PATHWAYS Study: Puberty Suppression

Baroness Cass Excerpts

Wednesday 24th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand the point that the noble Baroness is making but, in answer to her first question, this is not outwith any trial or intervention because there always has to be the clinical evidence and the approach to make sure that we are always seeking benefit, not harm. I am glad that the noble Baroness acknowledged the extensive safeguards. I hope that would reassure your Lordships’ House. Indeed, for children and young people who do take part in the trial, there will, for example, be repeated follow-up physical checks, questionnaires, blood tests, bone density scans and cognitive testing, all at the relevant time points. There will be psychosocial care throughout the trial. Importantly, the protocol also clarifies that, where there are significant concerns—again, I know this is a matter of concern about psychological well-being—that case then has to be promptly reviewed by the right clinician.

As for the future, I think we should wait for what the trial says. I am not going to speculate. I point out that we are not waiting, in terms of NHS care and support. Three services for children and young people have already opened in north-west London and in the south-west for those with gender dysphoria. NHS England will aim to deliver service provision in each region of England by the end of 2026-27. Again, that programme of work, rightly, was started under the previous Government. I think we all acknowledge that there are young people with gender dysphoria. They are to be seen, supported and dealt with in the most caring, appropriate and scientifically evidenced way possible.

[Baroness Cass (CB)]

My Lords, this is complex, and people across both sides of the House share one objective: to be cautious, careful and protective of children and young people. It is not my place here to answer many of the perfectly valid questions that have been raised, but I am developing a briefing based on proceedings in the Commons yesterday and I am listening carefully today, so I will not pick up on issues around the linkage study. I will refer to the Minister on one or two things.

The noble Baroness, Lady Cash, is right to say that the vast majority of children and young people desist, but the noble Baroness, Lady Barker, is also right to say that some do not. The clinicians working in the new centres are gaining considerable experience and working holistically to try to determine which young people—a tiny number—they feel may benefit from these medications.

I am not worried about the children in the trial but I am seriously worried about the children not in the trial. Approximately 240 children who have come to the new clinics have admitted to being on an extraordinary cocktail of medications, including testosterone from age 11, with facial hair at 13. Why are they doing this? They are not being perverse: we have told them for 15 years that these drugs are safe, effective and even life-saving, so is it any surprise that they will now go to any lengths to get them? They are not foolish, and they say they want to know the answers on that. We as the medical profession have created this issue, so it is on our heads to solve it. Does the Minister agree with me that the children in the trial will be at considerably less risk than the ones we know about who have come to the NHS and the very many more we are aware of who are not coming to the NHS but are going straight to rogue providers?

[Baroness Merron (Lab)]

I agree with the noble Baroness and I thank her for the offer of the briefing, which I mentioned earlier, and for her observations. I associate myself with what she said about the complexity of the matter, which is why I take it so seriously. The fact is that this situation exists. I am exercised about those who are accessing puberty blockers in an unregulated fashion. It is extremely concerning, which is another reason for this trial, as well as the services being set up. That is why we indefinitely banned the sale and supply of puberty blockers via private prescriptions, taking effect from January 2025. If offences are committed then those involved will be brought to justice, and rightly so.