Clinical trials are not supposed to foster delusions. If there were an outbreak of distressed children claiming they could fly, no one would expect researchers to fit them with makeshift wings and push them off a cliff. Yet a trial of puberty blockers has just been given the go-ahead, encouraging children to believe that preventing puberty is desirable and that human beings can change sex.

The trial, carried out by King’s College London, is effectively sanctioned by the NHS because its participants will be children attending specialist NHS gender clinics. Girls as young as 10 and boys aged 11 will be prescribed puberty blockers for two years, drugs that are illegal in all circumstances other than clinical trials. The “diagnostic criteria” give the game away: they include a “strong desire to be a different gender” to their birth sex and a “strong dislike” of their sexual anatomy.

This is the language of activism, which promotes the hugely contested claim that gender is as real as sex. Hannah Barnes, the journalist who exposed the dangers of puberty blockers, was not given a pass to attend the launch of the trial in London on Friday. But she has reported that the criteria also talk about children who prefer “make-believe or fantasy play, toys, games or activities and playmates” typical of their preferred gender rather than birth sex.

This is stereotyping on stilts, the kind of conventional thinking that used to insist that baby boys should wear blue and baby girls pink. Most women have been mocking it for years, pointing out that female people can wear Doc Martens without panicking that they’ve turned into men. But it gets worse: children in the trial will have to have had a diagnosis of “gender incongruence” for more than two years, often leading to a desire to “transition” through hormonal treatment, surgery or other interventions “to make the individual’s body align…with the experienced gender”. What on earth does this mean?

A ban on puberty blockers for under-18s was introduced last year, after the Cass Review debunked claims that there was solid evidence for their safety. While Dr Hilary Cass acknowledged that the evidence was in fact “remarkably weak”, her recommendation to launch a clinical trial — like the one just announced — dismayed many.

NHS England admits that it’s “common for children to show an interest in clothes or toys that society tells us are associated with a different gender”, yet that’s one of the “diagnostic criteria” for acceptance on the trial. It also points out that “in many cases, gender-variant behaviour or feelings disappear as children get older”.

In that case, how are clinicians to know which children to put on puberty blockers? The possibility of prescribing powerful drugs, whose effects on bones and developing brains are mostly unknown, to children who don’t need them raises all sorts of ethical questions. What does it even mean to say that children aged 10 to 15 identify as transgender? Children believe all sorts of things, many of them unlikely or absurd, but it doesn’t mean they need “treatment”.

It’s very disturbing to see the extent to which the language of ideology has infested medical websites, including some operated by the NHS. Phrases like “gender-questioning children” and “gender-affirming care” are everywhere. Yet some of these children are suffering from internalised homophobia, afraid to acknowledge they’re gay or lesbian, and the last thing they need is drugs.

Every week, it seems, produces further evidence of how deeply embedded transgenderism is in institutions like the NHS. What we need is an acknowledgement of the damage it’s still doing — and a pledge from ministers like the health secretary, Wes Streeting, that delusions about changing sex have no place in medicine.

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Joan Smith is a novelist and columnist. She was previously Chair of the Mayor of London’s Violence Against Women and Girls Board, and is on the advisory group for Sex Matters. Her book Unfortunately, She Was A Nymphomaniac: A New History of Rome’s Imperial Women was published in November 2024.

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