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- I beg to move,That this House has considered e-petition 751839 relating to the clinical trial into puberty blockers.It is always a pleasure to speak under your chairmanship, Mr Mundell. I sincerely thank everyone I met in preparation for this debate: the legal and medical professionals who shared their expertise and the individuals with deeply personal, lived experience on both sides of this discussion. It goes without saying that this is a complex topic. I am grateful for the time and care that people have taken to help inform this debate.I also thank the petition’s creator, James Esses, and petition supporter and campaigner Keira Bell. I had the pleasure of meeting them ahead of this debate, and they are watching today. Their petition asks that the clinical trial for the use of puberty blockers be cancelled. They believe that medical intervention in this area is dangerous, poorly evidenced and ethically questionable. They have asked Parliament to ensure that children are protected from potential harm.I want to make it crystal clear that this debate is not about trans rights or whether people who identify as transgender have the right to exist and live free from discrimination. This discussion focuses on a clinical and ethical issue: whether puberty blockers should be prescribed to children experiencing gender dysphoria, and specifically whether a new NHS-backed clinical trial into their use should proceed.Puberty blockers are medicines that suppress the production of sex hormones. They press pause on puberty, delaying changes like periods, breast development, voice changes and facial hair growth. Historically, they have been prescribed to children who enter puberty unusually early and, in some cases, for the treatment of cancers or endometriosis. Importantly, they are distinct from gender affirmation or cross-sex hormones. Blockers temporarily pause development, while cross-sex hormones actively induce the physical changes of the opposite sex and are generally irreversible.The petition raises two main areas of concern: the possible long-term medical side effects of puberty blockers, and whether meaningful consent can ever be obtained from a child or adolescent.
- The hon. Gentleman is making a very good start to his speech. I appreciate that this is very contentious, but I am concerned about the manner in which young people—children—are asked questions. The KIDSCREEN-10 index is a primary outcome measure for the PATHWAYS trial, and when I look at the questions, I wonder how my son would have answered them aged 11. One of them asks:“Have your parent(s) treated you fairly?”The truth is that any child at that age would probably say, “No.” Does the hon. Gentleman share my concern that these questions are not fit for purpose?
- I thank the hon. Member for her intervention, but she will understand that it is my job as Chairman of the Petitions Committee to present a fair description of both sides of the discussion, which is what I hope to do.James Esses, who started the petition, is a psychotherapist, and he impressed on me the benefit that good psychiatric intervention could have, without medicalisation. Puberty, he argued, is rarely a picnic for anyone—it can be confusing, uncomfortable, and sometimes miserable—but it is an essential developmental stage, and suppressing it pharmacologically could alter physical and cognitive development in ways we do not yet fully grasp. His argument is not to remove care for children experiencing gender incongruence, but to focus efforts on careful psychological support.Others question the trial’s purpose, noting that puberty blockers have already been paused for new NHS patients with gender incongruence, following concerns about safety. They fear that authorising a new trial implies a level of confidence that the evidence base does not yet justify, arguing that enough data exists to recognise the potential harms, from reduced bone density to uncertain impact on brain development. Continuing could erode the safeguards that protect young people.
- The hon. Member is making great efforts to be balanced in his presentation on behalf of the Petitions Committee. He says this is a complex area, but surely it is actually quite simple: we should not be experimenting on children, particularly as we cannot do double-blind experiments. Those are two fundamental reasons why these so-called experiments should not go ahead.
- I note the sincerity with which the hon. Gentleman makes his remarks. There is the legal and ethical question of whether a child can ever truly consent to something like this.
- I have five children, and have watched half of them go through puberty. They continually change their minds about things. Ethically, I can see no justification for allowing children to be experimented on. What might be a short-term solution could become a permanent solution that people often grow to regret.
- I thank the hon. Member for his intervention, which was, I believe, made with as much sincerity as the previous intervention.
- I believe many children were treated with puberty blockers, among other drugs, before the Gender Identity Development Service programme was closed down. Does the hon. Member know what has happened to all the data from those children who were previously treated, or why it should be necessary to treat any more children with these drugs until enough time has elapsed to enable that data, and the treatment’s consequences, to be verified?
- What I am about to say relates to the right hon. Member’s intervention. It is not unusual in medicine for children to participate in clinical trials, provided that there are robust safeguards, clear parental consent and proper oversight. But can a distressed teenager and a family desperate to help truly grasp these long-term implications? The legal experts I consulted spoke about the delicate ethics at play. Medical research always involves balancing competing risks: the risks of harm from an intervention versus the risks of harm from withholding it.Puberty blocker trials pose unusual challenges as they cannot include placebos, so the design requires special scrutiny to ensure that informed consent is meaningful. There is still work to do to ensure that children and parents fully understand what entering a study means. On the other hand, opponents of the petition—those who support the new trial—say that the only way to reach clear conclusions about safety and efficacy is through rigorous, carefully monitored research. We do not yet know about the potential harms of puberty blockers for treating gender dysphoria, but we do know that the effects of cross-sex hormones can be irreversible.Following the Cass review, NHS England proposed a very different approach from the old Tavistock model, focusing on smaller numbers and much stricter controls. The new design would have national oversight, tight eligibility criteria and a multidisciplinary team around each young person, and only about 5% of participants might receive puberty blockers compared with around 27% who were prescribed them while at Tavistock.Also important is that cancelling the NHS trial would not prevent young people from accessing puberty blockers. In some gender clinics, clinicians report that between 10% and 20% of clients are obtaining them privately or online, outside regulated healthcare systems. Those unmonitored routes carry greater risks because dosages, purity and outcomes are not tracked or supported. Proponents of the trial point out that without direct research we remain in a state of uncertainty, which carries its own risks. If puberty blockers help some young people to avoid serious distress, we need to understand that better.
- Several hon. Membersrose—
- Order. I remind Members that they should bob if they wish to be called. As the debate is heavily subscribed, I am afraid that I will have to impose a two-minute speech limit from the start, and even that will not guarantee that everyone will be called.
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- It is a pleasure to serve under your chairship, Mr Mundell. Any debate in which we are talking about the health and wellbeing of children and young people requires us all to be measured in our remarks, not least in the context of a debate that has been so toxic at times.Our focus in clinical studies and in any treatment that we offer anyone, let alone children, should be: “First, do no harm.” It is that axiom that seems to be at the heart of the Medicines and Healthcare products Regulatory Agency intervention that has paused the puberty blocker trial. To summarise where we have got to with the PATHWAYS trial, parents are being asked to consent to a potentially life-altering intervention to their children in the absence of a life-threatening condition, based on an unreliable diagnosis with an unknown trajectory.I urge the Government to go one step further and cancel the trial altogether, not least because there are alternative approaches for us to establish the facts regarding the use of puberty blockers, and to do so with an approach that is compassionate, understanding and holistic. The only question we should be asking in relation to gender dysphoria is: what is the best approach to support those who experience it?Dr Cass said in her review:“The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.”In the context of that really good review, the PATHWAYS trial was a mistake. I welcome the trial being paused, because there is so much else that we can do.The MHRA has said that ultimately puberty blockers can be very dangerous for bone health and cognitive development, with other long-term effects. We must move from a pause of the trial to its cancellation. There are other types of studies that we can do; I suggest we focus on a data linkage study.
- Thank you, Mr Smith, for keeping to time, which I am sure Rebecca Paul will do as well.
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- The use of puberty blockers on healthy children is deeply wrong. Children given those drugs are being locked into their discomfort and put on a one-way pathway to cross-sex hormones and surgeries. All of that leads to a lifetime of sexual impairment, fertility issues, bone density loss and other catastrophic psychological and emotional impacts. No child put on puberty blockers at the earliest stage of puberty and whose natural puberty is blocked will ever have an orgasm or be fertile. That is what anyone in this room cheerleading this trial is supporting.In December, the Health Secretary said at the Dispatch Box:“Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that.”—[Official Report, 17 December 2025; Vol. 777, c. 929.]However, on 20 February, we found out that the MHRA had U-turned and was expressing serious concerns about the current trial. The issues it raised were not new, though, having been raised from the outset by many in this room. Making children infertile and harming bone structure are not minor points of detail, but fundamental safety flaws. That last-minute intervention raises questions about the rigour and diligence of the overall approval process. How did a trial with such potentially catastrophic health impacts make it through the research ethics committee approval process?Having looked through the minutes of the meetings, I can see that the committee members met three times over Zoom; nine out of 12 attended the first, only five attended the second and only three attended the third. What stands out most to me is the REC’s delegation to a sub-committee of approval responsibilities for such a profoundly dangerous trial. Section 4.2.24 of the REC governance policy document indicates that sub-committees can be used when
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