A trial of puberty blockers for children under 16 has received major backlash, undermining a previous government ban.
In March 2024, the NHS banned puberty blockers for under-18s indefinitely. An investigation of the prescription practices revealed them to be unsafe, uncovering cases of children being prescribed hormone blockers by foreign medical practitioners after filling out an online form and having a brief call.
Following this, the use of puberty blockers was prohibited for the treatment of gender incongruence and dysphoria.
In response, King’s College London announced the ‘PATHWAYS’ trial, facilitating the use of puberty blockers for children under 16 diagnosed with gender incongruence.
Set to launch in January 2026, it will evaluate the effects on physical, social and emotional well-being, gaining an estimated 226 participants. Separated into two randomised groups, both will receive puberty-blockers, with one group starting treatment a year later than the other.
The aim of this trial is to gather additional evidence about the possible benefits and risks. Thus far, research on the topic has been inconclusive, according to Baroness Hillary Cass, who is responsible for the Cass Review and the ‘PATHWAYS’ trial.
The potential benefits include better adjustment in social settings, increased comfort in one’s body, and alleviation of symptoms of depression and anxiety. The potential risks, however, include negative effects on brain development, bone density, fertility, and more.
The trial has faced vast opposition. Sceptics and people with negative transition experiences have spoken out against the trial, and written to the Health Research Authority urging the trial’s halt.
Keira Bell, a female at birth, who transitioned to male as a teen and has since come to regret it, told the BBC that “children are essentially going to get harmed.”
Despite this, many people who began transitioning at a young age cite it as completely pivotal in improving their mental health as they entered adulthood.
Nate* is a 21-year-old trans man who has been taking testosterone for the past three years. Coming out publicly in 2020, he says he had always felt this way, but didn’t know about the concept of being transgender. When he learned about it, everything fell into place.
“In primary school, I always told my friends I was secretly a boy, and my mom just wanted me to be a girl. I was obviously doing this completely innocently; I didn’t know what I was thinking.”
While it took a while for his parents to accept such a massive change, and his mother is still coming to terms with it, his friends and siblings were all immediately supportive. Some even said they had seen it coming.
Nate explained the process of beginning a medical transition. “I never even tried to go through the NHS, because I had heard so many horror stories, and the waiting lists are so long. I went private straight away. I was lucky that I had a job and was able to afford it.
“Getting a gender dysphoria diagnosis is long and difficult. You feel like you’re always having to prove yourself, and if you don’t meet their criteria of what a trans person is supposed to look or feel like, you’re denied it, or the process is prolonged.
The company he used was GenderGP. He says many look down upon it, due to how easy they make it to secure a prescription.
“It’s all done online, all the consultations. Nothing’s ever really face-to-face. They just kind of trust that you’re getting blood tests occasionally; no one ever really checks up on you or your hormone levels.”
He assures me he does get routine blood tests, monitoring his hormone levels himself, and adjusting the testosterone dosage accordingly.
I ask if he wishes he had started earlier. “If you had asked me at 18, I would have told you yes. At that point, it felt like a need. But now, I do think it’s a good thing I had a few years to adjust socially and think about what a transition would entail for me, and whether I want one at all,” Nate said.
“I think there are points to be heard from both sides. Obviously, there’s people like me that never go back, but there’s a handful that do, so I do think an age limit feels like a sensible choice.”
Having transitioned at a relatively young age, I ask whether it had a positive effect on his emotional and mental well-being, given that that’s what the trial is all about.
Without a doubt, he tells me: “The way I carry myself, navigate life, and my relationships have all improved so drastically. I feel so much more confident, which isn’t even that much, really, but it’s leaps and bounds ahead of how I was at 14 and 15.
“Before I knew about transitioning, it felt like there was a wall holding me back. When I came out, it went away. The further I progress into adulthood and my transition, the more I feel that way.”
On December 17, 2025, I attended a protest outside the Department of Health, opposing the PATHWAYS trial, looking to hear more about the scepticism surrounding it.
I spoke to a member of the group ‘Christian Concern‘. Chris* is a middle-aged man, who medically transitioned to become a woman in his 40s, and has since reversed that decision, and now lives as a man.
“After three sessions with a psychiatrist, I was advised to have a gender change. At that point, I was in my 40s, and since then, I’ve been diagnosed with autism. After hormones and bottom surgery, I am still urged by the NHS to proceed with the transition, even though I am now living as a man. I am a man,” he said.
“For the past seven years, I’ve had to take testosterone every single day just to live. My body doesn’t produce it naturally anymore.”
After a man undergoes surgical removal of the testicles, or an orchiectomy, their body produces little to no testosterone organically. Therefore, reversing the transition will require taking testosterone for the rest of their life.
Ben is a young gay man and a member of the LGB Alliance. After going to university to study sociology, he discovered “gender ideology” and began to identify as non-binary due to being “feminine”.
Some time later, he came to the conclusion that he feels there are only two genders, and he is simply a gay man. Upon publicly retracting his non-binary label, he felt shunned by a large number of his peers in the gay community, demonised for his personal decision, under the pretence that it was damaging to the LGBT cause.
He converted to Christianity as an adult, and says it is the only place he has felt genuine compassion and was able to finally accept himself for who he is.
He fears that it is far too easy for kids to be swayed by “gender ideology” into believing they are trans, leading to an action with life-altering consequences.
“I plead with gay men and lesbians to hear what we have to say. We are not bigots; we come from a broad section of society. I’m a socialist, I have friends that are Conservatives, I have friends that are Labour supporters, it’s a big coalition. The bigotry is coming from the other side.”
As we converse, the counter protest across the street begins to get increasingly rowdy. I head over, looking to get a balanced range of views on the issue.
As I approach, I hear: “HRT HRT, over the counter and for free” through a megaphone, shouted by people wearing face masks, a feature that the protest across the street lacked entirely.
Using the same exact opener, I’m faced with rejection upon rejection. I’m confused. Seeing as most of them are wearing masks, I figure that, perhaps, being recorded is the issue.
I am polite, non-confrontational, introducing myself as a “journalist” and making it clear – I simply want to talk, recording only their voice – no video. My aim was not to argue; it was to get a balanced set of opinions from both sides.
After nobody would engage with me beyond an “ask someone else”, I saw a person in conversation with another journalist, and went over. Listening in, the person was explaining the ‘Gillick competency,’ a framework used by medical professionals to test the competency of a child to make a medical decision of such gravity.
The guidelines are not set in stone. The medical practitioners dealing with the child are responsible for the decision, taking into consideration their age, maturity, and mental capacity. They must determine whether the child understands the potential risks and see whether any coercion has taken place.
A child with gender incongruence, however, in a state of mental distress, is likely to be fairly determined to go through with the procedure, despite knowing of the potential risks. The medical practitioner’s ideological stance on transitioning will also heavily influence how they approach the issue.
This conversation, however, was quickly cut short, as the person was suddenly pulled back by two other members of the group and scolded for speaking with us.
“Stop it! Stop. It. Do not engage!” They were told. Shielding themselves with umbrellas, they hit my fellow interviewer on the head with a trans flag and continued to yell about over-the-counter HRT.
To better understand the mindset of another potential contender for the trial, I found Mike*, who is currently a university student aged 19.
Born male, he publicly identified as a trans girl for a number of years in school, changing his name and pronouns accordingly. Since then, he has gone back on that decision, now living life as a cisgender man.
He first encountered this feeling between the ages of 14 and 15. In treatment for depression at the time, his self-esteem was low, resulting in a profound desire to change himself. “Looking back, I don’t think those feelings were ‘false’, I believe that, at the time, that was genuinely how I felt.”
He cites online communities he frequented at the time as a significant factor in the formation of his beliefs. He recalls his experiences on Discord, a social platform originally designed for gamers, now frequented by a wide range of demographics.
“I remember asking questions about how I was feeling, and strangers that knew nothing about me would give me advice. I don’t think these people were being intentionally manipulative, I think they just resonated with what I was saying, and projected their feelings onto me.”
He recalls some interactions with another trans person at school: “It was weird. It felt like someone that was already trans, pushing someone that hadn’t fully decided, towards a major life decision with no regard for the consequences. They insisted I should get hormone replacement therapy when I turn 16. I’m so glad that didn’t happen.”
As the symptoms of his depression lifted, he came to conclude he was not trans and went back to his birth name and pronouns, leaving the transgender identity behind.
While it was hard to accept, deep down, he was relieved that he didn’t have to navigate the world as a trans person, as the social challenges that come with it are tough.
“I was sure I would face judgment from others, but I just didn’t care anymore. I was focused on bettering myself and was fine with whatever the outcome would be. If these people are really my friends, they’ll just accept me for who I am and move on. I had a much easier time than I thought.”
He considered transitioning medically; however, that was not a viable option for him at the time. “Obviously, I’m glad I didn’t transition, but that’s a very personal decision for everyone. At the end of the day, trans people should be able to exist happily alongside everyone else. After all, they’re not making anybody’s lives that much harder.”
When questioned about the trial, Labour MP Zubi Ahmed put out a statement on behalf of the Department of Health and Social Care, detailing the safety of the ‘PATHWAYS’ trial.
“The trial has been subject to independent scientific, ethical, and regulatory scrutiny and peer review and has received the necessary research approvals. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people’s wellbeing,” the statement said.
“Acceptance into the trial is subject to robust procedures including consent from a parent/carer and informed assent from the young person, a diagnosis of gender incongruence for at least two years, receipt of tailored psychosocial support, and the puberty suppression being deemed clinically appropriate, within the context of a study, by both their NHS care team and the national multi-disciplinary team. The research sponsor is responsible for organising insurance for the trial.”
Featured image by qimono via Pixabay.