Why the NHS puberty blocker trial is appalling

[Soontobe60]

Stella O’Malley from Genspect telling it like it is - that a state endorsed trial of puberty blockers for gender dysphoric children should NOT go ahead.
the NHS are not walking into this nightmare blindly - there are enough experts out there telling them what will happen happen to these children if they’re given these life changing drugs.
https://x.com/genspect/status/1989896741358113127?s=61&t=gKvvk-rWmOlYFGMZN8QVvQ

God, this is so upsetting 😔 At best, it’s insanity and at worst, downright evil.

From the Times article - they want to see if they can achieve “better alignment between body features and long-term identity”. How does a ten year old know how their long-term identity will pan out? At ten I was a short-haired tomboy who hated being a girl and by the time I was twelve I had long hair and was messing about with makeup. Neither of those stages actually reflect much on who I went on to be, or all the other phases I’ve been through.

Surely the exclusion criterion “Insufficient understanding of PATHWAYS TRIAL” excludes everybody since it makes no fucking sense.

And personally I would find it horrific for sheep and baby monkeys to be put through experimentation for this madness too.

Someone under the Times article (1.3k comments and rising and I've not seen a single comment in favour) pointed out that if this was being done to animals, all those cheerleading it on would be protesting.

Funny how kid's safety is always expendable for the trans extremists.

I'm so disappointed in Streeting. I thought when transactivists dropped all those cardboard coffins at his office and claimed banning blockers would lead to masses of suicides, he would have seen how utterly crazy they are.

You would think that him having to get Professor Louis Appleby to point out that banning blockers hasn't in fact led to an increase in suicide would be enough to silence the activists.

It just reeks of corruption. Who benefits from the sale of these drugs? Because it certainly isn't the confused children.

I find this aspect of it very upsetting too. I'm sure lots of us have stories.

At 12 I was traumatised by my breasts, which had grown very quickly and were getting attention I didn't know how to handle. I'm sure if someone told me this was evidence that I was 'born in the wrong body' I'd have been inclined to believe them. In time, I got used to them.

Puberty can be an upsetting, confusing time. But trying to opt out of it is not the answer in a sane world.

I had a browse of Reddit to see what they're saying about it over there, found it surprisingly negative. Most of them seem to think it's a stitch-up, rigged, harmful, unethical. They've apparently spotted links to SEGM therefore, according to them, the whole thing must be transphobic.

There is a child I know, the sister of DC’s friend, who reminded of myself at ten. She is now non-binary and is calling herself by a unisex name. When I saw her recently I could see she is trying to look more masculine and I really hope she doesn’t go down a path of damaging herself with drugs and surgery 😥 She is such a bright girl with so many interests, and clearly neuro-atypical. It’s not my place to get involved, of course, but I worry for her.

I thought I didn't see any support of this either but there is one commentator who claims that it's better to stop puberty from happening rather than trying to reverse it later all based on the one transwoman he knows, and there is one now (very recent post) who says they came here for all "the anti-trans rage".

As you say, they didn’t keep records and they didn’t follow up.

Having put fairly simple research projects through my university’s ethics approval process (and even though I just wanted to interview adults about topics that are in no way controversial or triggering, I am aghast that this got though any ethics approval process.

Makes me think it is already ideologically biased.

I think they've created a problem for themselves with this trial, quite aside from the fact that it is a) stupid b) unethical. The Times report says that the "initial" findings (ie not even the final findings) will be available in four years, ie two years after the trial has ended.

So the children will have the drugs for two years, during which they will presumably be monitored, then stop taking the drugs, and then for another two years will continue to be monitored to evaluate the ongoing effect of the drugs after they've stopped taking them.

That means that after the initial two years, they have to stop giving the children the drugs. They can't possibly carry on giving the drugs to some of the children otherwise they will fuck up the trial - all the children in the experimental group have to be in the same situation. So all the children and their parents who are thinking that puberty blockers are wonderful are going to have to come off them to preserve the integrity of the trial.

So for those children and parents, what is the point of the trial? You're going to spend two years having drugs that will almost certainly be physically harmful, but even if they have psychological benefits, or you imagine they have psychological benefits, you are going to have to stop taking them and go through puberty anyway, just at a later stage. If these drugs are, as their proponents argue, "life-saving", then you are negating their supposed benefits by forcing the child to go through the very thing they want to avoid.

Good luck with that.

The Cass Review was clear: there isn't enough evidence that puberty blockers are safe or beneficial for children with gender incongruence.

The evidence is that they block puberty, Wes. Of course that's unsafe.

I understand why Streeting is toeing the line of 'we must follow the recommendations of the Cass report' and to be perfectly honest, I think it's the most sensible approach he could take.

I understand why Dr Cass left a trial
option open, it was the logical thing to do. Though, as I said upthread, she will have started to realise that the internal issues around captured staff would make this very problematic.

I guess the question for her is whether drawing attention to this was within the scope of what she was asked to do or not. It certainly would have upped the stakes significantly for her - and the stakes were high to begin with.

Which brings us to the ethics committee, which should have been the safety valve/off ramp that Streeting and Cass were relying on. I want to know what went down here.

There are questions in my mind about whether Cass should have foreseen that the ethics committee wouldnt be a sufficient check/balance in this case. But I don't know.

https://www.whatdotheyknow.com/request/ethics_approval_of_iras_1011645

'Dear Health Research Authority,

This is a request for information under the Freedom of Information Act 2000.
In November 2025, the London - City & East Research Ethics Committee (REC) approved the Pathways Trial (Puberty Suppression and Transitional Healthcare with Adaptive Youth Services (PATHWAYS). PATHWAYS TRIAL, PATHWAYS CONNECT, and PATHWAYS HORIZON Intensive.) (IRAS ID 1011645) with reference 25/LO/0500. [1]
Please could you supply, subject to any necessary redactions to omit personal information which is not pertinent, copies of:

1. The minutes of any meetings of the REC in which this study was discussed.
2. Any communication from the REC about the approval of the study, including the approval of the study itself.
3. A copy of any correspondence submitted to the REC or HRA by external stakeholders related to the approval of the study.
4. Any other internal documentation of the REC or HRA pertinent to the ethical assessment and ethical approval of the study.

Please can you share this information as soon as possible and no later than the end of the statutorily-prescribed timeframe of 20 working days.'

https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/pathways-trial/

So the EHRC guidance on the SC judgement is complicated and must be delayed, but a research study to give puberty blockers to young people is completely fine?

https://www.bmj.com/content/391/bmj.r2458

'A major UK study to track the long term health of young people attending the NHS’s gender incongruence service has started recruiting participants.
The Puberty Suppression and Transitional Healthcare with Adaptive Youth Services (Pathways) Horizon study, led by King’s College London and co-sponsored by the South London and Maudsley NHS Foundation Trust, was quietly approved in July and has now begun. It aims to recruit 3000 participants, making it the largest global study of its kind.'

FAQs here

PATHWAYS: Puberty Suppression and Transitional Healthcare with Adaptive Youth Services | King's College London

'PATHWAYS TRIAL

2.1 How will PATHWAYS TRIAL study puberty suppressing hormones? PATHWAYS TRIAL will use a randomised controlled trial design, as this method can determine whether puberty suppressing hormones cause benefits and/or risks. This approach helps ensure that any observed effects can be attributed to the specific treatment itself, rather than other parts of care that patients may have received. The trial will compare impacts on young people’s physical, social and emotional wellbeing and cognition between two groups: one being offered puberty suppressing hormones immediately and the other after one year. This will help us understand whether earlier intervention improves quality of life, mental health, or reduces distress, and what are the effects of longer versus shorter length of treatment.

2.2 Who can take part in PATHWAYS TRIAL? The trial will only include young people who want this treatment, have consent from their parents/legal guardians and are deemed clinically eligible by their care team and the National Multidisciplinary Team (NMDT). It is expected this will be a very small group of the young people attending the Gender Service. If young people and their parents/legal guardians agree to participate in PATHWAYS TRIAL, they will be randomised (allocated by chance) to be offered puberty suppressing hormones immediately, or after a delay of one year. They will have an equal chance of being offered puberty suppressing hormones immediately or after one year. '

'2.5.1 Short-term side effects

.. These medicines may affect bone health by slowing down bone strength development. We do not know whether this persists after stopping puberty suppressing hormones. Very rarely, a condition called idiopathic intracranial hypertension can occur, which causes severe headaches, vision problems, or ringing in the ears. There is a very small chance of changes in heart rhythm, especially if puberty suppressing hormones are taken alongside other medicines. The study will carefully monitor for common and more rare adverse effects.

2.5.2 Longer-term possible effects Some possible risks may not show up until later in life. These include possible effects on: - Future fertility, especially if young people go on to cross sex hormones like testosterone or oestrogen - Bone health – increased risk of fractures - Sexual development and function - Memory and thinking skills There currently isn’t any evidence about how common these are or whether these effects are directly related to puberty suppressing hormones. This is because studies that exist look at people who choose further treatments such as cross-sex hormones. This means these effects have not yet been comprehensively studied for puberty suppressing hormones on their own. '

'The upper age limit at consent is 15 years 11 months. This ensures participants enter the study during mid-puberty, allowing enough time to observe treatment effects before full maturation. This also aligns with NHS commissioning guidance and ethical safeguards for paediatric research, ensuring the intervention remains clinically relevant. Over and above being in puberty, young people will need to meet all the other eligibility criteria, which include demonstrating a good understanding of the intervention and its possible benefits and risks. Ethical practice dictates that children who are clinically eligible should not be discriminated against on age alone. Nevertheless, it is very unlikely that many of those under age 11 years will show the necessary level of understanding of the treatment to be able to take part. '

'Before deciding whether to take part, each young person will have a series of meetings with clinicians, both individually and together with their parent(s) or legal guardian(s). These meetings will cover the known and unknown possible benefits and risks of puberty suppressing treatment, potential long-term effects and alternative treatment options. Doctors will discuss fertility, including possible long-term effects and options for fertility preservation such as sperm or egg storage. Young people will have the option to see a fertility specialist. '

'2.12 What will happen when a young person comes to the end of their two years of treatment within PATHWAYS TRIAL?

When the trial ends, the young person’s doctor will talk to them and their parents/legal guardians about how they have found the treatment in terms of their quality of life, mental and physical health and their experience of their gender and body. Young people will discuss the next steps for their care, what the options are, and what they would like to do. These might include staying on puberty suppressing hormones, stopping the treatment, or going on to another treatment. It is not possible to know before starting puberty suppressing hormones what the treatment plan for any single young person will be at the end of the trial. This will depend on several factors, including their experience of puberty suppressing hormones, their mental and physical health, and their preferences for future care. We also do not know whether safety monitoring from the trial more generally may be showing that there are significant risks from this treatment, which could mean it is not a good idea to stay on puberty suppressing hormones.

If a young person wants to stay on puberty suppressing hormones and their doctor in the NHS Children and Young People’s Gender Service agrees that they may continue to benefit from it, their care will be reviewed again by the NMDT, who will need to agree that they should stay on puberty suppressing hormones. If the NMDT don’t agree, they will give the young person reasons why they think this is not the right ongoing care for them. If they make that decision and the young person’s circumstances change so the reasons they gave no longer apply, the young person’s doctor can ask for another review of your care. If a young person stays on puberty suppressing hormones their care will need to be reviewed by the NMDT every year while they are on it, to check it is still the right treatment for them.'

I thought this had been made illegal in the UK for under 18s

'3.1 What is the ethical basis for PATHWAYS TRIAL?

Randomised controlled trials are undertaken when there is uncertainty about the effectiveness and/or the safety of an intervention. This is called equipoise and means that there is a roughly equal chance of either outcome – in this case whether the treatment is helpful overall or it is not helpful overall, when balancing any benefits and there is a reasonable chance that a randomised controlled trial will help find that it is helpful overall or unhelpful overall. We described above (Section 1.3) how the evidence for either benefits or risks of puberty suppressing hormones is very uncertain. This means that we are at clinical equipoise for puberty suppressing hormones and there is a reasonable chance that a randomised controlled trial will find that it is overall helpful or overall unhelpful.

There are also questions about the balance of longer-term effects between those that are helpful (for example better psychological adjustment, better alignment of body shape with gender) and those that are harmful (bone health, possible effects on brain development and sexual health). These are important questions, but we don’t know the answers yet. We first need to examine short-term effects and then follow young people up into adult life. This is why PATHWAYS TRIAL is so important.'

'3.4 Why can't research rely on retrospective records from gender services who have previously prescribed puberty suppressing hormones?

Retrospective studies are important, but they won’t answer the question about the balance between benefits and risks of puberty suppressing hormones for several reasons. Firstly, this is because we have seen an increase in the number of young people experiencing gender incongruence and seeking care in recent years. We think this group of young people are likely to be more diverse in terms of their personal characteristics and previous experiences and could have different support needs to those who have attended NHS gender services in the past. So, it’s important to study the needs and experiences of this specific, current group of young people over time.

Secondly, to be able to understand the range of potential benefits or risks that young people receiving puberty suppressing hormones may experience, researchers need detailed records from when they were receiving puberty suppressing hormones as children or young people, using the same measures for everyone. Previous records which include the wide range of outcomes that will be assessed in PATHWAYS TRIAL are not available.

Thirdly, young people receiving puberty suppression in the new Gender Service will also get comprehensive non-hormonal care at the same time, which is important to factor in. These changes in other treatments means they might respond differently to puberty suppressing hormones. Finally, observational data cannot show a cause-and-effect relationship meaning it cannot determine whether any observed benefits or harms are a result of the puberty suppressing hormone treatment, or whether they are attributable to other factors, either about the participants or other aspects of the care they receive including psychological support. A randomised controlled trial helps to eliminate some of these biases and confounding factors, allowing for stronger conclusions about the benefits or harms caused by the treatment. '

Why are they using the phrase "young person" instead of "child" when the study terms dictate that the only eligible people will be children?

It reads very differently when you replace it with the word child.

That doc says they use 'child' for those under 12, and 12-18 y.o. use 'young people'.

The Scottish govt are very keen on this, too.