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EasternStandard · 22/02/2026 17:34

HerefordshireLass · 22/02/2026 17:27

“It feels to me like they are responding to political pressure rather than to science.”

Annoying when that happens isn't it, Hilary?

Geez at that quote. How about reality ethics concerns? We are meant to take that into account not do whatever.

Fidgetbreak · 22/02/2026 18:08

Cass couldn't possibly consider the initial approval was a mistake. It's not like she has done any reports which highlight significant mistakes from the medical community.

"you should not be subjecting children to a flawed study.…"
I agree with this bit, but I'd say the whole trial has been massively flawed from the start. Please stop.

JellySaurus · 22/02/2026 19:01

HoppityBun · 22/02/2026 17:11

Apparently Dr Cass is critical of the suspension of the trial.

“I have not changed my position an inch since I wrote my report, and yet, suddenly, people from the gender-critical side of the debate
seem surprised or discomforted that I'm supporting a trial,” she said.
“I called for a trial two years before the report, and I said in the report that everything that we do to these young people needs to be done in the context of a proper research programme, because otherwise we can't improve what we're doing for them.”

Cass told The Observer she was “disappointed” by the MHRA’s intervention. “There are no new research findings and the MHRA hasn’t presented any new evidence,” she said. “It feels to me like they are responding to political pressure rather than to science.”
The trial was launched after Cass’s 2024 review of gender services, which said research was needed since there was little evidence whether or not puberty- suppressing hormones helped children with gender dysphoria. After the paediatrician’s report, the NHS stopped use of the drugs at gender identity clinics, although they continue to be used for children whose puberty begins abnormally early.
Cass said the trial was necessary because “we genuinely don’t know if some children will benefit or have no benefit”.
By raising the age limit to 14, it would cut out children who might benefit, which “will make the results invalid”, Cass said. “It would make the design really, really flawed and you should not be subjecting children to a flawed study.…

Certainly research is needed on how best to support or treat these children. But this is not research. This is severely flawed experimentation.

MyAmpleSheep · 22/02/2026 19:13

Brainworm · 22/02/2026 13:37

That’s my understanding too.

Jolyon Maugham’s analogy of researching the efficacy of condoms when applied after sex made a fair point.I think his take that this is part of a conspiracy to conclude that they ‘don’t work’ is off.

I don’t think the proposed trial makes it clear what the purpose of blocking puberty is, which might account for the MRHA considering a 14+ study viable.

A useful interjection from Cass would be to explain what she thinks the delay enables or improves. She ruled out ‘time to think’ stating there was evidence that this isn’t an outcome.

Show quote history

Jolyon Maugham’s analogy of researching the efficacy of condoms when applied after sex made a fair point.

I don't think so. If a trial of putting condoms on after sex showed that it was dangerous because it made a man's penis fall off then it wouldn't be ethical to have a trial about putting them on before sex to see if that was better.

The NHS website says

The PATHWAYS Trial is a UK-wide clinical study investigating the effects of puberty-suppressing medication in children and young people (CYP) who experience gender incongruence...
The medication being studied is a gonadotropin-releasing hormone analogue (GnRHa), which temporarily pauses puberty. Although this treatment is already used in some countries, there is limited high-quality evidence about its benefits and risks in this context. The PATHWAYS Trial aims to provide robust, independent possible evidence on benefits and harms.

The trial isn't therefore primarily about "pausing puberty" - its about the effects of GnRHa.

It still makes sense to me to look for benefits and harms when provided from the age of 14.

nicepotoftea · 22/02/2026 19:25

MyAmpleSheep · 22/02/2026 19:13

Jolyon Maugham’s analogy of researching the efficacy of condoms when applied after sex made a fair point.

I don't think so. If a trial of putting condoms on after sex showed that it was dangerous because it made a man's penis fall off then it wouldn't be ethical to have a trial about putting them on before sex to see if that was better.

The NHS website says

The PATHWAYS Trial is a UK-wide clinical study investigating the effects of puberty-suppressing medication in children and young people (CYP) who experience gender incongruence...
The medication being studied is a gonadotropin-releasing hormone analogue (GnRHa), which temporarily pauses puberty. Although this treatment is already used in some countries, there is limited high-quality evidence about its benefits and risks in this context. The PATHWAYS Trial aims to provide robust, independent possible evidence on benefits and harms.

The trial isn't therefore primarily about "pausing puberty" - its about the effects of GnRHa.

It still makes sense to me to look for benefits and harms when provided from the age of 14.

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But what would be the point if the goal is to prevent puberty?

We already prescribe GnRHa for a variety of reasons post puberty.

MyAmpleSheep · 22/02/2026 19:40

nicepotoftea · 22/02/2026 19:25

But what would be the point if the goal is to prevent puberty?

We already prescribe GnRHa for a variety of reasons post puberty.

Show quote history

But the goal of the study isn't "to block puberty". It's to, as stated in the study, look for benefits and harms of GnRHa drugs.

If it's being sold to participants as stopping their puberty, that's a PR issue.

We already prescribe GnRHa for a variety of reasons post puberty.

Not, apparently, to people with gender incongruence issues.

BettyBooper · 22/02/2026 19:51

Shedmistress · 22/02/2026 15:53

Didn't she attend a meeting to agree the trial before the report that carries her name was published?

I expect that somewhere along the lines a behind the scenes agreement to carry out a trial was part and parcel of the report being allowed to be published.

From 2023. Sorry about the blurriness in advance...

Puberty Blocker Trial Paused
Puberty Blocker Trial Paused
tropicaltrance · 22/02/2026 19:51

I've been reading Hannah Barnes's book today. They were originally only prescribed from age 16 upwards - that was experimental and reducing the age ever lower was also experimental and the result of pressure. There is no coherent explanation or evidence base behind the basic premise of this trial.

It's all become so corrupted and distorted over time that I don't think they even know what they're arguing for anymore. If they do, they're certainly not articulating it successfully. Why is Cass protesting that these drugs should be given to young children? What kind of paediatrician wants to experiment on children to see what happens if you prevent them from going through puberty? Why?

Government is too much of a boys' club to bother thinking about any of this deeply enough to deal with it appropriately. That's why we're in this mess.

Brainworm · 22/02/2026 19:55

MyAmpleSheep · 22/02/2026 19:40

But the goal of the study isn't "to block puberty". It's to, as stated in the study, look for benefits and harms of GnRHa drugs.

If it's being sold to participants as stopping their puberty, that's a PR issue.

We already prescribe GnRHa for a variety of reasons post puberty.

Not, apparently, to people with gender incongruence issues.

Edited
Show quote history

We know that the medication blocks puberty, we know the side effects of these medications as they have been identified from use with other conditions. The Pathways trial is about exploring the impact on gender incongruence related symptoms and outcomes

The MHRA intervention asks for tighter monitoring of known negative side effects so medication / participation will be halted if/when they occur.

tropicaltrance · 22/02/2026 19:59

Brainworm · 22/02/2026 19:55

We know that the medication blocks puberty, we know the side effects of these medications as they have been identified from use with other conditions. The Pathways trial is about exploring the impact on gender incongruence related symptoms and outcomes

The MHRA intervention asks for tighter monitoring of known negative side effects so medication / participation will be halted if/when they occur.

Show quote history

Why is that the purpose of the pathways trial though?

Why is it not exploring the impact of any other pathway except this one?

nicepotoftea · 22/02/2026 20:19

MyAmpleSheep · 22/02/2026 19:40

But the goal of the study isn't "to block puberty". It's to, as stated in the study, look for benefits and harms of GnRHa drugs.

If it's being sold to participants as stopping their puberty, that's a PR issue.

We already prescribe GnRHa for a variety of reasons post puberty.

Not, apparently, to people with gender incongruence issues.

Edited
Show quote history

Not, apparently, to people with gender incongruence issues.

And the reason they are suggested as a treatment is to prevent puberty, and the reason that the study has been paused is because 'blocking' puberty, among other things, causes infertility.

I don't think it's possible to separate the use of the drugs from their purpose.

moto748e · 22/02/2026 20:35

We already prescribe GnRHa for a variety of reasons post puberty

I thought that was only done in cases where there was a serious medical problem?

HildegardP · 22/02/2026 20:59

nicepotoftea · 22/02/2026 19:25

But what would be the point if the goal is to prevent puberty?

We already prescribe GnRHa for a variety of reasons post puberty.

Show quote history

Those prescriptions are last-resort & time-limited to periods far briefer than either the original study proposal or the MHRA suggestion, not least because of the known risk of depression & suicidality that they carry, even in adult subjects.

nolongersurprised · 22/02/2026 21:12

TwoLoonsAndASprout · 22/02/2026 12:56

But what is the research justification?

By which I mean, why do we think that stopping puberty will improve the quality of life of prepubescent kids with gender incongruence? What are the previous studies that suggest that this specific thing might be worth examining as a treatment with this specific outcome?

Like, do we have previous studies that show that stopping puberty was effective in treating some other mental health issue? Or do we have studies that show that something chemically similar to puberty blockers, but not the same drug, had a positive effect on the mental health of kids with gender incongruence? Like, how are we getting to “I know, let’s stop their puberty?” rather than any other flipping thing? Why not, as I’ve said before, prescribe eating ground up glass for breakfast? It seems to have the same level of justification.

You don’t just pull these things out of a hat unless you want to retroactively justify their use when they have already been prescribed for totally different reasons.

This is what I cannot, as a researcher, get my head around.

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My impression, is that, as with the original Dutch study, what adult men have said they wanted is the driving force behind it all.

The Dutch study was done in response to TiMs lamenting that they didn’t pass. The cohort in the Dutch study was not deemed otherwise mentally unwell, whereas the trans-identified children now are usually very unwell, with multiple mental health co-morbidities.

These children’s mental health distress is often centred around what they deem treatment, ie blockers, hormones etc. Whereas in the original study it was the OUTCOME that was supposed to improve functioning, not the PROCESS.

It’s unsurprising that social media, the media, activists etc have somehow convinced children that they need blockers etc or they’ll be suicidal but it’s kind of crazy that we’re at this point now,

nicepotoftea · 22/02/2026 21:57

nolongersurprised · 22/02/2026 21:12

My impression, is that, as with the original Dutch study, what adult men have said they wanted is the driving force behind it all.

The Dutch study was done in response to TiMs lamenting that they didn’t pass. The cohort in the Dutch study was not deemed otherwise mentally unwell, whereas the trans-identified children now are usually very unwell, with multiple mental health co-morbidities.

These children’s mental health distress is often centred around what they deem treatment, ie blockers, hormones etc. Whereas in the original study it was the OUTCOME that was supposed to improve functioning, not the PROCESS.

It’s unsurprising that social media, the media, activists etc have somehow convinced children that they need blockers etc or they’ll be suicidal but it’s kind of crazy that we’re at this point now,

Show quote history

If the puberty blockers in themselves were supposed to relieve distress, I suppose you could hypothesise that the act of delaying puberty for a couple of years might improve mental health, but the lack of children who have been prescribed PBs and then don't go on to have further 'gender affirming treatment' already suggests that this isn't the case.

Prettyneededbread · 22/02/2026 22:15

Wasn't the Cass report also criticising the use of PB in girls, as there was no rationale for their use, since testosterone is a very potent masculinising hormone? At the time I thought the trial might even exclude girls!
I really don't understand Dr Cass anymore, she is contradicting so much of what's written in the report.

DameProfessorIDareSay · 26/02/2026 16:29

Hannah Barnes:

https://archive.is/wJBgy#selection-981.0-981.54

"Inside the decision to pause the puberty blocker trial
The MHRA’s U-turn raises questions over regulatory process"

DameProfessorIDareSay · 26/02/2026 16:30

And here is the statement from Streeting:

https://questions-statements.parliament.uk/written-statements/detail/2026-02-26/hcws1369

TheywontletmehavethenameIwant · 26/02/2026 16:34

DameProfessorIDareSay · 26/02/2026 16:30

Woo, does it mean he's going after the info that Cass wasn't able to get, so it can be used and there'll be no need to collect more, in the foreseeable future at least?

borntobequiet · 26/02/2026 16:42

Thank goodness for Hannah Barnes and her tireless work exposing this.

ThreeWordHarpy · 26/02/2026 16:46

DameProfessorIDareSay · 26/02/2026 16:30

At longer bloody last. Let’s hope that this time the clinics comply and don’t mysteriously lose the files.

DameProfessorIDareSay · 26/02/2026 16:47

"The study was planned to take place during the lifespan of the Cass Review, and a statutory instrument was brought forward in 2022 to protect those disclosing protected information for the study. However, it is well documented that some clinics did not share data to allow the study to commence and the study was therefore not completed as planned. Further to this, it is the government's view that the 2022 order now needs to be updated to sufficiently protect those who will now be sharing information for the purposes of the study."

Well they didn’t comply the first time for a Conservative health minister, so wonder how Streeting will fare?

RedToothBrush · 26/02/2026 16:59

DameProfessorIDareSay · 26/02/2026 16:47

"The study was planned to take place during the lifespan of the Cass Review, and a statutory instrument was brought forward in 2022 to protect those disclosing protected information for the study. However, it is well documented that some clinics did not share data to allow the study to commence and the study was therefore not completed as planned. Further to this, it is the government's view that the 2022 order now needs to be updated to sufficiently protect those who will now be sharing information for the purposes of the study."

Well they didn’t comply the first time for a Conservative health minister, so wonder how Streeting will fare?

It'll be interesting. I do believe the government have the power to force it because there are so many in the public interest caveats that apply which override data law and issues on this one. I thought this all along.

It's fascinating that a new study was seen as preferable to doing this in the first fucking place though.

I expect this one will end up in court too btw.

TheywontletmehavethenameIwant · 26/02/2026 17:04

RedToothBrush · 26/02/2026 16:59

It'll be interesting. I do believe the government have the power to force it because there are so many in the public interest caveats that apply which override data law and issues on this one. I thought this all along.

It's fascinating that a new study was seen as preferable to doing this in the first fucking place though.

I expect this one will end up in court too btw.

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I expect this one will end up in court too btw.

Who between, genuine question, will the country's government have to take the country's health trusts to court, because that would be bonkers.

All though good for us because if they're not going to revisit the trail question until they've got the data, and had time to analysis the date, the longer it takes for them to get the data the better. 🥳

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