Secretary of State for Health and Social Care (): 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 (MAF) 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 NHS Children and Young People's (CYP)
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 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 (NICE) 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 has
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 they 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.
