Puberty Blockers

Gregory Stafford Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Dr Johnson]

This is not a form of gene therapy. It is a medication that is a GnRH analogue, and what it essentially does is delay puberty. It was designed as a drug to treat children who go into puberty much earlier than they would be expected to, and to delay it until, as it were, the right time. The effects of the use of puberty blockers in older children and for a much longer period, at an age when they ought to have started puberty, are not fully understood.

[Gregory Stafford (Farnham and Bordon) (Con)]

My hon. Friend says that we do not know the effects, but a number of children have been put through this process via the now discredited Tavistock process. Why does she think that the NHS will not refer to the data linkage study and use the data that would have been gained from the children who were put through that process, in order to find out what the effects are before deciding to put a whole new cohort of children through what is clearly a damaging procedure?

[Dr Johnson]

My hon. Friend raises a very good point, and I will come to the data linkage study shortly. What we do know from the Cass review is that the vast majority of children who went on to puberty blockers in adolescence went on to receive cross-sex hormones, which are known to have permanent effects.

One fact that is crucially important is that it is not possible for clinicians to confidently determine which children with gender incongruence will persist with the trans identity into adulthood, and which will not. How can the clinicians possibly know that they are not injecting potentially dangerous drugs into children whose incongruence will resolve itself? The answer is that they cannot. Will the Secretary of State tell us whether he is aware of new evidence allowing clinicians to work out confidently which children will persist with the trans identity at 11 and which will not? We need to think about the risk involved in the treatment, and whether it is worth the benefits that they will purportedly receive.

The trial researchers suggest that they will take a wide approach to looking at potential benefits, that they will look at quality of life and body satisfaction, and that there must be a reasonable prospect of benefit; but how can they know whether there is a reasonable prospect of benefit when they do not know whether or not the condition will persist? Some have suggested that giving puberty blockers will help the few adults who retain their trans identity into adulthood to pass as the opposite sex. Does the Secretary of State think that the long-term damage to many is worth it for the cosmetic benefit of a few? The Medicines for Human Use (Clinical Trials) Regulations 2004 specify that “anticipated benefits” must justify the risk. This is an ethical rather than a medical question. Does the Secretary of State think that the benefits justify the risk?

I regret that we have ended up discussing the details of a clinical trial in the Chamber—the reality is that things should be done impartially by scientists in most cases—but with this topic we have seen the quashing of open debate, which is why we have ended up where we are.

I will move on to the point made by my hon. Friend the Member for Farnham and Bordon (Gregory Stafford). Even if the Secretary of State thinks the principle of the trial is right, he must surely agree that it is unnecessary and unethically broad. For example, if someone was designing a trial to treat children with a specific form of cancer, the children who would be entered into the trial would have that specific form of cancer. We would not include children with any disease, because that would make the results unreliable in terms of benefit to the target group and children would be unnecessarily put at risk of receiving experimental drugs that they did not need.

The same applies to this trial. The Cass report tells us that many of the children in the proposed trial will get better on their own. The Secretary of State said yesterday that

“we are talking about a very small subset of a very small group.”—[Official Report, 22 June 2026; Vol. 788, c. 56.]

--- Later in debate ---

[The Secretary of State for Health and Social Care (James Murray)]

I know what a sensitive, emotive and difficult issue this is. As I said in the House yesterday, I have myself struggled with the profound challenges this subject raises. We all, as adults, owe a duty of care to every child and young person in this country. That is a responsibility I bear, both as a citizen and as Health Secretary, with the utmost seriousness and sincerity. It is why, in all my deliberations on this matter, my consideration is to protect the safety and wellbeing of children and young people. Children’s healthcare must always be evidence-led, safe and effective. The way to ensure that is to follow expert clinical advice, which is what the Government are doing.

Dr Hilary Cass, the clinician who I think has more respect in this space than any other, has spoken about the importance of this trial in recent days. I remind the shadow Minister that it was her party that commissioned the Cass review and accepted its findings, which included the Pathways trial. I have been clear to the House that this is a challenging area. I accept and welcome the scrutiny of Members, but I encourage us to keep in mind Dr Cass’s request to consider the issues sensitively and cautiously. She says:

“Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”

I do not think that there is any question that a few years ago, children’s safety and wellbeing was not being protected when it came to gender incongruence. From around 2009, the number of children and young people being referred for NHS support around their gender identity increased rapidly. Stories subsequently emerged of young people struggling after undergoing radical and permanent transition surgery at an early age, of children rushed into taking medication without adequate therapy beforehand, and of clinicians disregarding conditions such as neurodiversity and mental health issues. As such, there was rightly deep concern about the vulnerability of these children and young people, the care and treatments they were receiving, and the surge in referrals. And so, in 2020, NHS England commissioned the leading paediatrician, Dr Hilary Cass, to carry out a review into NHS gender identity services for under-18s.

What Dr Cass uncovered was shocking and scandalous, and she made a series of recommendations for how children can be better protected and supported. It was, in my mind, unquestionably wrong for children and young people to be routinely prescribed puberty blockers for gender dysphoria without any clear evidence on their benefits or risks. The situation then was out of control and so I fully supported the indefinite ban introduced by my predecessor, my right hon. Friend the Member for Ilford North (Wes Streeting), which followed the temporary ban brought in by the previous Government.

In considering what to do next, Dr Cass identified that treatment for gender incongruence was

“an area of remarkably weak evidence”.

She found that even clinicians working in the field were divided on the best way to support, treat and care for young people suffering from gender dysphoria. Where there is strong divergence of medical opinion on treatment, the two possible responses are either to continue with uncertainty—and with that, conflicting opinions and advice—or to undertake a trial. It is only by doing that that we can ensure that children with gender-related distress get the same access to and standards of care as everyone in the NHS.

[Gregory Stafford]

There is a third option, which is to get NHS England to motor ahead with the data-linkage study, so that we can use the data that has already been collected to find out the answers to the questions that the Secretary of State is posing. Only then, if the information is not there, should the trial go ahead. Why is he not pushing that third way?

[James Murray]

The hon. Gentleman’s question allows me to address that matter directly. The data-linkage study will not provide clear evidence of the risks and benefits of puberty-suppressing hormones, which is needed to guide future clinical practice for this cohort. The type of information that would be available in a linkage study is much more limited than the detailed information that the research team will collect about the relative benefits and harms of puberty-suppressing hormones when accessed alongside a holistic model of care.