This analysis of the proposed PATHWAYS puberty blockers trial is very detailed. I thought I'd create a thread for it to allow for easier finding in the future.
I've included a few excerpts from the beginning of the analysis to give an idea of what it discusses:
https://criticaltherapyantidote.org/2026/01/15/cass-wpath-and-the-puberty-blocker-trial-gender-identity-ideology-undermining-science/
…The new proposed research programme is called Pathways. In many ways, it resembles the first puberty blocker trial, to the extent that it could perhaps be more accurately construed as GIDS 2. One of the overarching aims of the research is “to determine the short/medium-term benefits and risks of GnRHa for puberty suppression” (KCL, 2025: 23). This phrasing is almost identical to that used in the original research submission made for GIDS 1 in 2011 (Barnes, 2023: 53). The research design is different, in that GIDS 1 was an observational cohort study, with no control group for comparison purposes. In fact, GIDS 2/Pathway has picked up and run with the original REC’s suggestion of a deferred treatment group for comparison purposes. This design also relates closely to the suggestion from European Professional Association for Transgender Health (EPATH), i.e. “An alternative might be a waiting-list control group” (2025: 2). Thus GIDS 2: Pathways is a randomised controlled trial, relying on comparison between two groups receiving puberty blockers, with the second group starting puberty blockers a year after the first group. There is no placebo or ‘no treatment’ group for direct and sustained comparison. There is, therefore, no way to establish causality in a strict sense. The research will, no doubt, produce masses of data, including brain scans, but cannot, in its present format, produce definitive outcomes…
…the research protocol for the GIDS 2: Pathways study acknowledges a host of possible risks to be covered in the informed consent process. These side effects are included in an eye-watering , extensive list of possible harms. They range from (in children) depression and altered mood, and (in adults) anxiety, pain, sleep disorders and weight gain (KCL, 2025: 75-6). However, the research protocol crucially fails to mention that many of these are potentially irreversible in nature, which is surely a significant consideration (Lesbians United, 2022: 14). There also seems to be resistance to fully acknowledging the extent of existing research on the proven harms of puberty blockers (i.e. irreversibility of some types of harm, cognitive impairment: Biggs, 2022) and future known risks (regret/detransition; longer term suicide risk as fully transitioned adults: Dhejne, 2011).
In narrow research terms, the case for clinical equipoise needed to justify the trial is therefore very weak. There is a clear admission by the research team regarding the risk of osteoporosis that ”studies show decreased age standardised bone mineral density with GnRHa” (KCL, 2025: 27 PJ: emphasis added). The research programme’s interest lies in “whether these changes are persistent after ceasing GnRHa and/or commencing on gender affirming hormones” (KCL, 2025: 27). This is hard to justify as a compelling argument for exposing participants to what is a known and acknowledged risk of further likely harm. Finding out whether this risk is short-term or long-term, and reversible or irreversible, is not at all an ethically sound reason for exposing vulnerable children to this grossly unacceptable degree of risk….
…The research protocol appears to be constrained within a post-modernist, anti-scientific research paradigm. This is because it is centred on the concept of gender identity as an autonomous driver of social, medical and legal transition. Gender identity is par excellence an unfalsifiable belief, with no substantive agreed criteria or definition. Prescribing puberty blockers to children therefore amounts to providing medical treatment in order to comply with and endorse an unfalsifiable belief system held by the patient and/or parent. It is not at all equivalent to addressing a proven medical or psychiatric condition, despite the trial’s reliance on the ICD-11 diagnostic label of ‘gender incongruence’. Yet it is striking how spurious and misleading parallels are constantly made by its advocates between research into established medical conditions and research into the efficacy of puberty blockers. This is presumably as a way of establishing the legitimacy of the trial’s focus….
… one of the FAQs for the research protocol refers to the participant goals of ‘body alignment with gender’ (KCL FAQs, 2025: 9). This phrase is curiously close to the stated aim of WPATH’s SOC 8 for its patients. This is “to better align their body with their gender identity” (Coleman et al, 2022: S31). There is also perhaps a further clue in the protocol’s frankly reductive and dismissive terminology used for psycho-social and psychological approaches i.e. as ‘non-endocrine intervention for CYP with gender incongruence’ (KCL, 2025: 22).