NHS Gender Care: Hormone Therapy Paused for Teens – Review Findings

NHS England has paused new referrals for gender-affirming hormone treatment for 16- and 17-year-olds, a move prompted by a recent review that found insufficient evidence to support its continued use in this age group. The decision, announced Monday, impacts access to masculinising and feminising hormones for young people experiencing gender dysphoria and comes after the conclusions of the independent Cass Review into children’s gender care.

Understanding Gender Dysphoria and Hormone Therapy

Gender dysphoria refers to the distress a person experiences when their gender identity differs from the sex they were assigned at birth. Treatment aims to alleviate this distress, and for some young people, hormone therapy – the use of hormones to induce physical changes consistent with their gender identity – is considered as part of a broader care plan. Hormone therapy can include puberty suppressing hormones and gender-affirming hormones. The NHS explains that treatment options vary depending on the individual and their stage of life.

Currently, those under 18 already receiving cross-sex hormones will be able to continue treatment, but their cases will be reviewed by clinicians individually. New referrals for this treatment are paused for a 90-day consultation period, during which NHS England will consider removing the treatment as a routine procedure.

The Evidence Review and Cass Review Findings

The pause follows an in-depth review commissioned by NHS England after the publication of the Cass Review. The review found the evidence base supporting the use of hormone therapy for 16- and 17-year-olds with gender incongruence or dysphoria was “too weak” to determine whether the treatment is beneficial or harmful. Hilary Cass, who led the independent review of children’s gender care, had previously recommended “extreme caution” in providing such treatment, advocating for a “clear clinical rationale” before initiating hormones, potentially delaying treatment until the individual reaches 18. As reported by The Guardian, the NHS is continuing to examine the evidence for hormone treatments in adults.

It’s important to note that the review specifically addresses masculinising and feminising hormones. Puberty suppressing hormones, which are used to delay the onset of puberty, are already not routinely available to children and young people for the treatment of gender dysphoria or gender incongruence due to a lack of sufficient evidence regarding their clinical safety and effectiveness. The NHS website details this current position.

What This Means for Young People and Families

This decision will undoubtedly cause concern for young people who have been waiting for treatment, and for their families. The long waiting times for referral and treatment for gender dysphoria are already a significant issue, and this pause will likely exacerbate those delays. The NHS acknowledges these existing delays. The pause does not affect those already receiving treatment, but it does mean that new referrals will not be processed during the consultation period.

The multidisciplinary teams involved in assessing young people with gender dysphoria – including clinical psychologists, psychotherapists, psychiatrists, family therapists, and social workers – will continue to provide support and assessment. These teams typically conduct detailed assessments over several months, and options may include family therapy, individual psychotherapy, parental support, and regular monitoring of gender identity development. For more serious emotional issues, referral to a local Children and Young People’s Mental Health Service (CYPMHS) may likewise be considered.

The Importance of Psychological Support

The NHS emphasizes that most treatments offered at this stage are psychological rather than medical. This approach is based on the understanding that, in many cases, gender variant behaviour or feelings may diminish as children reach puberty. Psychological support remains a crucial component of care, even for those who may eventually pursue hormone therapy.

Navigating the Consultation and Future Guidance

NHS England has launched a 90-day consultation to gather feedback on the proposed changes. This consultation will involve a range of stakeholders, including clinicians, patients, families, and advocacy groups. The outcome of the consultation will inform future guidance on the provision of hormone therapy for young people with gender dysphoria.

Tammy Hymas, policy lead at advocacy group TransActual, expressed concern over the decision, stating that banning new prescriptions of gender-affirming hormones for 16 and 17-year-olds is a significant step. The Guardian reports on this reaction.

For young people and families affected by this decision, it is important to stay informed about the consultation process and to seek support from healthcare professionals and advocacy organizations. The NHS website provides information on gender dysphoria and available services. The Telegraph provides further context on the history of prescribing practices.

Staying Informed: Updates on the consultation and any changes to guidance will be published on the NHS England website. Individuals are encouraged to check for official updates and to discuss any concerns with their healthcare provider.