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

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.

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.

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 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.

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.

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.

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?

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?

From the protocol

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

Thats quite the coincidence.

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)

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?

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.

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

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.

Yes, just watched that......shocking!

Such a huge medical scandal and to think we're going ahead with a further 'trial' here - in the face of all of this evidence to the contrary - is just appalling.

It’s in the June document too, page 29.

Why would you need another source, are you suggesting that the claim of funding pending approval in the protocol is incorrect?

We know Finland did? No idea what other countries have done. We know the Tavistock was shit at collecting data, as were the adult gender clinics. That doesn’t mean that no data was collected at all, but inconsistently and haphazardly means you can’t conduct decent statistical analysis on it. This is where you end up with ‘low certainty’ conclusions at best.

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

They’ve defined it, as it is in the international classification of diseases.

I’ve said this before, not liking the answer isn’t the same as an answer not being provided.

Yes, I would like it validated from another source, since both the most recent versions of the protocol contradict themselves and I haven't found anything else confirming that. I would feel more confident that the funding exists and it would also be good to have a draft of the open-label follow-up protocol.

I haven't RTFT, so apologies if this is a duplication, but @Seethlaw has posted a link to a useful article on another thread:

https://www.mumsnet.com/talk/womens_rights/5555091-dutch-protocol?reply=153570413&utm_campaign=reply&utm_medium=share

It's a great pity that PBs were ever invented, because they have serious side effects even when used on-label (for precocious puberty, for a very short time, followed by normal puberty for the patient's sex), and do not deliver the promised diagnostic benefits (virtually all patients on PBs go on to cross-sex hormones).

They act as a figleaf to make treatments seem cautious and conservative, when in fact it would probably be less medically dangerous to carry out a gonadectomy and start cross-sex hormone treatment at the age of twelve. Of course this would not fly, because it makes it blatant that children are being committed to a loss of reproductive and sexual function from an early age.

This is the article, but Seethlaw's post is worth reading too (I don't know why my link doesn't go straight to it):

https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2121238#d1e146

"the ultimate aim of the intervention is to promote long-term well-being and good psychosocial and psychosexual functioning over the life-course."

Isn't this study a maximum of 5 years? Where the youngest ones still won't be adults at the end of it. Do they know what 'long-term' means?

Lots of doctors prescribed thalidomide, too.

It's still a useful drug, just not safe for pregnant women to take.

PBs can still be useful when they are prescribed for their proper use, I'm certain. Only for a maximum of six months because there are too many dangerous side-effects if they are prescribed for longer, to be sure, but....* And weren't they meant to treat prostrate cancer, in the first place? They might still be useful for that, so the pharmaceutical companies won't have lost all their money if PBs are no longer handed out like smarties to children, just been stopped from making the mahoosive profits from them that they are at present.

*I'm sure this trial to feed them to children for two years has taken that into account.

And again I’ll ask, why is it ok to question the supposed experts’ treatment, but not the supposed experts’ diagnosis?

It’s perfectly possible to question the ICD 11 diagnosis. Why isn’t the essential research focussed on that first?

That’s the fundamental block in this discussion. Some people accept that it’s worth maintaining the illusion because the protocol and the ICD repeat it, and that we can see what answers it brings.

Helen Joyce calls this Tooth Fairy medicine. You can do a trial to see if leaving the tooth in a bag vs wrapping it in a tissue leads to more money and kid yourself into thinking you’ve learnt something about the Tooth Fairy. This is what you want to continue. You are happy to allow the perpetuation of the belief in the Tooth Fairy in order to prove that leaving a tooth in a tissue makes no difference.

Some people want a clear answer on whether the Tooth Fairy exists first.

Because it’s not about leaving teeth in tissues, it’s about sterilising children.

Again, GIDs at the Tavistock was supposed to be undertaking a clinical trial and still ended up with crappy data.

I admire your ability to put faith over experience in backing this new trial so enthusiastically.