1 March 2025 - 4:00pm
The NHS has this week announced its £10.7 million clinical trial into care for gender-distressed children, following the recommendations of the Cass Review last year. Including the prescription of puberty-blocking drugs — currently banned in the UK — the trial has been christened Pathways. As if there are multiple ways of becoming an adult in a sexed body, as opposed to just one.
Dr Hilary Cass herself has welcomed the news, but there are many who had hoped it would never take place. In another world, the Cass Review would have offered a route — tentative at first — to undoing what is a medical scandal of epic proportions. For the past decade, more and more children have been subjected to damaging treatments based on the lie that one can be born in the wrong body. The pertinent question should be “How did this happen?”, not “How damaging is it, really? And if we’re careful and ask the right questions, can we still make it look okay?”
Perhaps we should not be surprised that things have progressed in this way. When it comes to “gender-affirming care”, it is hard to acknowledge that so many people have been complicit in doing so much harm. It is natural that many will want to keep insisting that this is an incredibly complex area where more data is needed. After all, “Let’s do more research” feels, on the face of it, much more reasonable than “This has always been a terrible idea and anyone could have seen this from the outset.” But the latter position is the correct one.
There is already plenty of evidence that puberty blockers have a negative impact on bone density and brain development, and that almost all of those who are prescribed them end up taking cross-sex hormones. Even if that were not the case, seeking to press pause on an essential life stage is intrinsically damaging in social and emotional terms. Blockers do not create a neutral space for learning the truth about one’s “real” self, free from the onslaught of adolescent hormones and the stress of a changing body. As the detransitioner Keira Bell told the Beyond Gender podcast this week: “the trope that [blockers] buy you more time is a complete lie, because your body’s in shutdown”.
The limited scope of the Pathways trial, not least its proposal to monitor participants for just two years, creates the uncomfortable impression that the aim is not to find better data. Instead, it is to find a way of justifying what is already, self-evidently, wrong. Regular brain scans may or may not show damage within the two-year window, but as the psychotherapist and Tavistock whistleblower Marcus Evans has tweeted, “the consequences won’t be evident in two years, when individuals may still be caught in the euphoria of having seemingly triumphed over their biological development. The real reckoning will come in twenty years, after prolonged use of puberty blockers, cross-sex hormones, and surgical interventions”.
Puberty blockers are the cure that creates the illness. The very existence of the Pathways trial implies that halting puberty, rather than supporting a distressed child through it, is not in and of itself a form of abuse. It implies that, unless there are specific negative effects unrelated to the glaring one of pausing a child’s development, the treatment is justified. It is like deciding cutting is not harmful if septicaemia can be avoided, or rubber-stamping bulimia as a coping mechanism providing the cost to tooth enamel is lower than assumed.
It is missing the bigger picture. No one knows, two, three, four years after going through puberty, whether it was “worth it”. This is not a meaningful question. You grow and change, even when it hurts, because that’s what being human is. No £10.7 million trial is going to prove otherwise. Simply, it should not be taking place.
