Hilary Cass sent a document to every single MP and Peer, justifying and defending the puberty blockers trial

Repeatedly quoting the protocol doesn’t get away from the fact the protocol doesn’t explain what gender incongruence really means.

It doesn’t explain why we can discount the anecdotes of treating this condition but can’t discount the anecdotes of how they conclude a child has this condition.

It doesn’t explain what “gender” is.

Essentially the protocol relies on the assumption of particular things as being unquestionable fact, and it’s only a few things that follow that are uncertain.

The protocol relies on an illusionary truth effect. We are expected to believe that gender incongruence is real, well defined, and an easily confirmable diagnosis because it has been repeated many times that this is so. The only question is the best way to treat it.

Most people here have seen through that illusion. We have seen that this illusionary truth effect isn’t real, and so we question, time after time after time, what is being treated. This is because we can all see that it has to be something beyond solid - rock solid, unwavering, as accurate as possible - when the potential intervention is as serious as being proposed.

The protocol does NOT tell us anything. It only tells us the illusion.

And let's not forget Jackie Green pretended to be a girl to get his girls toys back.

I am always, as a female engineer, fascinated by the 'persistent not wanting to be the gender you were born' argument.

This just forces girls to pretend to like dolls in order to not be sterilised.

And people do this with a straight face.

I'm sorry but I can't find another source for the supplemental funding of the trial.
This is the NIHR website:PATHWAYS: Puberty suppression And Transitional Healthcare with Adaptive Youth Services - NIHR Funding and Awards
where there is the initial funding of 10 millions awarded (no trace of further funding).
There are also the three documents of the trial design
Microsoft Word - PATHWAYS Trial Protocol v3.2 18.06.2026 CLEAN
The sentence about further funding has appeared in the February 2026 document, but I can't find it reported anywhere else.
In another part of the document (paragraph 15.5, June document) they state:
Long-Term Safety Monitoring via Registry Linkage: To address potential long-latency outcomes (e.g., bone health, fertility, cognitive development), participants will be invited to consent to long-term follow-up through linkage with national health registries and routinely collected NHS digital datasets. This approach minimises participant burden while enabling systematic capture of clinically relevant endpoints such as fracture incidence, fertility-related interventions, and major health events. Active study follow-up will continue for up to the duration of the study. Post-randomisation; thereafter, data will be obtained passively via registry linkage, subject to participant consent and applicable legal regulations. Participants will be informed of this plan in the Participant Information Sheet and Informed Consent Form, including the option to withdraw from registry follow-up at any time without affecting their clinical care.
(the bold is mine, and it's what I was remembering - the passive follow up through the NHS databases - glad to see I can rely on my memory).
So it's really unclear to me, because the two parts of the protocol contradict each other. How binding is the future funding commitment? It there any idea whether all the patients will be included in the follow up (I don't think so, as the protocol for the open-label follow up is not written yet)? Will it include also people who continue with cross-sex hormones?

Also, interview with his mum well worth a listen

His mum did an episode with Beyond Gender. She spent YEARS touring round doctors because Jonni was peeing blood. They ALL said it couldn't be the puberty blockers (which it was later confirmed to be)

Did they ALL fail to take any after prescription follow up notes?

Thats quite the coincidence.

From the protocol

What does “it does work” mean?

There isn’t any doubt that puberty blockers stop pubertal development. So in that sense they work.

But what is the aim of the treatment? Stopping puberty forever? That’s not a good idea from a health perspective.

The original aim in the Netherlands was to prevent puberty in males so that they could pass better as female in later transition. Driven by middle aged male transsexuals who thought they would have been happier if this had been available to them.

They are of no benefit to girls in this respect.

So what is the purpose of them?

think that it does work

But getting any of them, or anyone here to commit to what it is working for, is impossible.

So if their clinical experience can be discounted, why can’t their diagnosis of “gender dysphoria/incongruence” be discounted?

I mean, there appear to be lots of clinicians who think that it does work, given the fact that they’ve been prescribed for gender incongruence for over 20 years in various countries.

That's a good trick considering gender incongruence was only invented back in 2019 when ICD-11 was published. Whatever PBs were being prescribed for before 2019 it wasn't gender incongruence.

A young gay man who was transitioned at age 13. I'm not sure if it has already been posted?

https://x.com/IWF/status/2076667854158524503?s=20

I mean, there appear to be lots of clinicians who think that it does work, given the fact that they’ve been prescribed for gender incongruence for over 20 years in various countries.

It’s their clinical experience which is being discounted.

I think you are misunderstanding who this argument is aimed at. Puberty blockers are prescribed ‘off-label’ to children with gender incongruence. This means that they are not licensed for use with that indication or age group.

Of course I understand this.

This argument is saying ‘your clinical experience isn’t good enough. Pointing to positive outcomes for previous patients who have been treated isn’t good enough, because the profile of those being treated has changed massively to previously. We mustdo a proper trial on this group’.

This just translates as “anecdotes aren’t data”.

But that’s not what that paragraph is saying. It’s saying previous studies have been done on one group and that data isn’t applicable to this new group.

It makes no sense. The whole argument of Cass is that there are “true trans” kids. The original Dutch research was meant to exclude children with other mental health issues. If any test subject was going to be as close to this “true trans” group it was them. And the treatment didn’t work.

Now the proposal is to do a study on this current cohort who are different, and they are different in every way that goes against the “true trans” idea. They’re complex, traumatised, ASD, multiple mental health diagnoses etc.

So what is the aim of the study? To test puberty blockers on the “true trans” kids Cass believes in?

Or is the aim of the study to test puberty blockers on kids with complex overlapping mental health conditions because we can’t be sure it doesn’t work on them like it didn’t work on the supposedly lesser complex original kids?

I think you are misunderstanding who this argument is aimed at. Puberty blockers are prescribed ‘off-label’ to children with gender incongruence. This means that they are not licensed for use with that indication or age group.

This is allowable, a clinician can use their clinical experience to prescribe rather than having to wait for a clinical trial. This argument is saying ‘your clinical experience isn’t good enough. Pointing to positive outcomes for previous patients who have been treated isn’t good enough, because the profile of those being treated has changed massively to previously. We must do a proper trial on this group’.

Incidentally ‘low certainty of benefit’ doesn’t mean ‘probably doesn’t work’, it means that the demonstration of benefit came from studies with crappy statistical validity - so benefit was demonstrated but confidence about whether the conclusion is correct is low.

The thing I don’t understand is what do they think happens long term to a child who is unhappy about the upcoming development of secondary sexual characteristics?

Even if their mental distress is reduced by blocking their puberty, that’s only a very short term answer to their mental distress and blocking an essential part of human physical and mental development in the long term looks like a terrible idea.

It is short term thinking. It will obviously lead to heightened distress that child has their belief confirmed that puberty is so dangerous for them that they must be protected from it.

Avoidance is not the best way to help anxiety.

The clock will always then be ticking for that child. I can see why most of them end up on the cross sex hormones pathway - nothing has been done to help them come to terms with their body as it is.

Similarly, what are parents thinking who transition a very young child? What were they planning on doing as that child approaches secondary school age? It is short-termism.

I have had to parent a child through anorexia, and we had to deal with the extreme mental distress head on; it was not suggested that the mental distress should be relieved by giving weight loss drugs because the clinicians were looking at long term outcomes.

"The observed changes in the population of CYP presenting at Gender Services, in terms of age, birth-registered sex and neurodevelopmental traits or disorders, means that clinical experience from and longitudinal follow-up earlier cohorts may not be applicable to the group of young people currently seeking care. Hence new research studies are needed. "

But this just translates as:

“The kids we puberty blocked previously are different to the kids wanting puberty blockers now, so we need research to see what puberty blockers does to this group.”

It doesn’t explain why puberty blockers are the treatment that we must research and not other things.

It also doesn’t explain why new research isn’t research into validity of the “gender incogruence” diagnosis or the reason they should be given puberty blockers, given such notable changes in patterns of kids who say they’re trans.

Many healthcare professionals and parents/caregivers have expressed concerns about over-reliance on the views of CYP at this dynamic and formative developmental stage and request clearer and more objective clinical evidence to guide decision-making in the interests of longer-term positive outcomes."

And again, how will an experiment of puberty blockers on these kids help combat the child’s view of what they think they are and what they think they need, any more than what we already know about this treatment from the multiple systematic reviews that have been done so far?

Child: “I am trans and really want puberty blockers.”

Gender doctor: “Multiple systematic reviews have shown that low certainty of benefit, that means it probably won’t help you.”

”Child: “You could do just one more study to make sure?”

Gender doctor: “You’re right! Because the systematic reviews done so far only looked at the previous population, not the current changing population because it’s so different and you can’t possibly apply that research done just in the last few years to the children of today!”

Mental. Absolutely mental, all of it.

I've skimmed through the rest of the protocol, and I can't see anything which explains why they think this trial is necessary

"The observed changes in the population of CYP presenting at Gender Services, in terms of age, birth-registered sex and neurodevelopmental traits or disorders, means that clinical experience from and longitudinal follow-up earlier cohorts may not be applicable to the group of young people currently seeking care. Hence new research studies are needed. "

"Hence currently decisions about care are made in the context of very limited
evidence and against a background of strong personal preferences. This is
particularly pertinent for a condition in which intervention decisions rely heavily on the preferences of relatively young children and adolescents who are at a developmental stage intrinsically characterised by exploration of personal identity. Many healthcare professionals and parents/caregivers have expressed concerns about over-reliance on the views of CYP at this dynamic and formative developmental stage and request clearer and more objective clinical evidence to guide decision-making in the interests of longer-term positive outcomes."

"The question of any possible impact on brain development and cognition will be directly addressed, for the first time, in the PATHWAYS CONNECT and PATHWAYS HORIZON INTENSIVE studies."

But I am quite tired so I may have missed some details.

You haven’t. It’s the massive elephant in the room. They can’t explain why it’s needed.

I've skimmed through the rest of the protocol, and I can't see anything which explains why they think this trial is necessary. They plan to experiment on children, and see if they suffer adverse effects, particularly with respect to their bones or brains, and ask them if they feel happier. That seems to be it.

But I am quite tired so I may have missed some details. I'll try and have another look at it tomorrow.

I went looking for a bit more info on the pathways trial and read an interview with Cass and the SI in 2025 where Cass says:

While we don’t fully understand the cause—it’s not simply about being ‘born in the wrong body’—these children have always existed and we need to figure out the best way to support them,” she added.

How does she bloody know they’ve always existed? How does a scientist come up with this bit of narrative myth? Yes, older men presenting as women and some women dressing up as men are present throughout history but I’ve never heard about these trans children being found in history.

And referrals to gender clinics have fallen from 200 patients a month to just 30. This is not because demand has vanished, but because some gender incongruent young people—as MPs heard during a briefing about the trial—may be getting the drugs from other sources.

But maybe it’s because the pipeline to the Tavistock has been halted and so there are simply fewer girls being exposed to social contagion?

PS, am enjoying your analysis @OldCrone!

I absolutely would. I'm not sure what's wrong with me but it was the most relaxing experience of my life. Totally shut up my brain. I'd be first in the queue for a free one. If I could pay to have one, I would.

Especially as all the research pre-Dutch protocol indicates that around 90% of gender-incongruent children will outgrow it by going through puberty, and most of them will end up being gay or lesbian.

Just to add to my previous post, gender incongruence seems to be about impossible desires to be the opposite sex. It seems absurd to use medical and surgical treatment to try to change bodies to fulfil these desires, rather than psychological treatment to help children accept their bodies and their sex, leaving their healthy bodies undamaged.

Here's the definition of gender incongruence (which I think was posted earlier in the thread):

1. Diagnosis of gender incongruence according to ICD-11, which includes:
a. Strong desire to be a different gender than the birth-registered sex.
b. Strong dislike of sexual anatomy or anticipated secondary sex characteristics.
c. Gender Incongruence persisted for a minimum of 2 years.
d. Strong desire to ‘transition’ and live as the experienced gender.

The problem with this definition (well, there are several problems really), is that they use both "gender" and "sex". Do they mean these to be synonymous or is "gender" in this definition actually distinct from "sex"?

Substituting sex for gender in part (a) sort of makes sense:
a. Strong desire to be a different sex than the birth-registered sex.

I can understand that some people might want to be the opposite sex, although this is obviously impossible. Using gender here instead makes it meaningless though without some description of how "gender" and "sex" relate to each other.

Part (b) is quite easy to understand, and in section 1.2.2 that I quoted in my previous post they describe this as body dysmorphia.

Part (d) really needs some more explanation. What is an "experienced gender" and how does someone "live as the experienced gender"?

If this is the condition they're treating, it's really not well defined at all, and it's not clear why damaging the healthy bodies of children is seen as the best treatment for it.