Gender Incongruence: Puberty Suppressing Hormones

Tracy Gilbert Excerpts

Wednesday 30th April 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Ms Lewell. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an unacceptably toxic public debate. That is why Liberal Democrats have been arguing for much better specialist healthcare services for children and young people who find themselves in this distressing situation. The old system, a single clinic, with a shockingly long waiting list and rated “inadequate” by the Care Quality Commission, was clearly failing vulnerable young people at the most difficult time in their lives. Before GIDS closed, more than 5,000 young people were stuck on the list and left waiting for an average of almost three years for a first appointment. For vulnerable teenagers and pre-teens, going through what are often incredibly difficult experiences, those three years must have felt like an eternity.

Liberal Democrats have consistently campaigned for action to tackle appallingly long wait times across the NHS, whether for cancer treatment or mental health, and it is right that we do so for gender identity services as well. It is clear that change is needed. That is why we have long been pressing the Government to establish new specialist services and recruit and train more specialist clinicians, so that children and young people can access the appropriate, high-quality healthcare that they need. The move to create multiple new regional centres is, therefore, a very welcome one, but only two are open now—in London and the North West—leaving those who have already been stuck on waiting lists for years to wait even longer. There is no sign yet of when the other centres will open. Would the Minister be able to give us an indication of when they might?

Unless the Government show far more urgency in getting these centres up and running properly, more and more children will be denied the care they need as they languish on those long waiting lists. While it is right that treatment is largely based on talking therapies for both the child and their parents to give all gender-questioning young people the time and space to make clear and informed decisions about their future, that has got to mean that people starting their talking therapy when they need it, not after years of delay.

Following the Cass review, the Secretary of State announced that the NHS would be conducting clinical trials on the impact of puberty blockers. That is due to begin very soon. I would appreciate clarification from the Minister about the current status of the trials and the terms of reference under which they will be conducted. The announcement of the trial came alongside an indefinite ban on the prescription of puberty blockers as a treatment for young people with gender incongruence or dysphoria, unless they are part of that trial. Numerous organisations, including the Council of Europe, have raised concerns about the potential ethical implications of only offering a treatment to a small group of patients taking part in a clinical trial. I believe that the Secretary of State confirmed at the Dispatch Box that the trial would be uncapped when he gave a statement on puberty blockers to the House in December 2024. Would the Minister confirm whether that is the case?

The ban has caused fear and anxiety for some young trans people and their families, who have been so badly let down for so many years. I have met with families in my own constituency who have highlighted the severe mental health impacts that uncertainty over treatment can have. It is crucial that any clinical decisions are made by expert clinicians based on the best possible evidence, not politicians with a point to make.

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

Are the Liberal Democrats supportive of the views in the Cass review? I do not think that that has been stated on the public record as yet.

[Helen Morgan]

I have met with Dr Cass. We have considered the Cass review, and we are in support of the clinical trial that she has recommended. That is why I am asking the Minister to clarify some of the points that have been made as that trial progresses.

When that decision was made to indefinitely ban puberty blockers, it obviously caused some concern and uncertainty for the families that are affected. Would the Minister commit to publishing the supporting evidence, including the results of the consultation, to give those families confidence in the decision to ban their prescription?

With any medical treatment, especially for children and young people, it is most important that the clinical professionals follow the evidence on safety and effectiveness. I welcome the Government’s support for the research to improve evidence on the safety and efficacy of potential treatments; that research must take into account the direct personal experiences of those who have used those services in the past. More broadly, Liberal Democrats believe that all trans and non-binary people should have access to the high-quality healthcare that they deserve, and that Government should prioritise tackling unacceptable waiting times by expanding the provision of appropriate and timely specialist healthcare through NHS child and adult services for trans and non-binary people, ensuring that trans people have access to high-quality healthcare on the same basis as we would expect for all patients, with medical decisions made by patients and doctors together, informed by the best possible evidence, and supporting research using international best practice to improve evidence on the safety and efficacy of potential treatments.

For puberty blockers specifically, it is for expert clinicians to build the evidence base and determine whether they are safe and effective. I do not think any politician, such as me, who does not have that clinical experience or evidence to hand should be making pronouncements on whether or not they are. We need the NHS to act on building up that evidence base, and for the Government to provide certainty that they will follow the evidence and expert advice when that is available.

Children and young people with gender incongruence are uniquely vulnerable, potentially facing an identity crisis, difficult relationships at home and social isolation at a very young age. It is extremely important that they are treated respectfully, safely, quickly and in the way that is best for their long-term health and personal development. It is unlikely that the same treatment will be appropriate for every individual in that situation, but when it comes to any individual medical interventions, Liberal Democrats believe it is right that those decisions are made by clinicians and patients together, informed by the best possible evidence, as is the case in all areas of healthcare.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Ms Lewell. I congratulate the hon. Member for Reigate (Rebecca Paul) on securing this debate, on the constructive tone in which she has engaged with me and my Department, and on the way that she opened the debate.

The Government’s approach is governed by three principles. First, the health and wellbeing of children and young people is our primary concern—a point made by the hon. Member for Strangford (Jim Shannon). Secondly, evidence-led, effective, ethical and safe healthcare must be provided to all who need it, when they need it—a point well made by my hon. Friend the Member for Macclesfield (Tim Roca). Thirdly, this Government believe in the dignity and equality of every single one of His Majesty’s citizens.

Since the election, we have been calmly and cautiously guided by the evidence. We take children’s healthcare extremely seriously. That is why we remain committed to implementing the Cass review, and ensuring that children and young people who are looking for support in relation to their gender receive the highest quality of care, as one would expect of any other child health service in the NHS.

[Tracy Gilbert]

Dr Cass was clear in her review that the model of care for people with gender incongruence, and particularly for children and young people, needs to be changed to take into account their holistic care needs. Will the Minister update us on her Department’s progress in implementing those findings?

[Karin Smyth]

I thank my hon. Friend for that intervention; I hope to get on to that subject in my speech. It is important that people are aware of that progress.

I know that many people are concerned about the ethics of this research, as the hon. Member for Reigate and the right hon. Member for South Holland and The Deepings (Sir John Hayes) both noted. I assure hon. Members that the UK has, as we know, extremely rigorous and robust ethical approval pathways, and that no clinical trial can proceed without the necessary independent scientific approvals.

We already regularly use those processes to consider clinical trials in children so that we can evaluate new treatments for a whole range of conditions, including cancer, depression, respiratory infections, or any illness. Many aspects of the methodology of this trial are still being looked at, such as how long it will follow children, how many children will be on the trial and how the demographics of the trial will be constructed. That is all still to be confirmed and approved; many hon. Members asked about those points today. All participants in the trial will also be part of the ongoing observational study.

Following the decision by the Secretary of State for Health and Social Care about puberty blockers, which was based on the evidence, we needed to make sure that we got on with helping scientists, researchers and clinicians to do their jobs. Some people have called for the Government to stop those experts from pursuing this line of inquiry, and we have heard such calls again in this debate. They have argued that the decision to halt the sale and supply of puberty blockers should be the end of the matter, and that young people should not have access to this medication, come what may. That would be to ignore the distress and real experiences of young people, and the Government have no doubt that it would drive people towards possible illegal and underground routes, shutting off young people’s access to conversations with professionals and the opportunity to pause and consider other options.

Instead, as Dr Cass suggests, we can set out a proper path to treatment that involves young people, their parents, clinicians and mental health professionals. Knowing that they are on a path will reassure young people that they are being taken seriously. The cautious process that they will have to work through before joining a trial means that young people will have access to support and counselling, which may result in them deciding against joining the trial and pursuing a medical route. That is an approach entirely missing over recent years.

We all agree that treatment should be offered based on the best available evidence, and clinical trials in the UK are considered to be the gold standard for evaluating healthcare interventions. The Cass review found:

“The evidence base underpinning medical and non-medical interventions in this clinical area must be improved.”

That is why we have commissioned the PATHWAYS programme of research, one aspect of which includes the world’s first clinical trial designed to help us to better understand the relative benefits and potential wider effects of the use of puberty blockers in affected children.

We must look at the most appropriate medical and non-medical approaches to support physical, emotional and psychosocial health. That is why the trial forms just one component of a wider study and a growing portfolio of research, jointly hosted by NHS England. That includes looking at the experiences of the 9,000 adults who, as children, were cared for under a previous model of NHS care, which I know the hon. Member for Reigate has described as a “medical scandal”. Dr Cass was clear in her review that both a clinical trial on puberty blockers and a data linkage study, which many hon. Members have raised today, are important to improving the evidence base on gender incongruence in children and young people.

Regardless of individuals’ views on the practices of the Tavistock, I hope we can all agree that learning from the experiences of those thousands of people who have accessed puberty blockers is important; it will provide different and separately valuable information from the clinical trial. That data alone, however, will not provide the answer as to whether we should—or should not—consider routinely prescribing these drugs in the future, or continue the ban indefinitely.

The adult gender services have now committed to sharing their data, a point also raised by hon. Members. I acknowledge that we need to move quickly, and I expect to be making progress on this soon. We will consider all data that is relevant to puberty blockers, including from the adult gender clinics.

As with all clinical research, the team leading the trial must ensure that approval is obtained from the regulatory authorities, including one of the Health Research Authority’s independent ethics committees and the Medicines and Healthcare products Regulatory Agency. Those are all standard steps where the research receives full scrutiny. Once approvals are granted, the study protocol will be finalised and published, and only then can the trial commence. I am not able to comment on the finer details of that today, but we will issue further updates when they are available, and I commit to keeping Members updated.

I assure hon. Members that entry into the trial will be guided by strict eligibility criteria. It will involve only young people under the care of the NHS children’s gender services who have received a full assessment, where other appropriate forms of support have been offered and where their clinician supports a referral to the trial. Under the law, if a child is under 16, a parent will have to consent to their participation, and the child also needs to agree.

I am repeating myself slightly, but that level of caution was entirely missing over recent years. This is a more considered and evidence-based approach. In the past, puberty blockers were presented as the magic pill that young people needed to access; this trial will give children and young people the support they need to make these major decisions.

As we have heard today, we are currently in a situation where some people think it is unethical not to provide these treatments, and some think it is unethical to provide them. The reality is that we do not have definitive evidence. When that happens, we routinely ask for the study to be checked by an independent ethics committee. We spell out the uncertainty to young people and their parents, so that they can balance any such risk against their desire to join the trial before deciding whether they wish to participate.