England’s National Health Service (NHS) has announced it will block new referrals for gender-affirming hormone therapy for transgender youth under 18, restricting access to evidence-based care and undermining young people’s rights to health, bodily autonomy, and nondiscrimination.
The decision came into force on March 9 and will undergo a 90-day consultation period after which the NHS will issue a longer-term policy. During this period, youth already receiving hormone therapy will be allowed to continue treatment, but clinicians will no longer be permitted to initiate new referrals. The policy applies to publicly provided health care by NHS England and does not affect doctors working in private practice or public healthcare providers in other parts of the UK.
The restrictions are worrying. Medical care for adolescents is typically tailored to the needs of each patient. A blanket prohibition on referrals prevents clinicians from recommending a course of treatment appropriate for a particular young person.
Hormone therapy is widely recognized by major medical associations as a component of best-practice care for some transgender youth. Clinical guidelines generally recommend that treatment be provided following comprehensive psychological assessment and counseling. Medical guidelines also require that practitioners obtain informed consent from patients prior to treatment. A 2024 systematic review found that hormone therapy has been associated with a reduction in gender dysphoria and did not identify any harmful health outcomes.
Research indicates that gender-affirming hormone therapy can significantly improve mental health outcomes for transgender youth, including reductions in suicidality.
NHS England’s decision comes in the wake of the Cass Review, a 2024 government-commissioned study which called for restrictions on gender-affirming medical care. Medical experts have since criticized the study, questioning its review of evidence and clinical practices.
Following the Cass Review, the NHS also restricted access to puberty-delaying medications for transgender youth to clinical trials, a decision criticized by the the British Medical Association. These medications, widely considered reversible, allow young people additional time to explore their gender identity before making decisions about further treatment.
Transgender youth in England have long faced significant barriers to health care. Young people often waited an average of two years for an appointment at a state-run gender clinic. Of those treated at the clinic, only a small share were referred to endocrinology for puberty-delaying medication or hormone therapy.
NHS England should reverse this harmful decision and ensure transgender youth can access evidence-based, gender-affirming care consistent with their rights to health, bodily autonomy, and nondiscrimination.
