Puberty Blockers

Rebecca Paul Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Rebecca Paul (Reigate) (Con)]

I frankly cannot believe that we are here again. When the Pathways clinical trial was paused earlier this year, I felt that there had finally been—[Interruption.]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Forgive me—there is a five-minute time limit, which is the only way that I can incorporate all the Back Benchers who wish to contribute.

[Rebecca Paul]

Yesterday, even the Secretary of State for Health and Social Care conceded—the second one to do so—that he is “uneasy” and even “uncomfortable”. I suggest that his discomfort is nothing next to the lifelong damage that the trial will potentially do to an extremely vulnerable cohort of children, whom we should be protecting. That funny feeling in his stomach—[Interruption.] Oh, he has left. That feeling is his good judgment trying to be heard—he will not hear this if he has left—and it is not too late for him to listen to it. I agree with what one of my hon. Friends said yesterday: he is a good man who is being placed under intolerable pressure on this issue. But he needs to find his courage.

The number of children and young people presenting to the NHS with gender distress increased dramatically in the years after 2009, with an exponential rise from around 2014. What is behind the increase among Gen Z is unclear, but the reasons are likely to be multifaceted. It is speculated that the factors may include 24/7 internet access, the increased acceptance of trans identities, or even peer social and cultural influences. Over the past 20 years, groups such as Stonewall and Mermaids have called for better access to treatment and more rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands.

[Vikki Slade (Mid Dorset and North Poole) (LD)]

I am slightly concerned by the idea that trans acceptance is part of the problem. Does the hon. Member agree that trans acceptance is completely reasonable and that trans people have always been here?

[Rebecca Paul]

I am not saying that it is a negative thing; I am trying to explain why we have seen an increase in the numbers of young people with gender dysphoria. I am stating facts; we were just talking about the importance of doing so.

In 2009, only 51 patients were referred to the NHS Gender Identity Development Service for children, of whom two thirds were male. In 2016, there were 1,766 referrals and two thirds of them were female. That is quite the change. There has been an overall surge in the number of children suffering gender distress, but the increase is especially notable among girls. We also see over-representation of neurodiversity, mental health issues and trauma in this group. To put it another way, these children are much more likely to have been in care, to suffer with anxiety and depression, to be autistic and to have been abused. It is a group of incredibly vulnerable children.

GIDS was established in 1989. Its main approach to treatment at that time was therapeutic, referred to as watchful waiting. Early studies from the 1980s showed that in around 85% of cases, the gender incongruence or distress ceased in the child after going through puberty. Later studies reached a similar conclusion, with between 67% and 90% desisting after puberty. Only a small cohort of children continue to experience gender dysphoria or incongruence after puberty, and it was that extremely small group who would likely adopt a permanent trans identity in adulthood.

[Mr Andrew Snowden (Fylde) (Con)]

Recently, the Government announced that they will legislate to prevent under-16s from viewing social media. We already ban under-16s from drinking alcohol and smoking, because we believe that they should be protected from doing things now that may have negative impacts on them later in life, particularly to their health. Does my hon. Friend think that this should sit in that category of protections for children?

[Rebecca Paul]

I completely agree with my hon. Friend; a child of this age cannot possibly consent to the life-changing, irreversible changes that come from puberty blockers. We need to remember that almost all children who start puberty blockers go on to cross-sex hormones, and there is no going back from that.

We need to remember that we have already had a trial in the UK. When we started using puberty blockers in the UK after 2011, the preliminary results came out in 2015-16 and did not demonstrate psychological benefits, with some of the females actually suffering a worsening of symptoms, including a higher incidence of wanting to hurt or kill themselves. The results of the study, which were not formally published until 2020, demonstrated no statistically significant improvement in gender dysphoria or mental health outcomes. It is important to remember the early studies that told us that, in a majority of cases, going through puberty resolved gender distress. It follows, therefore, that stopping or delaying puberty using medication derails that natural desistance, essentially locking in.

[Dr Simon Opher (Stroud) (Lab)]

Speaking as a member of the political class and the medical class, may I ask the hon. Lady whether she would accept that it is better for politicians to accept advice from medical experts around medical issues?

[Rebecca Paul]

I thank the hon. Member for that excellent question. I obviously always respect and listen to different clinicians, but what is happening with this debate is that one set of clinicians with one view is being listened to. Let me remind everyone about lobotomies. Lots of very respected people came out for lobotomies; in fact, the person behind the idea won a Nobel prize. I think we would all agree that those clinicians got that wrong, so it is incumbent upon us in this House to always question. It is absolutely right that we listen to clinicians, but unfortunately we are seeing only one set of clinicians with one set of opinions being listened to here.

A Finnish study was published in April that looked at more than 2,000 adolescents and young adults who had been referred to gender services. It found that medical interventions did not reduce psychiatric problems and may even be associated with worsening mental health. How many times have we heard it said that puberty blockers offer a pathway towards improved mental health and reduced psychiatric distress for those struggling with gender identity? I have lost count. But there is hard evidence that not only says different; it says the opposite. I would be keen to understand from the Minister and the Secretary of State whether that study was taken into account before deciding to go ahead with the trial.

I want to point out that children and young people who grow up to be same-sex attracted are over-represented in this cohort, and that is something we need to think about. If we look at the case of Keira Bell, she was a lesbian struggling with her sexuality, and instead of people saying, “It’s okay to find other women attractive—there’s nothing wrong with that. You do not need to change your body,” they said, “Ah! You’ve got gender dysphoria.” They put her on puberty blockers, and then she went on to testosterone shots. She then had her breasts removed in a double mastectomy, and then she detransitioned. This is a deeply homophobic approach to healthcare. Those on the other side of the argument think they have the progressive position. I am sorry, but you are repeating mistakes that have been made historically—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Obviously, I have not said anything, so I am not repeating anything. No “yous” and “yours”.

--- Later in debate ---

[Christine Jardine (Edinburgh West) (LD)]

It is a pleasure to follow the hon. Member for South Derbyshire (Samantha Niblett), who made a very effective and powerful speech. All of us here today are concerned about the safety and wellbeing of children, and we want to ensure that young people facing a crisis of identity get the support that they need and that is appropriate for them. In many cases, that will be talking therapies. We need to give children and their families time to figure out exactly what the issue is and whether they will develop out of it in time, but that is not always the case.

My concern, and I believe the concern of many here today, is for those children who do not, as the hon. Member for Sleaford and North Hykeham (Dr Johnson) put it, grow out of it as if it were some problem—children who have a genuine fear of what puberty will bring, and of what adulthood in a body that they do not recognise as theirs will mean. Those children currently feel that they have no option. If we take away the possibility of puberty blockers, where will they go? Where will they turn? Too many young people are committing suicide, and we have to acknowledge that that is the very real danger of putting up a very different type of block—a block to understanding and to helping them develop.

[Rebecca Paul]

I thank the hon. Lady for giving an eloquent speech. It is really important that we are very responsible in the way we talk about suicide, and I would like to point out that Professor Louis Appleby did a study on exactly this issue following the ban of puberty blockers. His conclusion was that we were not seeing an increase in suicides as a consequence. He also made the point that it is important not to suggest that denying young people puberty blockers causes them to commit suicide. That is a negligent thing to do, and it is important that we put that on the record.

[Christine Jardine]

I thank the hon. Lady, but I point out that that is not what I said. I said that we were leaving children without an option. I also point out that if we are going to be responsible, we should not accuse people of being homophobic because they are trying to support the transgender community. Many of those people who support the transgender community are lesbians or gay. I know this because I am the honorary president of the LGBTQ+ community within the Liberal Democrats, and there is a great feeling of community between the two. I would caution people not to call anyone who wants to support the trans community homophobic. 

These children need our support. In providing that, we should listen to clinicians and experts, such as Dr Hilary Cass, who has said, as so many Members have pointed out, that this trial will help protect children and will mean that they are less likely to be harmed. I think we should take that as our guiding principle.

My hon. Friend the Member for Mid Sussex (Alison Bennett) clearly laid out my party’s policy. I am proud of the fact that, as a women and equalities spokesperson, I was responsible for the formation of most of our policy on the transgender community. I have to say that I spoke to a great many of them, and they would be appalled if they felt for one moment that we were not going to support them, not going to support this trial or not going to stand up for them at a time when they are under increasing pressure and we are seeing the demonisation of that community.

The young children facing a crisis of identity—wondering who they are, and wondering what support they will get—are looking to us to give them that support, and that is why I will oppose the Conservatives’ motion.

--- Later in debate ---

[Stephen Kinnock]

I know that feelings on these matters are strong and heartfelt. If the Conservative party has changed its position and is putting forward its arguments with sincerity and honour, that is a perfectly acceptable position to take, but I simply remind the House of the journey that the party has been on.

[Rebecca Paul]

The Cass review also suggested a clinical trial for cross-sex hormones. On that basis, will the Government launch a clinical trial on cross-sex hormones as well?