NHS England has announced a pause on new referrals for masculinizing or feminizing hormone treatments for transgender patients under the age of 18, a move that comes amid ongoing policy changes in the United Kingdom’s youth gender care system.
The decision affects new patients aged 16 and 17 seeking gender-affirming hormone therapy through the National Health Service. Those already receiving treatment will be allowed to continue, but their care will now be reviewed individually with clinicians.
NHS England said the pause follows a review of clinical evidence commissioned after the 2024 Cass Review, a major government-ordered examination of gender identity services for children and adolescents. According to the health service, the evidence currently available does not clearly demonstrate whether hormone treatment for under-18 patients is beneficial or harmful.
As a result, the NHS has launched a 90-day public consultation on whether to permanently remove hormone therapy as a routine treatment option for minors with gender dysphoria. During that consultation period, clinicians will not be able to refer new under-18 patients for these medications through NHS gender services.
The treatments in question involve prescribing testosterone or estrogen to help transgender patients develop physical characteristics aligned with their gender identity. These medications can produce permanent physical changes such as voice deepening from testosterone or breast development from estrogen.
The policy shift marks the latest development in a broader restructuring of youth gender care in England. In 2024, the NHS stopped routinely prescribing puberty blockers to minors outside of clinical research trials following recommendations from the Cass Review.
Advocacy organizations have strongly criticized the new pause. Tammy Hymas, policy lead at the UK transgender advocacy group TransActual, called the decision “a profound attack on young people’s bodily autonomy,” arguing that transgender youth are again being singled out in healthcare policy debates.
Supporters of the change, however, say the move reflects caution around treatments that can have long-term effects. Helen Joyce of the campaign group Sex Matters argued that minors are not able to fully understand the consequences of medical transition and welcomed the NHS decision.
NHS officials say that despite the referral pause, transgender youth will still have access to specialist gender services, mental health support, and clinical assessment through newly established regional programs designed to replace the former Gender Identity Development Service.
Once the consultation period ends and responses are reviewed, NHS England is expected to publish a final policy determining whether hormone therapy will remain available to minors within the public health system.
For now, the pause represents another significant shift in the UK’s approach to transgender healthcare for young people, a topic that continues to generate intense debate among clinicians, policymakers, and advocacy groups.
