 September in response to question HL3452, since 1 January 2025, fulfilment of private prescriptions for puberty blockers for people under 18 years old with gender incongruence or gender dysphoria has been banned under the provisions of section 62 of the Medicines Act 1968. This includes prescriptions issued by prescribers in the European Economic Area (EEA) or Switzerland.

While United Kingdom pharmacies can otherwise dispense prescriptions issued by appropriately regulated prescribers in the EEA or Switzerland, they can refuse to dispense a prescription if they have concerns about whether it is genuine, clinically appropriate, or safe. The Government is currently considering the findings of our recent call for evidence on non-National Health Service prescribing, including on the recognition of EEA and Swiss prescriptions in the UK.

The regulatory oversight of clinics operating outside the England, and not providing regulated activities in England, is a matter for the governments in the jurisdiction in which those clinics are based.

The General Medical Council is clear that a decision about whether to enter into a shared care agreement is for the general practitioner (GP) to make. NHS England has provided specific guidance advising GPs against shared care agreements with unregulated providers in relation to hormone medication to children and young people under 18 years old as a response to gender incongruence or gender dysphoria.”