Puberty Blockers

Iqbal Mohamed Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Dr Johnson]

I am sorry, but I just do not support that. We would not give children cocaine on the basis that they wanted it and would get it illegally otherwise. These are not sweeties; they are powerful drugs and need to be treated with respect.

Even if we accept the premise that a very small number of people might benefit from treatment, how could clinicians decide which children to treat? On what ethical or moral code would we want to inject powerful drugs into children who are likely to have a self-limiting illness and therefore do not need it? That is what the Government have chosen to do, and it is not necessary.

Following on from the point made by my hon. Friend the Member for Farnham and Bordon, they have this data already. The Tavistock was a travesty, but it means that the Government could analyse the data from the outcomes of those children. They could establish the outcomes as children went into adulthood, and Baroness Cass tried to do this using the data linkage study. Shockingly, six out of seven adult gender clinics refused to provide the Government with the data. Even when a specific piece of legislation was passed by the previous Government to clarify that it was legal to provide the information to this trial, the gender clinics still did not provide it.

I understand that NHS England is working on the data linkage study, but I ask the Secretary of State why it is taking so long. Is the abolition of NHS England causing delay? Why is he letting this trial, which he has expressed reservations about, go ahead in the knowledge that it is unnecessarily broad and in advance of the data linkage study?

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Does the hon. Lady agree that unblocking the reasons why the data is not being made available should be the top priority, and that analysis of that data should be done before any further experiments on children are done?

[Dr Johnson]

The hon. Gentleman is exactly right, and he expresses my point succinctly. Why is the Secretary of State going ahead with a trial—experimenting on more children unnecessarily—when he has the data to analyse already? Why has he chosen to fund this trial? Is he worried about the children who will be put on a medical pathway that may lead to cross-sex hormones and a lifetime of medicalisation when they would have got better by themselves anyway?

I want to talk about the age of these young people. The Medicines and Healthcare products Regulatory Agency warned in February that the youngest patients are at the greatest risk, and may end up on puberty blockers for a much longer period. They have a higher risk to fertility because sperm and eggs have not yet fully developed at Tanner stage 2, but this Government have chosen to include children of 11 or 12. Some will wonder why it is 11 for girls and 12 for boys—indeed, I was asked that question yesterday—but as a paediatrician I am aware that puberty starts earlier in girls than in boys. It is somewhat ironic that a trial based on the premise that girls could be boys recognises this biology, but I am glad that in this respect it does. However, that means some of the participants will be primary school-aged children with the merest form of puberty. How can they possibly meet the eligibility criteria, which includes

“sufficient understanding of the treatment advantages and disadvantages, including discussion of fertility preservation”?

How can a child of 11 understand what it means to lose sexual function, to be unable to have children when they are older, to have difficulties in thinking and to have weak bones? Remember that this Government think that 14-year-olds are not old enough to watch social media, but they think 11-year-olds are capable of understanding this.

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[James Murray]

I have responsibility for NHS England as Secretary of State for Health and Social Care, and I am setting out the protocol agreed in relation to this trial, as it is a subject that is arousing a lot of questions in the Chamber, which is fair. [Interruption.] I will come back to that point, if the hon. Member for Gordon and Buchan (Harriet Cross) allows me to make a little progress.

[Iqbal Mohamed]

Will the Secretary of State give way?

[James Murray]

I will make a little progress, and then I will be open to more interventions. We need to be clear about who we are talking about. As Dr Cass said, the vast majority of children and young people who question their gender will resolve it without needing any support other than their friends and family. For many young people, questioning their identity, on many different fronts, is a normal part of growing up, and we should simply let them be. A small number of those young people, however, need greater support because of the level and longevity of discomfort that they feel, and that can often involve counselling or therapy.

For a very small number of young people, it is possible—and I emphasise the word possible—that medical treatment would help improve their quality of life and mental health and reduce their gender-related distress. That is why Dr Cass recommended a trial to study the effects of puberty-suppressing hormones on young people’s physical, social and emotional wellbeing, and to establish how best to support children and young people suffering gender incongruence.

[Iqbal Mohamed]

On that point, in normal clinical trials, the active substance and a placebo would be used, and the impact, changes or benefits that each cohort experienced would be checked. If children have a psychological leaning and are emotionally feeling that they are in the wrong body, is there not value in having a cohort that takes a placebo and seeing if that improves their mental health?

[James Murray]

The hon. Gentleman raises an important question around how the clinical trial is designed. In this case, the young people involved in the trial, of whom there will be around 226, will be split into two groups; one half will have the puberty blockers from the start, the other half will receive them after a year.

My understanding of this matter, having interrogated the detail carefully, is that a placebo would not be appropriate for this trial because the subject will be able to know the impacts of having the puberty blockers; they will be aware of whether they are having the medication. What is important, however, and what I hope will set this Pathways trial in a wider context, is all the other work that is being done to study the incidence of gender incongruence and the responses to that among young people, which will go beyond the trial we are talking about to look at children and young people questioning their gender through talking to them, understanding their mental health and their approach to that. All that will happen alongside this trial, which is one part of a much wider study to understand how best to support young people who are facing these gender-related issues.

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[Alison Bennett (Mid Sussex) (LD)]

This debate is on a subject that, it goes without saying, is emotive and complex. We must therefore as always endeavour to have this conversation with compassion and empathy. The Liberal Democrats’ position is clear and simple, as reflected in our amendment to the motion: any medical treatment and the approval of any clinical trial, including the one we are discussing, must be led by expert medical advice. It should not be led by personal belief, no matter how sincerely and passionately that belief is held. Politics has a place, but not in questions of medical trials and clinical consensus—those are better left to experts.

The Cass review, originally commissioned by the Conservatives, was clear that there was a need to gather more evidence. The safety of young people is paramount, and the experts involved in this space know that better than anybody; they work with these children day in, day out and understand the risks of both action and inaction. That is why we supported the previous decision to pause the trial after the MHRA raised concerns, and why we now support the decision to start it again.

We will listen to the experts and the clinicians, but to build trust in expert advice we need transparency and clarity, and throughout the process, we have pushed for exactly that. We want the expert opinions on the public record, as that allows us as politicians, as well as the wider public, to approach this issue with clarity and facts, not ideology or misunderstanding. That is why we called for the Government to publish how the MHRA arrived at its decision when concerns were first raised, and yesterday we called for the Secretary of State to confirm that the MHRA had confirmed that its concerns had been substantially addressed. Transparency is needed so that people can be confident that clinical advice is being followed.

[Iqbal Mohamed]

Will the hon. Member give way?

[Alison Bennett]

I am afraid that I will not.

Liberal Democrats have been arguing for many years that improved access to better specialist healthcare services for children and young people struggling with their gender identity is extremely important. Those young people have been badly let down by low care standards and extremely long waiting lists. The closure of the Gender Identity Development Service made it clear beyond doubt that change was needed. We have consistently campaigned for real action to tackle the shocking waiting times across the NHS, including for gender identity services.

Liberal Democrats welcome the move to create new regional centres to offer this care to the young people who need it. There is a need for multiple geographically dispersed clinics so that care is closer to those who need it, but roll-out has been slow, and more needs to be done to tackle the waiting lists—quite simply, a three-year average wait is not acceptable. For the centres to run effectively, we must support the specialists who provide children and young people with high-quality, compassionate and clinically appropriate care.

Treatment, first and foremost, should be based on talking therapies. Space and time to talk through feelings is vital for young people struggling with their gender identity. It is a deeply complex set of feelings, and questioning and understanding one’s identity is never an easy thing, especially for a child, but for talking therapies to be an effective first step, children must be able to access them when they need them, not after years on a waiting list.

The debate is about access to a form of healthcare—one that is led by doctors and clinicians—and, as for any other form of healthcare, we must listen to the experts: the people who have spent years training and years delivering care.

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[Sarah Owen]

Absolutely. I thank my hon. Friend for his commitment to the LGBT+ community and for his work, including with his constituents. We have heard a lot today about throwing children into wild experiments, but that is not what we are talking about. We are talking about something done in collaboration with parents—parents who love their children and want the best for them, and with medical professionals who want the same. The rhetoric around the trial really needs to change.

No child will be able to take part in the trial without parental consent. That has been confirmed again by the Secretary of State from the Dispatch Box. Of course, there will be some children who will never gain their parents’ consent: a heartbreaking situation for any family. However, there will be many parents who will truly support and know the wishes of their child; they will agree with the suitability of the treatment and want to support them on their journey.

Much has been discussed about the child, but parents have huge agency in the process. We are not just talking to the children; we are talking to adults who want the best for their child, and that point should be recognised.

[Iqbal Mohamed]

My hon. Friend is making a powerful speech. I have huge respect for her and I completely agree that nobody here or outside should be looking to disrespect or harm any individual, whatever their age. Would she agree that parents should also be given all the information available around this condition, its treatments and the paths that children follow? Over 93% of children who experience gender dysphoria grow out of it and then are happy in their natural body. Does she agree that that and other information should be made available to the parents?

[Sarah Owen]

I thank the hon. Member for his intervention and his kind words at the beginning; that is the right tone, which we need to set, and information is key. People need to be able to make informed decisions—whether it is the child or a parent—and there needs to be independent information so that people can make fully informed decisions.

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[Joy Morrissey]

My doubts come from why, for example, we are not allowing the data linkage study to be fully completed before proceeding with the new trial. That study would find out what has happened to all the children who have already taken puberty blockers. I wanted to ask the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), that question, but I was not able to make that intervention; I do not know whether that had anything to do with the £1.5 million donation from Ferring Pharmaceuticals that the Lib Dems took before the 2019 election. I do not know whether that had anything to do with it, but there has to be some level of declaration if a political party has taken donations from a pharmaceutical company that is promoting this drug. That is relevant to how one represents oneself in the Chamber.

There is no justification for proceeding with the Pathways trial before the data linkage study is complete. Puberty is how a child transitions from childhood to adulthood, and anything that affects that process is going to have long-term effects. Those effects are going to be felt, not in one or two years, but in 10 years. The brains we have as adults, at the age of 24, are very different from the brains we have as 11-year-olds—our frontal cortexes are not fully developed. This is not just about the effect on these children’s psychology; what effects do these drugs have on humans over the long term? We do not know that, so why not look at the data linkage study? It does not have to be perfect, but it will allow us to protect the children going into this trial, so that the trial is as well-run as possible.

[Iqbal Mohamed]

I thank my hon. Friend for giving way, and for making such a passionate speech. I think we all agree, across the House, that we are here not to politicise or to demonise, but to try to make the right decisions for the safety of children. I think that all Members here share that intention. It was said earlier that these drugs are already used to treat different conditions, such as prostate cancer, endometriosis and precocious puberty. For the first two conditions they are taken by adults for a very short time, and for the third they are taken for a limited period until the child reaches the age of puberty. Such misinformation—or comparison—is not really valid, and should be avoided.

[Joy Morrissey]

That is an excellent point. When I heard about those other uses for the drug, I thought that I would be interested to see more clinical trials for conditions such as endometriosis and cancer to establish its long-term effects. However, that is for adults. When it comes to protecting children, I want to ensure that this trial involves as much safeguarding as possible.

We do not fully understand the long-term risk. We come to the House again and again to discuss what constitutes a child and what constitutes protecting a child. We need to be clear about the fact that we must protect people under the age of 16, or 18—I do not care which age it is, but it should be an age on which we all agree—and that they must be subject to extra protection and safeguarding until they reach adulthood. That is why we are asking for so many safeguards—we need to ensure that the unintended consequence of trying to help a few young people does not lead to greater harm to many—and it is why we are here today.

I do not feel that asking the Government to include the data linkage study is too much to ask. This trial is a trade-off: long-term health is being exchanged for short-term happiness. This trial, in my opinion, is not safe, and this trial will not protect children from harm.