NHS Pathways puberty blockers trial sets minimum ages for trans youngsters
Trans youth can no longer access puberty blockers via the NHS after its PATHWAYS trial was paused. (Getty)
New guidelines on the Pathways puberty blockers trial have been published (Image: Getty, stock image)
NHS England’s Pathways Trial for puberty blockers has introduced minimum entry ages of 11 for trans boys and 12 for trans girls, alongside revised safeguards ahead of its planned start date.
The changes were set out in an update on the Pathways clinical trial published on 19 June.
The £10million, two-year study was launched late last year, but was put on pause by officials in February of this year over concerns for safety and welfare. It is scheduled to commence on 1 August 2026 under the updated guidance.
The Medicines and Healthcare products Regulatory Agency (MHRA) said: “The modified protocol includes strengthened safeguards including the introduction of minimum ages of entry to the trial and more clearly defined discontinuation measures.”
The revised protocol also gives clearer guidance on when treatment should be stopped, including monitoring “safety for bone health, cognition, and vaginal bleeding”, as well as providing more detailed information for participants on fertility preservation.
What participation will involve
Young people taking part will undergo more than 13 hours of medical assessments and complete around 50 forms before accessing treatment, alongside physical examinations. Half of participants will receive puberty blockers immediately, while others will wait one year.
Children must have parental consent and must meet eligibility requirements to take part, including “demonstrating a good understanding of the intervention and its possible benefits and risks”.
Debate and reaction
In 2024, the UK introduced restrictions on prescribing puberty blockers to under-18s outside research settings, intensifying criticism of NHS gender services.
The Cass Review has remained a major reference point in political and clinical debate, including when the British Medical Association said they no longer opposed it, apart from the ban on puberty blockers.
LGBT+ Conservatives said they oppose the trial, writing on X: “If we are willing to restrict social media to protect young people, we should be even more cautious about medical interventions with lifelong consequences,” adding: “We support Kemi Badenoch in putting children’s wellbeing first.”
From the perspective of trans advocacy groups, Chay Brown, health director for TransActual, said: “It breaks my heart when I think of the young people affected.”
Brown added: “This research is not about the safety of these medications, which have been used for this very purpose since 1989. It is the result of an ideological view at the very top of the NHS that being trans is a ‘less desirable outcome.’”
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