December 2025
Executive Summary
The UK government faces intense controversy over the PATHWAYS clinical trial scheduled to begin in January 2026, which will administer puberty-blocking drugs to approximately 226 children aged 10-15. Despite making puberty blockers illegal outside research contexts in January 2025, Health Secretary Wes Streeting has approved the trial while admitting he is ‘deeply uncomfortable’ with it and ‘wrestles with’ the decision daily.
Public opposition is overwhelming: 63% of UK adults want the trial stopped, rising to 70% among parents. The controversy has sparked protests, legal challenges, a Labour backbench revolt, and condemnation from across the political spectrum.
Current Situation
The Legal Framework
On 1 January 2025, an indefinite ban on puberty blockers for under-18s came into effect following recommendations from the Commission on Human Medicines, which determined that prescribing these drugs for gender dysphoria represents an ‘unacceptable safety risk’ for children. The ban applies to all private and NHS prescriptions outside of research contexts.
However, the PATHWAYS trial creates an exception. Children as young as 10 will receive these drugs deemed too dangerous for routine use, creating what critics call a fundamental contradiction.
The Trial Design
The trial will involve 226 children under 16, randomised into two groups: one receiving puberty blockers immediately, the other after a 12-month delay. All participants will be monitored for two years. The study is led by Professor Emily Simonoff of King’s College London and funded by NHS England with £10-10.7 million.
Critical design flaws identified by critics:
No true control group - both groups ultimately receive the drugs
Only two-year follow-up period, inadequate for assessing long-term effects
Cannot be double-blind as effects are immediately visible
Approximately 12.5% of current gender clinic patients are excluded due to already self-medicating with hormones
Public Opinion and Political Response
Overwhelming Public Opposition
A nationally representative poll conducted 12-14 December 2025 by Whitestone Insight revealed:
63% want the trial stopped (only 14% disagree)
70% of parents believe puberty blockers should never be given to under-18s, even in trials
74% believe services should focus on psychological support rather than medical intervention
59% of 2024 Labour voters oppose the trial (only 23% support it)
Opposition cuts across all political affiliations and demographics
Ministers Supporting the Trial
Wes Streeting (Health Secretary)
Has approved the trial despite admitting he is ‘not comfortable’ with it and stating that medication that ‘delays or indeed stops a natural part of our human development, which is puberty, I am deeply uncomfortable with.’ He claims to be following clinical advice and says he ‘wrestles with every day’ over the decision.
Streeting reported his constituency office windows have been smashed three times by trans activists and he has received ‘all sorts of threats’ since the trial was announced.
Prime Minister Keir Starmer’s position remains unclear - Downing Street has not confirmed whether he is comfortable with the trial.
Ministers and MPs Against the Trial
Conservative Party Opposition
Kemi Badenoch (Conservative Leader) - Called for it to be stopped ‘before more damage is done’
Dr Caroline Johnson (Shadow Health Minister, consultant paediatrician) - Questioned funding experiments on ‘physically healthy children’
Liz Truss (former PM) - Called it ‘evil’ and said ‘it should be a crime’
Labour Backbench Revolt
Multiple Labour MPs are opposing the trial, creating a significant backbench revolt:
Jonathan Hinder MP - Called the trial ‘uncivilised’
Rosie Duffield MP - ‘I cannot believe I came to Parliament to have to point out that we should NEVER use experimental/irreversible drugs in trials on children under 13’
Preet Kaur Gill MP - Concerns about safeguarding warnings not being heard
Multiple unnamed Labour MPs expressing private concerns to media
Reform UK
Nigel Farage - Called it ‘state-sponsored child abuse’ and wrote to PM demanding it be halted
Rupert Lowe MP and Iqbal Mohamed MP - Both vocally opposed
Origins and Key Players
Whose Idea Was It?
The trial recommendation came from Dr Hilary Cass in her 2024 Review, which concluded there was ‘remarkably weak evidence’ to support gender treatments for children. However, critics argue that while Cass recommended a trial to ‘fill gaps in the evidence,’ the actual trial design contradicts her broader findings that puberty blockers are ‘powerful drugs with unproven benefits and significant risks.’
Critics from organisations like Transgender Trend argue the trial ‘takes us from the evidence of Cass back to the ideological belief of the Tavistock, a service that was judged to be unsafe and closed down,’ suggesting activists have manipulated Cass’s recommendations as cover.
Organisations Supporting the Trial
NHS England - Commissioning and funding the trial
King’s College London - Leading the research (Professor Emily Simonoff)
National Institute for Health and Care Research (NIHR) - Working with NHS England
Some trans advocacy groups who view it as access to treatment
Organisations Opposing the Trial
LGB Alliance - CEO Kate Barker argues the trial will ‘trans away the gay’ given that 89% of girls and 81% of boys at the former Tavistock clinic were same-sex attracted
Sex Matters - Pursuing legal challenges
Transgender Trend - Commissioned opposition polling
Genspect - Advocating non-medical approach
Christian Concern - Organised protests
Bayswater Support Group - Legal challenge alongside Keira Bell and James Esses
Key Statistics and Facts
Trial Numbers
226 children to be recruited over three years
Youngest participants: 10-11 for biological females, 11-12 for biological males
Upper age limit: 15 years and 11 months
Cost: £10-10.7 million
Two-year monitoring period
150 participants will undergo MRI brain imaging (Pathways Connect study)
Self-Medication Crisis
Close to one in eight (12.5%) young people at Great Ormond Street Hospital’s gender clinic have disclosed self-medicating with irreversible masculinising or feminising hormones purchased online. This automatically excludes them from the trial, raising questions about who the trial actually serves.
A 2014 study found one in four trans women self-prescribe cross-sex hormones before attending gender clinics, primarily via the internet.
Historical Data
89% of girls and 81% of boys at the Tavistock clinic were same-sex attracted
98% of children started on puberty blockers progress to cross-sex hormones
Approximately 80% of children naturally grow out of gender dysphoria after going through puberty
International Context
Countries Restricting Puberty Blockers
Sweden
In 2022, authorities stated risks likely outweigh benefits. Hormone treatment continues only within research frameworks in exceptional cases.
Finland
Hormonal treatments given only if identity as another gender is clearly of ‘permanent nature and causes severe dysphoria.’
Denmark
Dramatic shift: patients receiving hormone treatments fell from 67% in 2016 to just 10% in 2022. Most youth now receive therapeutic counselling instead.
Norway
Puberty blockers limited to clinical trials.
France
National Academy of Medicine recommended ‘greater reserve’ in 2022 regarding puberty blockers.
Italy
National Bioethics Committee recommended in November 2024 that puberty blockers should only be provided after mental health interventions fail, and only in research trials.
Germany
Situation described as ‘very confused’ with trans-affirmative guidelines but increasing critical voices pointing to lack of scientific evidence.
Countries Still Prescribing
Spain, Poland, Japan, South Africa, The Netherlands, Switzerland, Belgium, Mexico, Canada, Australia, and New Zealand continue to prescribe puberty blockers, though often with varying levels of restriction and oversight.
Political Context in Europe
Far-right European politicians have led many recent restrictions, though leaders of progressive parties have also advanced restrictive policies. The UK ban was first implemented by Conservative leadership but continued and made permanent by Labour, making it an unusual case of cross-party consensus on restriction.
Recent Events - December 2025
17 December Protest
Protesters gathered outside the Department of Health and Social Care in London, bringing together diverse groups including LGB Alliance and Christian Concern. Baroness Claire Fox spoke at the protest. Passing vehicles honked in support.
The same day, Streeting admitted in Parliament that children cannot consent to the trial - they can only provide ‘informed assent’ with formal consent from parents or guardians.
Legal Challenges
Keira Bell (detransitioner), James Esses (psychotherapist), and the Bayswater Support Group launched a High Court challenge to stop the trial, arguing it fails to safeguard children’s rights, safety and wellbeing, and is unlawful given the limited known benefits of puberty blockers.
Upcoming Parliamentary Scrutiny
The Women and Equalities Committee is scheduled to hold a session on 22 January 2025 exploring the evidence base on the safety and clinical effectiveness of puberty blockers.
Core Arguments
The Fundamental Contradiction
Critics highlight an inescapable paradox: the Commission on Human Medicines determined that prescribing puberty blockers represents an ‘unacceptable safety risk’ for under-18s, leading to a complete ban. Yet the same government is now funding a trial giving these drugs to children as young as 10. If the drugs are too dangerous for routine use, how can they be acceptable for experimental research on minors?
The ‘Transing Away the Gay’ Argument
LGB Alliance CEO Kate Barker argues that with 89% of girls and 81% of boys at the Tavistock clinic being same-sex attracted, the trial risks medicalising homosexuality. She contends this makes Wes Streeting’s position particularly fraught as the first openly gay health secretary, potentially becoming complicit in a process that targets gender-nonconforming children who would likely grow up to be lesbian, gay or bisexual.
Consent Issues
Streeting himself admitted that children cannot consent to the trial - they can only provide ‘informed assent’ with parental consent. Critics argue this makes the trial inherently unethical, as children cannot fully understand the implications of permanent infertility, sexual dysfunction, and lifelong medical dependency that may result.
The Evidence Gap
The Cass Review found evidence for puberty blockers to be ‘remarkably weak,’ with no credible psychological benefits and concerning risks to bone density, brain development, and sexual maturation. Critics argue we already know puberty blockers don’t work and cause harm - we don’t need another trial. They point to approximately 9,000 children who went through the Tavistock, including an estimated 2,000 on blockers, whose outcomes remain unstudied.
Conclusion
The puberty blockers controversy represents a collision between political ideology, medical ethics, public opinion, and children’s welfare. With 63% public opposition, a Labour backbench revolt, legal challenges, and condemnation across the political spectrum, the trial faces unprecedented resistance.
The trial is scheduled to begin recruitment in January 2026. Whether it proceeds as planned or becomes another chapter in the UK’s reassessment of paediatric gender medicine remains to be seen.
What is certain is that the UK has become an international outlier - not in banning puberty blockers, as several European countries have done, but in banning them as unsafe while simultaneously using them in government-funded experiments on children.
Document prepared: December 2025