Today I am updating the House about NHS England’s decision to consult on a new clinical commissioning policy on the prescribing of masculinising or feminising hormones for children and adolescents with gender incongruence or dysphoria.
The safety and wellbeing of children and young people is paramount, and children’s healthcare must always be led by evidence and expert scientific and clinical advice. We are committed to ensuring that NHS children and young people’s gender services provide high-quality care for those with gender incongruence or dysphoria.
Currently, MAF hormones are only available to children and young people aged 16 and 17, and only in very limited circumstances. In line with the Cass review, which this Government and NHS England are committed to implementing, MAF hormones can only be prescribed with “extreme caution” and where there is a strong clinical rationale for not waiting until age 18.
Following an independent review of evidence, this consultation proposes that MAF hormones should no longer be available as a routine commissioning option through the NHS CYP gender service. The consultation, which will last for 90 days, sets out this proposal, and asks consultees whether all relevant evidence has been considered. NHS England will carefully consider the responses to inform next steps.
Throughout the consultation period and until NHS England has responded to the consultation, NHS England is pausing its existing clinical policy with immediate effect to safeguard children and young people. This means that no new prescriptions for MAF hormones will be initiated through the NHS CYP gender service, at least until the point when a final policy is determined, following full consideration of consultation feedback.
The full range of clinical support interventions, described by the national service specification, remain available for patients who are in the CYP gender service, including psychological and psychosocial support. Individuals who are on the national waiting list for CYP gender services will either have had previous arrangements made for them to access local CYP mental health services, or they would have had contact with CYP mental health services or NHS paediatric services at the point of referral, with care plans in place.
Young people aged 16 and 17 years who are receiving existing NHS prescriptions of MAF hormones may continue their prescriptions under the care of the NHS CYP gender service. Each individual’s lead clinician will need to undertake a review of the circumstances of the patient’s care plan and make a shared decision with the young person—and family, as appropriate—about the future treatment approach within an enhanced informed consent process.
Evidence base
NHS England can only commission treatments based on evidence of clinical effectiveness, and with appropriate assurances around safety. This important principle applies to all treatments, not just for gender incongruence and dysphoria.
In 2021, an independent evidence review by the National Institute for Health and Care Excellence found that there is very limited evidence about the safety, risks, benefits and outcomes regarding the prescribing of MAF hormones to young people under 18 years of age.
In line with the Cass review, NHS England made changes to its existing clinical policy to place restrictions on the use of MAF hormones. This meant that MAF hormones could only be prescribed to 16 and 17-year-olds if a recommendation for their use was supported by the NHS CYP gender service and a national multi-disciplinary team.
Dr Cass also recommended that NHS England review its policy on MAF hormones. NHS England began that review in 2025, and commissioned an independent third party to undertake a further evidence review of published evidence. This included research that had been published since NICE’s review of the evidence in 2021.
The evidence reviews found very limited and weak evidence to support the continued access to MAF hormones by children and young people under the age of 18 years. After careful consideration, NHS England has concluded that there is not enough evidence to support the safety and clinical effectiveness of MAF hormones to make the treatment routinely available.
In addition to NHS England’s consultation, the Government have been examining the private prescribing of MAF hormones by the independent sector, including overseas practitioners. The Department will continue to closely monitor this position with regards to any implications and next steps. NHS England will reissue guidance from May 2025 that advises GPs not to agree shared care arrangements with unregulated providers who offer access to masculinising and feminising hormones to under 18s.
The Department is also awaiting the results of the Medicines and Healthcare products Regulatory Agency’s engagement on the Pathways trial, following concerns that it raised regarding the protocol. Any potential implications of this revised prescribing policy for the Pathways trial will be considered and discussed with the regulators during the period of consultation, and any further announcements will be made in due course.
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