Puberty Blockers

I inform the House that Mr Speaker has not selected the amendment. I call the Opposition spokesperson.

I beg to move, That this House calls on the Government to take steps to prevent the PATHWAYS clinical trial into the effect of puberty suppressing hormones on children with gender incongruence.

Before I start, I declare an interest as an NHS consultant paediatrician, a member of the Royal College of Paediatrics and Child Health, and a member of the British Medical Association. It is also important for us to recognise at the beginning of this debate that we are talking about the protection of children—vulnerable children who are troubled, and who need our care and compassion and the very best quality of healthcare.

The healthcare of children distressed about their gender is an area in which attempts have been made to shut down debate with threats and accusations of transphobia; we saw the way that the hon. Member for Canterbury (Rosie Duffield) was treated when she raised concerns. As adults and as elected Members of this House, we have a duty to safeguard children in our country. That means protecting them from adults who—with whatever motivation, good or bad—could do them harm.

As a children’s doctor, I have recruited patients for trials, and I have cared for children and babies participating in clinical trials. I recognise the value of a well designed clinical trial in improving clinical care, but today the House is not being asked to consider the principle of performing clinical trials in general, or on children in particular—I hope we can all agree that a well designed trial can improve care. Rather, we are being asked to consider the Pathways trial: whether it meets ethical tests, what it does, the cohort, the protocol and the consent. I will go through each of those points in turn.

The Pathways trial is part of a group of studies run by King’s College London and funded by the Government. So what does it do and why are we so concerned? The trial will take 226 children who are physically healthy—who are developing normally—and inject them with powerful drugs to delay that normal development in a way that may weaken their bones, affect their ability to think, damage their sexual function, and leave them unable to have children of their own.

We are told that the purpose of this is to treat a diagnosis of gender incongruence. So what is gender incongruence? The International Classification of Diseases states that it is “characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex, which often leads to a desire to ‘transition’”.

We know that gender incongruence is a condition that is subjective. It is based on how someone tells us they feel. There are no blood tests and no lab markers that can be used to diagnose it. As a paediatrician myself, I understand that how patients feel, particularly in relation to their mental health, is very important. We know from the Cass review that the vast majority of children with gender incongruence will get better on their own. Again, as a paediatrician, I am used to providing supportive treatment for conditions such as respiratory viruses and gastroenteritis, which generally get better on their own, but I am not used to giving powerful drugs to children that can cause permanent long term damage for subjective, self resolving difficulties during adolescence.

As a consultant paediatrician, my hon. Friend will be able to give a definitive view on this matter. Some who campaign for this treatment and therapy argue that the effects of gene therapy are reversible. To what extent are they reversible? Should we be treating this as a reversible treatment? My hon. Friend has referred to permanent damage. Can we try to agree across the House at least on this matter: that gene therapy applied to children is not reversible?

This is not a form of gene therapy. It is a medication that is a GnRH analogue, and what it essentially does is delay puberty. It was designed as a drug to treat children who go into puberty much earlier than they would be expected to, and to delay it until, as it were, the right time. The effects of the use of puberty blockers in older children and for a much longer period, at an age when they ought to have started puberty, are not fully understood.

My hon. Friend says that we do not know the effects, but a number of children have been put through this process via the now discredited Tavistock process. Why does she think that the NHS will not refer to the data linkage study and use the data that would have been gained from the children who were put through that process, in order to find out what the effects are before deciding to put a whole new cohort of children through what is clearly a damaging procedure?

My hon. Friend raises a very good point, and I will come to the data linkage study shortly. What we do know from the Cass review is that the vast majority of children who went on to puberty blockers in adolescence went on to receive cross sex hormones, which are known to have permanent effects.

One fact that is crucially important is that it is not possible for clinicians to confidently determine which children with gender incongruence will persist with the trans identity into adulthood, and which will not. How can the clinicians possibly know that they are not injecting potentially dangerous drugs into children whose incongruence will resolve itself? The answer is that they cannot. Will the Secretary of State tell us whether he is aware of new evidence allowing clinicians to work out confidently which children will persist with the trans identity at 11 and which will not? We need to think about the risk involved in the treatment, and whether it is worth the benefits that they will purportedly receive.

The trial researchers suggest that they will take a wide approach to looking at potential benefits, that they will look at quality of life and body satisfaction, and that there must be a reasonable prospect of benefit; but how can they know whether there is a reasonable prospect of benefit when they do not know whether or not the condition will persist? Some have suggested that giving puberty blockers will help the few adults who retain their trans identity into adulthood to pass as the opposite sex. Does the Secretary of State think that the long term damage to many is worth it for the cosmetic benefit of a few? The Medicines for Human Use (Clinical Trials) Regulations 2004 specify that “anticipated benefits” must justify the risk. This is an ethical rather than a medical question. Does the Secretary of State think that the benefits justify the risk?

I regret that we have ended up discussing the details of a clinical trial in the Chamber—the reality is that things should be done impartially by scientists in most cases—but with this topic we have seen the quashing of open debate, which is why we have ended up where we are.

I will move on to the point made by my hon. Friend the Member for Farnham and Bordon (Gregory Stafford). Even if the Secretary of State thinks the principle of the trial is right, he must surely agree that it is unnecessary and unethically broad. For example, if someone was designing a trial to treat children with a specific form of cancer, the children who would be entered into the trial would have that specific form of cancer. We would not include children with any disease, because that would make the results unreliable in terms of benefit to the target group and children would be unnecessarily put at risk of receiving experimental drugs that they did not need.

The same applies to this trial. The Cass report tells us that many of the children in the proposed trial will get better on their own. The Secretary of State said yesterday that “we are talking about a very small subset of a very small group.”—[Official Report, 22 June 2026; Vol. 788, c. 56.]

The hon. Lady knows that she is one of my favourite Tories—I think I have said that before. She has quoted Baroness Cass many times. Of course, Baroness Cass thinks this trial should go ahead, because the benefits outweigh the costs. Why is Baroness Cass wrong and the hon. Lady right?

Well, one of the things with doctors is that if you ask two doctors, you might get two different opinions. I completely respect Baroness Cass. She has been president of the Royal College of Paediatrics and Child Health, of which I am a member, and she has done great work on the report that we commissioned in the last Parliament. I know she is concerned that people may obtain these drugs illegally if they are not provided, but I do not share that concern. Personally, I think the important thing is whether the people obtaining such drugs legally are using them in a way that is safe, and I am not convinced that that is the case.

By giving way a second time, the hon. Lady shows why she is my favourite Tory. Does Baroness Cass not say that she has met young people who have been self medicating with testosterone, which is irreversible? That is one of the problems that we are trying to address through this trial. It is about protecting young people so that they are not going down their own medical pathway, but are listening to medical advice and are well supported in a coherent framework.

I am sorry, but I just do not support that. We would not give children cocaine on the basis that they wanted it and would get it illegally otherwise. These are not sweeties; they are powerful drugs and need to be treated with respect.

Even if we accept the premise that a very small number of people might benefit from treatment, how could clinicians decide which children to treat? On what ethical or moral code would we want to inject powerful drugs into children who are likely to have a self limiting illness and therefore do not need it? That is what the Government have chosen to do, and it is not necessary.

Following on from the point made by my hon. Friend the Member for Farnham and Bordon, they have this data already. The Tavistock was a travesty, but it means that the Government could analyse the data from the outcomes of those children. They could establish the outcomes as children went into adulthood, and Baroness Cass tried to do this using the data linkage study. Shockingly, six out of seven adult gender clinics refused to provide the Government with the data. Even when a specific piece of legislation was passed by the previous Government to clarify that it was legal to provide the information to this trial, the gender clinics still did not provide it.

I understand that NHS England is working on the data linkage study, but I ask the Secretary of State why it is taking so long. Is the abolition of NHS England causing delay? Why is he letting this trial, which he has expressed reservations about, go ahead in the knowledge that it is unnecessarily broad and in advance of the data linkage study?

Does the hon. Lady agree that unblocking the reasons why the data is not being made available should be the top priority, and that analysis of that data should be done before any further experiments on children are done?

The hon. Gentleman is exactly right, and he expresses my point succinctly. Why is the Secretary of State going ahead with a trial—experimenting on more children unnecessarily—when he has the data to analyse already? Why has he chosen to fund this trial? Is he worried about the children who will be put on a medical pathway that may lead to cross sex hormones and a lifetime of medicalisation when they would have got better by themselves anyway?

I want to talk about the age of these young people. The Medicines and Healthcare products Regulatory Agency warned in February that the youngest patients are at the greatest risk, and may end up on puberty blockers for a much longer period. They have a higher risk to fertility because sperm and eggs have not yet fully developed at Tanner stage 2, but this Government have chosen to include children of 11 or 12. Some will wonder why it is 11 for girls and 12 for boys—indeed, I was asked that question yesterday—but as a paediatrician I am aware that puberty starts earlier in girls than in boys. It is somewhat ironic that a trial based on the premise that girls could be boys recognises this biology, but I am glad that in this respect it does. However, that means some of the participants will be primary school aged children with the merest form of puberty. How can they possibly meet the eligibility criteria, which includes “sufficient understanding of the treatment advantages and disadvantages, including discussion of fertility preservation”?

How can a child of 11 understand what it means to lose sexual function, to be unable to have children when they are older, to have difficulties in thinking and to have weak bones? Remember that this Government think that 14-year olds are not old enough to watch social media, but they think 11-year olds are capable of understanding this.

I just say this to the hon. Lady and, perhaps more importantly, to the Secretary of State, who is very genuine, personable and easy to speak to. In Northern Ireland, the Assembly and the Minister there have taken a decision not to pursue this. Would the hon. Lady agree that, when the Government pursue something here that may set a precedent for somewhere that has not agreed to it at the time, there could be an influence, with an adverse impact on the regional Administrations—the Northern Ireland Assembly where we are, and elsewhere—and it is important that the Government here do not take a decision that could influence areas they do not control?

I thank the hon. Gentleman for his intervention on devolution, and I am sure the Secretary of State was listening and considering what he has said.

To go back to the age of the young people, I am reminded of the judgment in Bell v. Tavistock, which says: “We do not think that the answer to this case is simply to give the child more, and more detailed, information. The issue in our view is that in many cases, however much information the child is given as to long term consequences, s/he will not be able to weigh up the implications of the treatment to a sufficient degree.”

I draw right hon. and hon. Members’ attention to the next part of the quote: “There is no age appropriate way to explain to many of these children what losing their fertility or full sexual function may mean to them in later years.”

Yet, as Secretary of State confirmed yesterday, the children must consent or assent to being in this trial. Another question that he did not answer yesterday is why the Government did not heed the MHRA recommendation for a minimum of 14 years. Having established that the Government are going to put a group of physically healthy children with a self resolving condition at a risk they may not fully understand, the remaining question is why they would they want to do this.

The trial itself has an interesting design. We are told that it is a randomised controlled trial—as a doctor, I am familiar with that term—but in this case it is a bit of a fudge. Yes, this Government sponsored trial will randomise which children get the drugs now and which get them in a year’s time, but the comparison group that does not receive puberty blockers—300 children from the Horizon Intensive trial, with whom the trial will seek to compare—may not be considered a reliable comparison, because the group is a different group with different eligibility criteria. When the results of this trial are published, this fact is bound to be used by people who dispute or disagree with the findings. The Secretary of State said this trial will resolve the dispute over the issue, but that is one of the reasons why I think it will not.

I want to discuss sexual function, because yesterday the Secretary of State said that the trial would involve the completion of a number of questionnaires, and one of my hon. Friends raised the question about what happens to children’s sexual function in the long term. What is sexual function? It is desire, arousal and orgasm. The trial organisers are clearly concerned about this, because they put into the trial the ALSPAC—Avon longitudinal study of parents and children—romantic relationships questionnaire. I read the questionnaire on the Health Research Authority website, and children from the age of 12 and over will be asked these questions, one of which is: “In the last year have you had oral sex with another person? (This is when they put their mouth or tongue on your penis/vagina or you put your mouth or tongue on their penis/vagina)”.

Let us be clear: if that is happening to a 12-year old, that is sexual abuse and the police should be called. Is the Secretary of State content for the Government to be asking these questions of such young children? Can he believe that they will be paid £20 for completing their questionnaires, alongside £30 for completing the assessment of cognitive ability and £15 for completing physical and height assessments, in addition to travel expenses?

There will be lots of talk this week about the Prime Minister’s legacy. Putting children as young as 11 on puberty blockers, with irreversible life changing consequences, would be the most disturbing final chapter in what has been a troubled book of leadership. Today, right hon. and hon. Members will be asked to vote to consider their approval or disapproval of the trial. I urge them to look at their conscience, read the trial protocol—it is online—and remember that these are vulnerable children who deserve the best care. One day, the children caught in the middle of this debate will be adults. It is our responsibility to ensure that when they look back on their one childhood, their one adolescence and their one chance to enjoy growing up, they must know that every decision was made with the utmost care, caution and respect for their future. The power to make that happen is in our hands today. I urge hon. Members to protect children’s futures.

I know what a sensitive, emotive and difficult issue this is. As I said in the House yesterday, I have myself struggled with the profound challenges this subject raises. We all, as adults, owe a duty of care to every child and young person in this country. That is a responsibility I bear, both as a citizen and as Health Secretary, with the utmost seriousness and sincerity. It is why, in all my deliberations on this matter, my consideration is to protect the safety and wellbeing of children and young people. Children’s healthcare must always be evidence led, safe and effective. The way to ensure that is to follow expert clinical advice, which is what the Government are doing.

Dr Hilary Cass, the clinician who I think has more respect in this space than any other, has spoken about the importance of this trial in recent days. I remind the shadow Minister that it was her party that commissioned the Cass review and accepted its findings, which included the Pathways trial. I have been clear to the House that this is a challenging area. I accept and welcome the scrutiny of Members, but I encourage us to keep in mind Dr Cass’s request to consider the issues sensitively and cautiously. She says: “Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”

I do not think that there is any question that a few years ago, children’s safety and wellbeing was not being protected when it came to gender incongruence. From around 2009, the number of children and young people being referred for NHS support around their gender identity increased rapidly. Stories subsequently emerged of young people struggling after undergoing radical and permanent transition surgery at an early age, of children rushed into taking medication without adequate therapy beforehand, and of clinicians disregarding conditions such as neurodiversity and mental health issues. As such, there was rightly deep concern about the vulnerability of these children and young people, the care and treatments they were receiving, and the surge in referrals. And so, in 2020, NHS England commissioned the leading paediatrician, Dr Hilary Cass, to carry out a review into NHS gender identity services for under-18s.

What Dr Cass uncovered was shocking and scandalous, and she made a series of recommendations for how children can be better protected and supported. It was, in my mind, unquestionably wrong for children and young people to be routinely prescribed puberty blockers for gender dysphoria without any clear evidence on their benefits or risks. The situation then was out of control and so I fully supported the indefinite ban introduced by my predecessor, my right hon. Friend the Member for Ilford North (Wes Streeting), which followed the temporary ban brought in by the previous Government.

In considering what to do next, Dr Cass identified that treatment for gender incongruence was “an area of remarkably weak evidence”.

She found that even clinicians working in the field were divided on the best way to support, treat and care for young people suffering from gender dysphoria. Where there is strong divergence of medical opinion on treatment, the two possible responses are either to continue with uncertainty—and with that, conflicting opinions and advice—or to undertake a trial. It is only by doing that that we can ensure that children with gender related distress get the same access to and standards of care as everyone in the NHS.

There is a third option, which is to get NHS England to motor ahead with the data linkage study, so that we can use the data that has already been collected to find out the answers to the questions that the Secretary of State is posing. Only then, if the information is not there, should the trial go ahead. Why is he not pushing that third way?

The hon. Gentleman’s question allows me to address that matter directly. The data linkage study will not provide clear evidence of the risks and benefits of puberty suppressing hormones, which is needed to guide future clinical practice for this cohort. The type of information that would be available in a linkage study is much more limited than the detailed information that the research team will collect about the relative benefits and harms of puberty suppressing hormones when accessed alongside a holistic model of care.

For clarity, are Scottish children going to be included in the trial, either by being able to travel south of the border or via NHS Scotland directly?

I have responsibility for NHS England as Secretary of State for Health and Social Care, and I am setting out the protocol agreed in relation to this trial, as it is a subject that is arousing a lot of questions in the Chamber, which is fair. [Interruption.] I will come back to that point, if the hon. Member for Gordon and Buchan (Harriet Cross) allows me to make a little progress.

Will the Secretary of State give way?

I will make a little progress, and then I will be open to more interventions. We need to be clear about who we are talking about. As Dr Cass said, the vast majority of children and young people who question their gender will resolve it without needing any support other than their friends and family. For many young people, questioning their identity, on many different fronts, is a normal part of growing up, and we should simply let them be. A small number of those young people, however, need greater support because of the level and longevity of discomfort that they feel, and that can often involve counselling or therapy.

For a very small number of young people, it is possible—and I emphasise the word possible—that medical treatment would help improve their quality of life and mental health and reduce their gender related distress. That is why Dr Cass recommended a trial to study the effects of puberty suppressing hormones on young people’s physical, social and emotional wellbeing, and to establish how best to support children and young people suffering gender incongruence.

On that point, in normal clinical trials, the active substance and a placebo would be used, and the impact, changes or benefits that each cohort experienced would be checked. If children have a psychological leaning and are emotionally feeling that they are in the wrong body, is there not value in having a cohort that takes a placebo and seeing if that improves their mental health?

The hon. Gentleman raises an important question around how the clinical trial is designed. In this case, the young people involved in the trial, of whom there will be around 226, will be split into two groups; one half will have the puberty blockers from the start, the other half will receive them after a year.

My understanding of this matter, having interrogated the detail carefully, is that a placebo would not be appropriate for this trial because the subject will be able to know the impacts of having the puberty blockers; they will be aware of whether they are having the medication. What is important, however, and what I hope will set this Pathways trial in a wider context, is all the other work that is being done to study the incidence of gender incongruence and the responses to that among young people, which will go beyond the trial we are talking about to look at children and young people questioning their gender through talking to them, understanding their mental health and their approach to that. All that will happen alongside this trial, which is one part of a much wider study to understand how best to support young people who are facing these gender related issues.

I acknowledge the serious way that the Secretary of State is approaching this. I think many people will be concerned that, as the shadow Minister has said, there is no objective blood marker for these individuals; I think they will be concerned that a group of people will be taken forward in this trial when a whole range of influences could have governed how they have got to that point, given that the implications of taking these drugs are quite profound for their life and further development. How does one reconcile the fact that there is no way of verifying the suitability and the way that these individuals have been selected for the trial? Perhaps he could help me to understand it better.

I thank the right hon. Gentleman for the tone he took in asking an important question, which I am pleased to be able to respond to. The bar for getting on to this trial is set extremely high, with strict eligibility criteria: parental consent, alongside the young person themselves consenting or assenting; a diagnosis of gender incongruence for at least two years; and consent from both the NHS care team and a national multidisciplinary team, including a wide range of disciplines, to understand all aspects of a young person’s health, context and situation. The level of approvals and scrutiny that young people will have to go through to participate in the trial will, therefore, set the bar extremely high.

rose—

I will give way one more time, and then I will make some progress.

I am grateful to the Secretary of State for giving way. He mentioned parental consent—what would happen in a situation where the child was in the care of the state? Would they be included or excluded from this trial?

If a child is looked after under a care order, the local authority has parental responsibility, so it would need to be part of the consent process as the corporate parent.

I turn to the points raised by the right hon. Member for Salisbury (John Glen) about young people becoming involved in the trial and the checks that are in place to enable that to happen. As I set out earlier, as the trial involves children, it comes with a responsibility to interrogate and understand its design. As Health Secretary, I have sought the most detailed assurances possible from my clinical advisers as to how children taking part in the trial will be protected.

There are a number of important safeguards. As I have said, children can participate only with the consent of a parent or guardian, and the child themselves must consent or assent. They can participate only if they have had a diagnosis of gender incongruence for at least two years, have received psychosocial support through the NHS and are of stable physical and mental health. They can participate only if they are not subject to any safeguarding concerns and if they and their parents demonstrate sufficient understanding of the nature of the treatment, including its possible advantages and disadvantages. They can participate only if the treatment has been deemed clinically appropriate by both the NHS care team and the national multidisciplinary team and if they are already accessing NHS gender services. On eligibility, the bar is extremely high.

The number of young people who would expect to qualify for the trial will be low and the safeguards to ensure their safety and wellbeing will be rigorous. I have sought and had an assurance that, once they are involved in the trial, participants may be withdrawn at any point. We are not proceeding with the previous, now decommissioned, model of care overseen by the Conservatives when they were in government. We are proceeding cautiously, with rigorous safeguards in pursuit of the evidence, as Dr Cass recommended.

Last Thursday, the independent MHRA approved an updated protocol that significantly strengthened the objective criteria for withdrawing children from the trial, which is a change that I welcome. Signs of greater risk to participants will now trigger increased monitoring, clinical review or their automatic withdrawal from the trial. All participants will be monitored before, at the start of, every three months during, and after the trial. Before and during the trial, information will be collected about mental health, quality of life, self harm and suicidality, body image, cognition, puberty stage, physical health and side effects.

I have been determined to ensure that the oversight of this trial is as rigorous and robust as it possibly can be, so I have requested monthly updates on its progress. That will include my being notified of any emerging risks.

This trial is rightly one of the most scrutinised UK clinical trials of recent times. We should expect nothing less when we are talking about the health and wellbeing of some of the most vulnerable children in our country. Yet, as Dr Cass has made clear, we have to build the evidence base to show whether the treatments are safe and whether they produce the positive outcomes that young people and clinicians want from them.

The Opposition’s motion would prevent us from following expert clinical advice, when proceeding with the trial is the most appropriate way forward. I say that not because I am suggesting that we should feel instinctively comfortable in doing so but because I have arrived at that conclusion after considering the clinical evidence and receiving robust assurances on the safeguards that are in place.

I know that the Secretary of State has agonised over this matter—he made that clear in his statement to the House last night and again today—but what is not in doubt is the harm that these drugs do. It is an established medical fact. He is determined to be driven by the evidence. That is evidential. We know that the drugs have harmful effects, so in essence what he is saying is that we are prepared to wear those harmful effects on the off chance that the drugs may have a beneficial set of effects, when there is no evidence to suggest up until now that they do.

The MHRA has introduced additional safeguards. As a result of its dialogue with the trial sponsors, the amended protocol published last week increases the level of safeguards. That means that if the regular monitoring, which will happen at least every three months—it can be more regular during the trial—shows any sign of increased risk of harm, that will lead to increased monitoring, clinical review and, when considered against objective criteria, automatic withdrawal from the trial.

It is a question of monitoring this trial, possibly more closely than any trial before—the level of scrutiny is very great indeed—to ensure that at the first sign of any increased risk of harm, action will be taken. That is the assurance that I have sought in interrogating this matter carefully in recent days, and that is the basis on which I am talking to the right hon. Gentleman and others in the House today.

We must come to a fair and settled conclusion on this matter to move forward as a country, and I believe that we should follow clinical advice and establish the clinical evidence gathered in a highly scrutinised trial with all the safeguards in place that I have described. Only that approach will give us the confidence about where we settle on this matter in the future. On that basis, the Government oppose this motion.

I call the Liberal Democrat spokesperson.

This debate is on a subject that, it goes without saying, is emotive and complex. We must therefore as always endeavour to have this conversation with compassion and empathy. The Liberal Democrats’ position is clear and simple, as reflected in our amendment to the motion: any medical treatment and the approval of any clinical trial, including the one we are discussing, must be led by expert medical advice. It should not be led by personal belief, no matter how sincerely and passionately that belief is held. Politics has a place, but not in questions of medical trials and clinical consensus—those are better left to experts.

The Cass review, originally commissioned by the Conservatives, was clear that there was a need to gather more evidence. The safety of young people is paramount, and the experts involved in this space know that better than anybody; they work with these children day in, day out and understand the risks of both action and inaction. That is why we supported the previous decision to pause the trial after the MHRA raised concerns, and why we now support the decision to start it again.

We will listen to the experts and the clinicians, but to build trust in expert advice we need transparency and clarity, and throughout the process, we have pushed for exactly that. We want the expert opinions on the public record, as that allows us as politicians, as well as the wider public, to approach this issue with clarity and facts, not ideology or misunderstanding. That is why we called for the Government to publish how the MHRA arrived at its decision when concerns were first raised, and yesterday we called for the Secretary of State to confirm that the MHRA had confirmed that its concerns had been substantially addressed. Transparency is needed so that people can be confident that clinical advice is being followed.

Will the hon. Member give way?

I am afraid that I will not.

Liberal Democrats have been arguing for many years that improved access to better specialist healthcare services for children and young people struggling with their gender identity is extremely important. Those young people have been badly let down by low care standards and extremely long waiting lists. The closure of the Gender Identity Development Service made it clear beyond doubt that change was needed. We have consistently campaigned for real action to tackle the shocking waiting times across the NHS, including for gender identity services.

Liberal Democrats welcome the move to create new regional centres to offer this care to the young people who need it. There is a need for multiple geographically dispersed clinics so that care is closer to those who need it, but roll out has been slow, and more needs to be done to tackle the waiting lists—quite simply, a three year average wait is not acceptable. For the centres to run effectively, we must support the specialists who provide children and young people with high quality, compassionate and clinically appropriate care.

Treatment, first and foremost, should be based on talking therapies. Space and time to talk through feelings is vital for young people struggling with their gender identity. It is a deeply complex set of feelings, and questioning and understanding one’s identity is never an easy thing, especially for a child, but for talking therapies to be an effective first step, children must be able to access them when they need them, not after years on a waiting list.

The debate is about access to a form of healthcare—one that is led by doctors and clinicians—and, as for any other form of healthcare, we must listen to the experts: the people who have spent years training and years delivering care.

Will the hon. Member give way?

I will not.

We must never lose sight of the fact that at the core of the debate is young people’s wellbeing and health. It is not about ideology; it is about what is best for young people. The Government must always prioritise clinical evidence and put the interests of patients at the heart of care.

I call the Chair of the Women and Equalities Committee.

It is a pleasure to follow the hon. Member for Mid Sussex (Alison Bennett). I wholeheartedly agree with her points about the importance of talking therapies. Those are incredibly important tools for children who are in gender distress. We need to see greater access to talking therapies for all children in a timely fashion.

May I first say that there is far too much debate about trans people without them? We would not tolerate this in any other debate. Yet somehow, whether in the media or in politics, in debate after debate—online, in the media and in this place—we talk about trans people and people in gender distress without acknowledging that we are lucky to be born into a body we identify with. I will never know the pain of gender distress. There are times when I look in the mirror and I think, “God, I wish I could change this.” Usually, I wish I could not look so tired, but I do not know what it is like to not be in a body that I identify with; I am fortunate and therefore speak from a position of great privilege.

I will start with the words of one of my constituents, an 83-year old trans woman called Teraina. She said, “I was born a male but I have never been a man. I tried but I failed. I always have felt female. Even at school as a boy, I was bullied for being”—in her words—“a ‘sissy’ so I left. I am 83. I have lived my life. This is about the future generations and the others who come next.”

Teraina discharged herself from hospital to have that conversation with me because she feels so strongly about future generations: that they should not be bullied for who they are; that they should be able to access treatment; and that they should be able to be who they are. We must get this right for the future generations of people like Teraina, because too many have lost their lives, or have suffered, living a life that was not fully theirs.

It is fair to say that there is a varied range of views in the Cass review. However, if future access to treatment for gender dysphoria is dependent on more research, it is vital that the Pathways trial goes ahead with the additional safeguards now put in place. Whatever one’s views on the trial, it is clear that every step has been taken to put the safety of patients at its heart. It has been designed by experienced clinical researchers and checked by independent scientists who advise the National Institute for Health and Care Research, and has included independent academic peer reviewers. As with all clinical trials, this one will be overseen by the data monitoring committee, as the safety and wellbeing of those taking part is vital.

All those safeguards should be welcome. After all, those people are the experts when it comes to the medical procedures and the science. The experts when it comes to individual children, however, are the parents. Both today and yesterday, some of the rhetoric around the statement has ignored the important role of parents in the trial.

I know the constituent my hon. Friend has spoken about. My hon. Friend also makes a valuable point about the need to speak with people who have lived a life, given that these things have been done in ignorance. Her point about parents is key. I have a constituent who is trans whose parents have engaged with me and explained the difficulties of learning to deal with and manage the situation. Their voices, alongside those of clinicians, are really important in understanding the issues. Does my hon. Friend agree?

Absolutely. I thank my hon. Friend for his commitment to the LGBT+ community and for his work, including with his constituents. We have heard a lot today about throwing children into wild experiments, but that is not what we are talking about. We are talking about something done in collaboration with parents—parents who love their children and want the best for them, and with medical professionals who want the same. The rhetoric around the trial really needs to change.

No child will be able to take part in the trial without parental consent. That has been confirmed again by the Secretary of State from the Dispatch Box. Of course, there will be some children who will never gain their parents’ consent: a heartbreaking situation for any family. However, there will be many parents who will truly support and know the wishes of their child; they will agree with the suitability of the treatment and want to support them on their journey.

Much has been discussed about the child, but parents have huge agency in the process. We are not just talking to the children; we are talking to adults who want the best for their child, and that point should be recognised.

My hon. Friend is making a powerful speech. I have huge respect for her and I completely agree that nobody here or outside should be looking to disrespect or harm any individual, whatever their age. Would she agree that parents should also be given all the information available around this condition, its treatments and the paths that children follow? Over 93% of children who experience gender dysphoria grow out of it and then are happy in their natural body. Does she agree that that and other information should be made available to the parents?

I thank the hon. Member for his intervention and his kind words at the beginning; that is the right tone, which we need to set, and information is key. People need to be able to make informed decisions—whether it is the child or a parent—and there needs to be independent information so that people can make fully informed decisions.

My hon. Friend is making a powerful and moving speech. Further to her point, does she not agree that the Opposition’s motion to prevent a clinical trial would not give people information, options and choices? It would cut down information, options and choices. She mentioned a constituent in her 80s who clearly did not grow out of her gender dysphoria, and this motion would close off lifesaving and life changing treatment for the 7% of people who do not grow out of gender dysphoria.

I thank my hon. Friend for his powerful intervention; absolutely, information and scientific evidence are key, and this trial will be conducted by experts with patients’ best interests at heart. We have heard from the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), and I am sure that, as a doctor, she cares about her patients as much as all the doctors and clinical specialists that will be involved in these trials.

Last year, the Women and Equalities Committee held a one off inquiry into the safety and effectiveness of puberty blockers. We stuck to the science. There were different views on our panel of witnesses, but I wanted to demonstrate something that has, sadly, not happened very often around this topic, which was that we could discuss it in a sensitive, respectful way, based on fact, not opinion—not for social media clips or for likes on a particular outlet’s sidebar of shame, but for the good of the people we represent.

We also examined the use of puberty blockers for other medical purposes—something that has not been discussed today when talking about the risks, or perceived risks, of puberty blockers. It is commonplace to use puberty blockers for certain cancers, for endometriosis and for children experiencing premature sexual maturity, also known as precocious puberty. When it comes to cancers such as prostate cancer, the professors on the panel described the need to essentially “turn off” testosterone. This is now a commonplace treatment for prostate cancer.

Another use of puberty blockers is for endometriosis. We already know the disgraceful delays in diagnosis and treatment for endometriosis and adenomyosis, with women waiting at least 10 to 13 years just for a diagnosis. They are living in pain for far too long, but experts are using puberty blockers, again, to essentially “turn off” menstruation and oestrogen for women with severe endometriosis.

I thank the hon. Lady for giving way; I am listening to her very intently. Does she know what a measure of success would be in this puberty blocker trial? If 80% of the children on it were happy with the outcome, would that be a success? What are the ultimate measurements of success?

Order. The hon. Member for Luton North (Sarah Owen) is making an important speech, but before she gets back to her feet, I must tell her that I need to get 12 more Members in to speak.

I know that further details will be coming from the Secretary of State as to what a marker of success is, but I think we have to ask ourselves what a marker of success is for the individuals and families. For some, staying in their sex from birth may look like success. For others, that will not be the case. This is very much on the individual.

Will my hon. Friend give way on that point?

I will not; I am going to make some progress, as I have been duly told to do.

The treatment of premature sexual maturity, or precocious puberty, in children—this is for children—uses puberty blockers now. The professors reported to our Committee that puberty blockers are “recognised as a reversible treatment.”

Professor Butler added that we know “from follow up studies with children who have received it for precocious puberty that there are no ill health effects in the long term nor are there any negative effects on fertility recovery.”

Professor Grossman pointed to a “huge amount of evidence” from Harvard University highlighting successful treatment and outcomes for girls prescribed puberty blockers for premature sexual maturity “in terms of fertility and their subsequent life.”

Will the hon. Lady give way?

I am not going to take any more interventions, as I have been told that I need to crack on.

These puberty blockers are the same drugs, prescribed in the same way, but instead of treating gender distress, they are treating prostate cancer, endometriosis and premature sexual maturity in children. Yet we have heard no call from scientists, campaigners or the medical community to stop the use of puberty blockers for those treatments.

Some have been critical of the trial going ahead, but what happens to young people experiencing gender distress if it does not? Dr Hilary Cass believes that without a trial, young people will continue to get drugs from “unregulated and dangerous routes”, and my Select Committee heard evidence to support that. Unfortunately, young people are now self treating because they see no other option. They are getting hold of medication from abroad, with no assessment, support or medical advice. Dr Hilary Cass was right to say that she is “absolutely convinced that more children will be harmed if we don’t do the trial than if we do.”

For me, safety is paramount, but this is an issue of access to healthcare, and there should never be a block to healthcare for anyone. While the trial goes forward, many young people, younger and older, will be scared and frightened about what the future holds. I hope that the Secretary of State can address the hostile environment for young trans people, as well as what support outside of legislation and the medical world needs to be more widely available for people in gender distress and the entire LGBTQ+ community.

I frankly cannot believe that we are here again. When the Pathways clinical trial was paused earlier this year, I felt that there had finally been—[Interruption.]

Order. Forgive me—there is a five minute time limit, which is the only way that I can incorporate all the Back Benchers who wish to contribute.

Yesterday, even the Secretary of State for Health and Social Care conceded—the second one to do so—that he is “uneasy” and even “uncomfortable”. I suggest that his discomfort is nothing next to the lifelong damage that the trial will potentially do to an extremely vulnerable cohort of children, whom we should be protecting. That funny feeling in his stomach—[Interruption.] Oh, he has left. That feeling is his good judgment trying to be heard—he will not hear this if he has left—and it is not too late for him to listen to it. I agree with what one of my hon. Friends said yesterday: he is a good man who is being placed under intolerable pressure on this issue. But he needs to find his courage.

The number of children and young people presenting to the NHS with gender distress increased dramatically in the years after 2009, with an exponential rise from around 2014. What is behind the increase among Gen Z is unclear, but the reasons are likely to be multifaceted. It is speculated that the factors may include 24/7 internet access, the increased acceptance of trans identities, or even peer social and cultural influences. Over the past 20 years, groups such as Stonewall and Mermaids have called for better access to treatment and more rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands.

I am slightly concerned by the idea that trans acceptance is part of the problem. Does the hon. Member agree that trans acceptance is completely reasonable and that trans people have always been here?

I am not saying that it is a negative thing; I am trying to explain why we have seen an increase in the numbers of young people with gender dysphoria. I am stating facts; we were just talking about the importance of doing so.

In 2009, only 51 patients were referred to the NHS Gender Identity Development Service for children, of whom two thirds were male. In 2016, there were 1,766 referrals and two thirds of them were female. That is quite the change. There has been an overall surge in the number of children suffering gender distress, but the increase is especially notable among girls. We also see over representation of neurodiversity, mental health issues and trauma in this group. To put it another way, these children are much more likely to have been in care, to suffer with anxiety and depression, to be autistic and to have been abused. It is a group of incredibly vulnerable children.

GIDS was established in 1989. Its main approach to treatment at that time was therapeutic, referred to as watchful waiting. Early studies from the 1980s showed that in around 85% of cases, the gender incongruence or distress ceased in the child after going through puberty. Later studies reached a similar conclusion, with between 67% and 90% desisting after puberty. Only a small cohort of children continue to experience gender dysphoria or incongruence after puberty, and it was that extremely small group who would likely adopt a permanent trans identity in adulthood.

Recently, the Government announced that they will legislate to prevent under-16s from viewing social media. We already ban under-16s from drinking alcohol and smoking, because we believe that they should be protected from doing things now that may have negative impacts on them later in life, particularly to their health. Does my hon. Friend think that this should sit in that category of protections for children?

I completely agree with my hon. Friend; a child of this age cannot possibly consent to the life changing, irreversible changes that come from puberty blockers. We need to remember that almost all children who start puberty blockers go on to cross sex hormones, and there is no going back from that.

We need to remember that we have already had a trial in the UK. When we started using puberty blockers in the UK after 2011, the preliminary results came out in 2015-16 and did not demonstrate psychological benefits, with some of the females actually suffering a worsening of symptoms, including a higher incidence of wanting to hurt or kill themselves. The results of the study, which were not formally published until 2020, demonstrated no statistically significant improvement in gender dysphoria or mental health outcomes. It is important to remember the early studies that told us that, in a majority of cases, going through puberty resolved gender distress. It follows, therefore, that stopping or delaying puberty using medication derails that natural desistance, essentially locking in.

Speaking as a member of the political class and the medical class, may I ask the hon. Lady whether she would accept that it is better for politicians to accept advice from medical experts around medical issues?

I thank the hon. Member for that excellent question. I obviously always respect and listen to different clinicians, but what is happening with this debate is that one set of clinicians with one view is being listened to. Let me remind everyone about lobotomies. Lots of very respected people came out for lobotomies; in fact, the person behind the idea won a Nobel prize. I think we would all agree that those clinicians got that wrong, so it is incumbent upon us in this House to always question. It is absolutely right that we listen to clinicians, but unfortunately we are seeing only one set of clinicians with one set of opinions being listened to here.

A Finnish study was published in April that looked at more than 2,000 adolescents and young adults who had been referred to gender services. It found that medical interventions did not reduce psychiatric problems and may even be associated with worsening mental health. How many times have we heard it said that puberty blockers offer a pathway towards improved mental health and reduced psychiatric distress for those struggling with gender identity? I have lost count. But there is hard evidence that not only says different; it says the opposite. I would be keen to understand from the Minister and the Secretary of State whether that study was taken into account before deciding to go ahead with the trial.

I want to point out that children and young people who grow up to be same sex attracted are over represented in this cohort, and that is something we need to think about. If we look at the case of Keira Bell, she was a lesbian struggling with her sexuality, and instead of people saying, “It’s okay to find other women attractive—there’s nothing wrong with that. You do not need to change your body,” they said, “Ah! You’ve got gender dysphoria.” They put her on puberty blockers, and then she went on to testosterone shots. She then had her breasts removed in a double mastectomy, and then she detransitioned. This is a deeply homophobic approach to healthcare. Those on the other side of the argument think they have the progressive position. I am sorry, but you are repeating mistakes that have been made historically—

Order. Obviously, I have not said anything, so I am not repeating anything. No “yous” and “yours”.

I must confess that Opposition days are beginning to feel a little bit like groundhog day. A party that largely sat on its hands during some of the most significant and difficult challenges is now returning to tell us where this Government are going wrong, and doing so with all the fervour of a party that has never held power, let alone governed for 14 years. Just to warn everyone, I will not be taking interventions.

This is a deeply emotional issue, and I recognise that it provokes strong and differing views across the House. I am not here to shout down or dismiss any perspective. I have never had to face this decision myself, either as a parent or as a young person. It is a decision that invites intense scrutiny and judgment, often unfairly casting those involved as villains for doing what they believe is right for a child. We would all do well to remember that we can never truly know what it is like to walk in someone else’s shoes.

Too often, this debate has been shaped by vilification and misinformation, much of it amplified by opposition voices and anonymous social media accounts, to the detriment of one of our most vulnerable communities. We hear the warped suggestion that people simply wake up one day and decide on a whim to embark on years of hormone treatment, to face discrimination and to fight for legal recognition, or, worse, that clinicians involved are reckless experimenters intent on subjecting vulnerable children to harm.

The Conservatives are, of course, entitled to their opposition, but what alternative are they actually proposing? As usual, they have found an apparent problem, but where is their suggested solution? Is it to return to a time when children experiencing gender incongruence were ignored or dismissed as an inconvenience? That approach belongs to the era of section 28, not to 2026. If their answer is an outright ban, they risk driving vulnerable young people into what Dr Hilary Cass has described as “unregulated and dangerous routes.”

We are already seeing reports of children presenting at clinics having already accessed irreversible treatments at a very young age.

The outrage we hear today about so called experimentation rings hollow when it is accompanied by no viable alternative, only a return to the same vacuum that previously existed. I do not suggest that this trial will provide all the answers, but it is undeniably better than turning our backs on a complex reality and leaving young people without safe, supported options.

Will the hon. Gentleman give way?

I will not, I am afraid—I did warn you, although I do like the hon. Gentleman very much.

Not too much.

Not enough to give way.

If we cannot trust Dr Hilary Cass, the author of a report that the Conservative party itself has endorsed, when she says she is “absolutely convinced that more children will be harmed if we don’t do the trial than if we do,”

who exactly are we prepared to trust? Do we follow the evidence, the clinicians and the science, or do we retreat into denial, burying our heads in the sand and pretending that trans people do not exist and have never existed? The process the Government have chosen to follow is not reckless; it is rigorous. The MHRA and King’s College London have undertaken detailed scientific scrutiny, and a revised protocol has been agreed that meets the highest regulatory and ethical standards. That is exactly what responsible, evidence led policymaking looks like.

It is up to us to decide what kind of Parliament we want to be: one that confronts complex and sensitive issues with care, compassion and evidence, or one that turns away, leaving vulnerable young people to navigate these challenges alone and in the shadows. For me, the choice is clear: we owe it to those young people not to look away, not to inflame and not to exploit, but to act, guided by science, led by compassion and grounded in responsibility. I am once again proud to be part of a Government who are doing just that.

Last autumn, on the announcement of the trial of puberty blockers on children, a cross party coalition of Members and peers assembled who have serious concerns and are campaigning together for the Government to reverse this terrible decision. These are Members from across the political spectrum—as diverse as the independent group, the Lib Dems, the DUP, Tories, Reform, Labour and Restore, who are not usually in agreement on most political issues—working together on something that we believe is about the fundamental safeguarding and protection of children.

The previous Secretary of State held a meeting for Members and peers that allowed us to directly question those responsible for overseeing the trial. I had one main question: is there a lower age limit? I was told no—categorically no—so a child presenting with possible gender dysphoria pre puberty could actually have been as young as eight years old. Thankfully in this latest evolution, the trial seems to have now excluded those younger children, and we are told that it is for those aged 11 and over, but an 11-year old child also has no possible way of envisaging life changing pathways, future, possibly serious, health issues, regret, infertility or damaged sexual function.

The Health Secretary talked yesterday of “consent or assent” being given by those children. We are told that at least one parent must consent, but you do not have to be a genius to work out that is a future nuclear missile aimed directly at the family courts. Separated parents, many of whom will not agree with each other about whether to affirm their child’s chosen gender identity, how to treat their gender distress or what, if any, social transition to accommodate at home or school, will be potentially battling each other over whether or not their child should be participating in this or future trials, all while their pre pubescent son or daughter begs for the medical treatment that they believe with all their heart will save all of their discomfort and distress.

Many expert clinicians who worked at the Tavistock and who informed journalist Hannah Barnes’ award winning investigations for “Newsnight”, and subsequent book “Time to Think”, are totally opposed to this trial. We have had meetings with several of them, including Marcus Evans and Susan Evans. Marcus is a former Tavistock consultant, psychotherapist and psychoanalyst, employed by the Portman NHS trust for 35 years, including as the head of nursing. Sue is also a psychoanalytic psychotherapist and mental health nurse, formerly of the Gender Identity Development Service. They both argue against the affirmative only model of treatment, such as the use of puberty blocking drugs, as it masks underlying issues, such as childhood trauma or autism. Along with psychologists Stella O’Malley and James Esses, both with years of experience of treating children and young people experiencing gender dysphoria, they are completely against the Pathways trial and the treatment pathway it puts very young people on.

Detransitioners often experience years of extreme distress and choose not to speak publicly about their own personal stories, but some would willingly engage with Ministers and Members. Keira Bell, Ritchie Herron, Philippa Roberts and Jonni Skinner, to name a few, have bravely shared their heartbreaking experiences of severe treatments, irreversible surgeries, mental health battles and years of painful regret. Although we have had nine Health Secretaries in just nine years, anyone in this post, however briefly, given the power to sign off such an enormously consequential trial, with huge potential for future investigations, must at the very least engage with those who have treated and been treated for this condition. I cannot think of any valid arguments against doing so and hearing from both sides of the argument.

There are many other reasons for stopping the plans for this trial—most important of all is proper analysis of the data that already exists, along with the Conservative Government’s previous decision to ban the use of these drugs on children. The data linkage study completion is the strongest reason, along with the social, psychological and physical reasons already heard.

The cross party coalition and I will not stop campaigning until this dangerous experiment on children is cancelled for good. Puberty is a natural, necessary life stage—a right. We should be able to help and support young people through it, until they are old enough to make life changing decisions with certainty and the maturity they lack as young children.

This has been an interesting debate so far and I am grateful to follow the hon. Member for Canterbury (Rosie Duffield), who has worked so much in this area. We should all acknowledge that this is not an easy issue.

The reason why I wanted to speak in the debate is that back when I was trying to get elected in 2024, I met the mother of a young trans woman. She told me about how her daughter really started to come to terms with who she was when she was entering puberty, but that led her to stop eating because she did not want to go into puberty. Her condition got so bad that she had to be taken to hospital, and she almost died. We should not view this as a lifestyle choice, and we should not think that doing nothing comes with no consequences. I know that not all cases are the same, but the reality is that doing nothing is not the answer. We do have to answer these questions.

I welcome the news this week that the Pathways trial is set to go ahead. Since the Government announced an indefinite pause on the prescription of puberty blockers last year, both young people and clinicians have been stuck in limbo. This uncertainty has helped no one—not the young people who are desperate for medical support, nor the researchers who need to gather data to fully understand the effects of these drugs. However, it is right that this renewed permission for a trial is based on clinical judgment, not political discourse. We should be led by science, not politics, where the health of our young people is concerned.

King’s College London and the MHRA have worked extensively to propose a safe and ethical trial, increasing safeguards since March and continuing dialogue with the Health Research Authority. I understand the concerns around the trial, and I think we all should. We all want to ensure the safety of the children involved, but it is time we find a way forward that balances the safety of the young people involved and the opportunity to enhance the care that we provide for children struggling with their gender identity. Far too often, that care is lacking.

Many Conservative Members have consistently called for the full implementation of the Cass review. Baroness Cass was quoted multiple times by the shadow Minister in her introduction to this debate, yet the Conservatives have called this debate to oppose the trial, despite it being one of Baroness Cass’s recommendations. Why are the Conservatives not willing to listen to Baroness Cass on that single issue?

In her original review in 2024, Baroness Cass made it clear that research into puberty blockers was necessary. Just this week, she has said that the trial to examine the risks and benefits of puberty blockers will reduce harm, not cause it. In fact, she goes further and tells us that the debate around the risks of puberty blockers has been exaggerated—we have seen some of that today, if we are all honest. She is absolutely right on this point.

The Conservative Government commissioned the Cass review. In their 2024 manifesto, the Conservatives committed to implement the review in full, which would include a trial. However, as my hon. Friend is saying, they now propose in this motion to stop the trial. Is that not proof that we actually need to have a trial? We need to take the party politics out of this matter, stop politicians from being the lead commentators and put it in the hands of the families and the clinicians.

Exactly. Baroness Cass is a respected expert in this field, and she made recommendations that were broadly accepted. We should be using science as a basis for decision making, not rejecting her findings purely on the basis of politics. Let me go back to what I said at the start: doing nothing will lead to our young people being harmed. That is an incredibly important point.

We cannot rely on debates in this place to decide how and when puberty blockers should be used. Rather, we should be relying on thorough scientific research, carried out in proper trial conditions and led by medical experts. We heard earlier the Health Secretary explaining some of the detail around protections for our young people. Baroness Cass is also clear that more children will be harmed by preventing the trial than by allowing one to go ahead. That is an incredibly important point.

Preventing a trial drives desperate children to look online or internationally for unregulated hormones or hormone suppressants. That leads young people to unsafe puberty blockers or to start taking hormones such as testosterone at a much earlier stage, which are irreversible once they start to take hold. We can prevent that by providing the properly regulated use of puberty blockers in the UK via this trial. The trial will provide understanding and allow clinicians to effectively guide Government on our next step. It is the right and necessary thing to do for the Government, clinicians and young people. We need to take better care of our young people, and we need to do that via a clinical trial.

Let me say again that doing nothing might seem like the easy thing to do, but it will come with consequences. I really hope that we hear more from Opposition Members about what they think the consequences of doing nothing will be for the health and wellbeing of our young people, because we have not heard that.

Will the hon. Gentleman give way?

I will, because I know the hon. Gentleman is keen to speak.

My hon. Friend the Member for Reigate (Rebecca Paul) mentioned the recently published studies in Finland. Does the hon. Gentleman not think there is any merit in waiting to see what the Finnish tests and trials throw up? We could then see what we could learn from them, rather than replicating or duplicating them here. International science should surely be respected.

I welcome that fantastic point. Until I was unexpectedly elected, I was an academic, and what I learned was never to focus on a single study when doing research, because a single study is basically an anecdote. We have to look at the breadth of the research. If I may say so, we see exactly the same in the climate change debate—the broad spectrum of science supports the argument for climate change, but there are always one or two contrary views. Those views are welcome, but we do not base our view on just one study; we look at the breadth of the research.

The reason I am in the Chamber today is the protection of children—that is why I care about banning social media, and it is why I am here to speak about puberty blockers. We protect young people under the age of consent from alcohol, heroin and sexual abuse, because they are children under the age of 18. This puberty blockers trial for 11-year olds makes me ask whether we are putting sufficient safeguards in place for those young people, and whether they have the cognitive ability to understand what they are doing. Do they have the cognitive development to understand that, when their brain is fully developed, they will have made an irreversible choice, one that will last for the rest of their lives?

We talk about these children giving consent. What about a class action lawsuit? Members have referred to 7% of people being happy to continue with the therapy. What will happen when these children are 18 or 25? Inevitably, a percentage will decide that they do not want to continue in the gender they chose as a child and want to go back to the gender they were before. What are they going to do? Are they going to sue the Government? Are they going to sue the clinicians for conducting the trial, because they were forced and coerced into something that they did not fully understand?

I thank the hon. Member, my constituency neighbour, for giving way on that point. There is a lot of “what about” in her remarks; will she reflect on Dr Hilary Cass’s comments that the trial will lead to less harm than would otherwise be the case? Why does she believe that Dr Cass is saying that? Does she doubt her expertise in this instance?

My doubts come from why, for example, we are not allowing the data linkage study to be fully completed before proceeding with the new trial. That study would find out what has happened to all the children who have already taken puberty blockers. I wanted to ask the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), that question, but I was not able to make that intervention; I do not know whether that had anything to do with the £1.5 million donation from Ferring Pharmaceuticals that the Lib Dems took before the 2019 election. I do not know whether that had anything to do with it, but there has to be some level of declaration if a political party has taken donations from a pharmaceutical company that is promoting this drug. That is relevant to how one represents oneself in the Chamber.

There is no justification for proceeding with the Pathways trial before the data linkage study is complete. Puberty is how a child transitions from childhood to adulthood, and anything that affects that process is going to have long term effects. Those effects are going to be felt, not in one or two years, but in 10 years. The brains we have as adults, at the age of 24, are very different from the brains we have as 11-year olds—our frontal cortexes are not fully developed. This is not just about the effect on these children’s psychology; what effects do these drugs have on humans over the long term? We do not know that, so why not look at the data linkage study? It does not have to be perfect, but it will allow us to protect the children going into this trial, so that the trial is as well run as possible.

I thank my hon. Friend for giving way, and for making such a passionate speech. I think we all agree, across the House, that we are here not to politicise or to demonise, but to try to make the right decisions for the safety of children. I think that all Members here share that intention. It was said earlier that these drugs are already used to treat different conditions, such as prostate cancer, endometriosis and precocious puberty. For the first two conditions they are taken by adults for a very short time, and for the third they are taken for a limited period until the child reaches the age of puberty. Such misinformation—or comparison—is not really valid, and should be avoided.

That is an excellent point. When I heard about those other uses for the drug, I thought that I would be interested to see more clinical trials for conditions such as endometriosis and cancer to establish its long term effects. However, that is for adults. When it comes to protecting children, I want to ensure that this trial involves as much safeguarding as possible.

We do not fully understand the long term risk. We come to the House again and again to discuss what constitutes a child and what constitutes protecting a child. We need to be clear about the fact that we must protect people under the age of 16, or 18—I do not care which age it is, but it should be an age on which we all agree—and that they must be subject to extra protection and safeguarding until they reach adulthood. That is why we are asking for so many safeguards—we need to ensure that the unintended consequence of trying to help a few young people does not lead to greater harm to many—and it is why we are here today.

I do not feel that asking the Government to include the data linkage study is too much to ask. This trial is a trade off: long term health is being exchanged for short term happiness. This trial, in my opinion, is not safe, and this trial will not protect children from harm.

Everyone should have the right of access to high quality, evidence based healthcare, whatever their age. At the heart of this debate are young people experiencing profound gender related distress, and the families who support them. Too often they have found themselves caught in the middle of a political argument while facing long waits, uncertainty, and a lack of clear treatment options. Every young person deserves compassionate, evidence based care, and that includes transgender young people and children with gender incongruence.

The irony of the Opposition motion is that it would stop the very research that many Members have argued is necessary before decisions about treatment can be made. If we are serious about evidence based medicine, we must also be serious about gathering evidence. The Pathways trial follows a recommendation made by Baroness Cass in her independent review, a recommendation that had enjoyed cross party support when it was published. Since then the trial has undergone extensive scrutiny by researchers, ethics committees, independent reviewers and regulators. Following further modifications and additional safeguards, it has been approved by both the Medicines and Healthcare products Regulatory Agency and the Health Research Authority. If Members believe that more evidence is needed, surely they should support a process that is designed to produce that evidence.

Much has been said about risk, and of course risk must be taken seriously, but the answer to uncertainty cannot simply be to refuse to learn more. The answer is careful, closely monitored research with robust protections. Participants must have experienced gender incongruence for at least two years, must already be receiving NHS gender services, must have undergone psychosocial support, and must be assessed as being physically and mentally stable. Both the young people and their parents must consent, and every participant must be approved by clinicians and a national multidisciplinary team. This is not an uncontrolled experiment; it is a tightly regulated clinical trial operating under some of the highest standards of oversight that are available in modern medicine.

The hon. Member for Reigate (Rebecca Paul) made a valid point about the need to ensure that children who realise that they are gay do not decide that they are transgender, and that we do not feel that we should push more gay people back into the closet, as they are feeling very much under threat at present. However, there is another risk that we must discuss, and that is inaction. For two years, puberty blockers have effectively been unavailable outside research settings. Young people and their families have been told repeatedly that more evidence is needed, and now, when a trial designed to generate that evidence is ready to proceed, some seek to stop it. What message does that send?

Behind every statistic is a family. Parents of transgender children and children with gender incongruence often speak of the distress of watching their child struggle and feeling powerless to help. They see anxiety, fear and growing distress as their child experiences physical changes that can feel deeply uncomfortable and alienating. These families are not political talking points; they are looking for support, answers and hope. For many transgender young people, puberty itself can be a source of profound distress. We should not pretend that doing nothing is a neutral act, because delays, uncertainty and the absence of treatment options have consequences too. Puberty blockers have generally been understood as a reversible intervention intended to pause puberty and provide time for further assessment and support, and the purpose of this trial is to strengthen our understanding of both the benefits and the risks. If opponents argue that more evidence is needed, blocking the research that would provide that evidence is a contradiction that this House should reject.

I also want to address something that often sits beneath debates such as this. If you come to this debate from the position that transgender people do not exist or that it is a fad, you are mistaken. Transgender people have always existed, and they deserve the same dignity, compassion and evidence based healthcare as anyone else. If, as I believe we all do, we come to the debate motivated by concern for children’s safety and wellbeing, how can we say that we are protecting children while being comfortable with them living in fear of the changes that puberty may bring? How can we say that we are acting in their best interests when some young people are terrified of growing into an adult body that does not align with who they understand themselves to be, while parents watch helplessly from the sideline? If our goal is to truly safeguard children, we should support careful research, rigorous oversight and evidence based medicine. We should seek answers, not prevent them. We should reduce uncertainty, not prolong it. That is why this trial should proceed.

It is a pleasure to follow the hon. Member for South Derbyshire (Samantha Niblett), who made a very effective and powerful speech. All of us here today are concerned about the safety and wellbeing of children, and we want to ensure that young people facing a crisis of identity get the support that they need and that is appropriate for them. In many cases, that will be talking therapies. We need to give children and their families time to figure out exactly what the issue is and whether they will develop out of it in time, but that is not always the case.

My concern, and I believe the concern of many here today, is for those children who do not, as the hon. Member for Sleaford and North Hykeham (Dr Johnson) put it, grow out of it as if it were some problem—children who have a genuine fear of what puberty will bring, and of what adulthood in a body that they do not recognise as theirs will mean. Those children currently feel that they have no option. If we take away the possibility of puberty blockers, where will they go? Where will they turn? Too many young people are committing suicide, and we have to acknowledge that that is the very real danger of putting up a very different type of block—a block to understanding and to helping them develop.

I thank the hon. Lady for giving an eloquent speech. It is really important that we are very responsible in the way we talk about suicide, and I would like to point out that Professor Louis Appleby did a study on exactly this issue following the ban of puberty blockers. His conclusion was that we were not seeing an increase in suicides as a consequence. He also made the point that it is important not to suggest that denying young people puberty blockers causes them to commit suicide. That is a negligent thing to do, and it is important that we put that on the record.

I thank the hon. Lady, but I point out that that is not what I said. I said that we were leaving children without an option. I also point out that if we are going to be responsible, we should not accuse people of being homophobic because they are trying to support the transgender community. Many of those people who support the transgender community are lesbians or gay. I know this because I am the honorary president of the LGBTQ+ community within the Liberal Democrats, and there is a great feeling of community between the two. I would caution people not to call anyone who wants to support the trans community homophobic.

These children need our support. In providing that, we should listen to clinicians and experts, such as Dr Hilary Cass, who has said, as so many Members have pointed out, that this trial will help protect children and will mean that they are less likely to be harmed. I think we should take that as our guiding principle.

My hon. Friend the Member for Mid Sussex (Alison Bennett) clearly laid out my party’s policy. I am proud of the fact that, as a women and equalities spokesperson, I was responsible for the formation of most of our policy on the transgender community. I have to say that I spoke to a great many of them, and they would be appalled if they felt for one moment that we were not going to support them, not going to support this trial or not going to stand up for them at a time when they are under increasing pressure and we are seeing the demonisation of that community.

The young children facing a crisis of identity—wondering who they are, and wondering what support they will get—are looking to us to give them that support, and that is why I will oppose the Conservatives’ motion.

It is a pleasure to follow the hon. Member for Edinburgh West (Christine Jardine), and I agree wholeheartedly with her comments about homophobia.

I remind the House that I am a former biomedical scientist, and I have probably read lots more medical publications than many in this Chamber. I have also volunteered many times for medical research, either as a healthy patient in my younger years or as a patient now in my slightly older years, so I know the process from both sides. I think it is really important that we recognise that the UK has some of the highest standards for medical research, especially when it involves patients. There is talk about why there is no placebo, but sometimes it is not ethical to do a placebo based trial. If we are withholding a form of medical intervention from someone just to prove that the next best thing will be the next best thing, that is not ethically right, because we are withholding medical care when someone needs it. That is very different from a healthy patient model, in which we are treating healthy patients to see if there is a biological change that would be harmful to all patients.

All too often, healthcare for the trans community is marked by lengthy wait lists, inconsistent treatment and discrimination—we have heard some of that stigma today—and there needs to be a concerted effort to change that. We have heard a lot about safeguarding children, and I think everyone in the Chamber agrees that that must be paramount, but I fear we are dividing trans children from other children when it comes to their medical needs and what support should be in place.

I am pleased that my right hon. Friend the Secretary of State for Health and Social Care confirmed yesterday that the Pathways trial will go ahead. We have heard many Members mention that young people getting better is a way through this, but that is very stigmatising for those who do hold on to their trans identity into adulthood. In fact, very many—the majority—of young trans people will go on to be trans adults, and we also know that those who detransition do in some instances retransition, because they detransitioned for the social reasons of not having a supportive family and other social pressures. This is not as static as some may think, and in fact young people often raise that fluidity with me.

Young trans people need this trial to move forward. For many, this represents the only legal route to access puberty suppressants at the moment. A pathway can be profoundly impactful, and we have heard people describe it as lifesaving. This has not fallen from the sky. There are well established scientific and clinical precedents for the use of puberty suppressing hormones, supported by decades of research and medical practice, and for a variety of different conditions. Even fertility clinics use these drugs in some of their regimes with certain patients. As I have mentioned, placebos are not the solution to making this a safer trial.

Puberty suppressing hormones are not new and they are not experimental. They have been used safely since the 1980s, and we have decades of clinical experience of supporting their use in controlled settings. But instead of engaging seriously with the potential benefits of such a trial, the Opposition have framed the issue as part of a broader culture war that is trying to erase trans children’s identities. By removing healthcare, we are not going to remove trans children; they will look for alternative access to treatments, including, as we have heard, starving themselves to prevent puberty starting. That is horrific to hear—as someone who has been very active on eating disorders, that is really quite terrifying.

We should be focused on ensuring that the voices of those people who will be most impacted—the young people and their families—are part of the discussion. The way in which the trial has been put together is of course not perfect—no medical trial is perfect—but it is really, really important, and the risk of harm from not going ahead with the trial has to outweigh the risk of harm from doing the trial. We need the data and the understanding, so we can make the right decisions when designing the clinical interventions and services that should be available to young people. Anyone who is denying that should think again about why they are making that argument. This issue is not about whether trans young people exist; it is about whether we choose to respond with the real—

Order. I call Carla Lockhart.

I am absolutely appalled by the Government’s decision to press ahead with the Pathways puberty blockers trial. When I look at the decision, I genuinely find myself asking: what lessons have this Government learnt from the last number of years? Parents have raised concerns, families have raised concerns, clinicians have raised concerns, campaigners have raised concerns, and many in this House have raised concerns. This is not a concern that has appeared overnight. The petition on this issue, which was debated some time ago, attracted significant support, and I must note that my constituency of Upper Bann was one of the leading constituencies in raising concerns about puberty blockers and their impact.

Ministers have been warned time and again. We had the Cass review, the closure of the Tavistock clinic and the decision to stop the routine prescribing of puberty blockers to children. All those developments pointed in one direction: greater caution, greater scrutiny and greater protection for vulnerable children. Yet somehow this Labour Government have looked at all of that and reached the conclusion that will harm more children, not less. They have decided that the answer to this difficult issue is to recommence a trial using the very drugs that are considered unsuitable for routine use, the very drugs that children cannot routinely be prescribed, and the very drugs that Ministers themselves acknowledge raise serious unanswered questions. That is the contradiction at the heart of the announcement to recommence the puberty blockers trial. If these drugs are not considered sufficiently safe, sufficiently evidenced or sufficiently understood to be routinely prescribed to children, why are the Government prepared to recruit children into a trial involving the same drugs?

What troubles me in particular is the age of the children involved: children as young as 11. When I think of an 11-year old, I think of a child at the very beginning of secondary school, maybe even in primary school; I think of a child still trying to work out who they are; I think of a child whose views, interests and outlooks on life can change dramatically in the space of a few months—indeed, even in the space of a few days; I think of a child who still needs adults to guide them, protect them and make decisions in their best interests. I do not think of somebody who should be carrying the burden of unresolved questions about fertility, bone development, neurological development and long term health outcomes. The Government tell us that more evidence is needed, but on whose shoulders are they placing that burden? The shoulders of children: children are being asked to participate because adults still do not have the answers. That cannot be right.

I have had the honour of meeting Keira Bell—one of the bravest campaigners I have encountered in public life, because she has been willing to speak publicly about consequences that she will carry for the rest of her life. When people discuss the issue, they often hide behind clinical language and advice. Clinical advice can be wrong. I queried clinical negligence and malpractice in Northern Ireland through a recent freedom of information request; in one year, £9 million was paid out. That shows that clinicians can be wrong. Yes, we need them and we depend on them, and I have so much respect for them, but they are not always right.

Keira Bell has spoken openly about the loss of her healthy breasts, concerns about her future fertility and the permanent changes that she lives with because of the pathway she was placed on as a vulnerable young person. Perhaps the most heartbreaking thing she has said is, “I was a vulnerable teenager who needed help”—not drugs, but help. She has also said, “I believe I should have been challenged on my views.” Let us think about that: a young woman looking back and saying that the adults around her should have asked harder questions, exercised greater caution and protected her.

We are all called to this place to do the right thing. The right thing is to look at the data that is already there and the young people who have been on this pathway, and to stop the puberty blockers trial with immediate effect.

I support an individual’s freedom to choose to live their life in whichever manner they want, subject only to the law. That includes someone’s right to want to live a life in a different gender identity to that which they were born with. But this debate is not about that; it is about administering powerful drugs to children. Although I have no direct experience of what it is like to want to live a life as somebody with a different gender identity, I have represented parents in the family court disputing their child’s gender identity—in one case, a child under that age of 10—in legal proceedings.

There is an absolutist argument that I want reject: the argument that this is only a clinical question, and that politicians, decision makers and the Government must follow clinical advice. The clinical advice itself is disputed, but I accept the weight that the Government have placed on the Cass review, which was commissioned under the previous Government. It is right that the current Government place weight on that. This is much more than a clinical question, though—it is an ethical question, a moral question and a legal question—and the issues that need to be grappled with fall on the shoulders of the elected Members in this place.

I want to explore one of the issues that I think is fundamental: the issue of consent. What can consent mean when we are talking about young children? What can it mean when we are talking about a parent giving consent for something to happen to their child? The issue of consent is not new. We have the legal age of consent for engaging in sexual activity. Society, through this place and the courts, has decided that children should not be engaging in sexual activity under the age of 16. That is not a fundamentally clinical issue; it is an issue around the emotional, psychological, moral and ethical impact on a child who does not fully understand what they are getting themselves into.

When it comes to a child under 13, we have a law that says consent is impossible. Under 13, there is no such thing as consent to sexual activity; it amounts to what we might term statutory rape. However, in the trial we are talking about today, children under the age of 13—at the age of 12—are going to be asked if they have engaged in oral sex in the last year. That is something that is illegal—something that they cannot consent to by law. Why are they being asked a question like that in these clinical trials? I ask the Minister to address that point directly. Plainly, consent is meaningful only if a child understands all the ramifications. I challenge anyone to stand up and back the idea that a child under the age of 13, for example, understands what it is like to give up the possibility of fertility, to live a life in a different gender and to really understand, at that age, what gender means in its adult entirety.

I turn now to the role of the parent. What parent can possibly say whether their child has been able to grapple with those issues in any meaningful way? They may be better placed than anyone else, but that does not mean that they can really form a judgment or view. After all, it would be preposterous to suggest that an adult could consent to their own child engaging in sexual activity, so how can they possibly consent to a child grappling with those ideas such that they administer a powerful drug to suppress their development and puberty?

We have a Government who have taken the view, which I welcome, that an adult cannot possibly consent to their own child having a social media account because they are not in a position to assess all the harms. How, by extension, can they say that an adult is in a position to consent to their child taking powerful drugs that will suppress their puberty and sexual development? It lacks any sort of coherence. I urge the Government to think again.

It is a great shame that this debate has been broken up along party lines. It should have been had as the debate on assisted dying was, where people from across the House could stand up and make their own case. Indeed, many Members from across the House have been supportive of what I am about to say.

Following the publication of the Cass review in 2024, the use of puberty blockers for gender dysphoria in children and young people was restricted by the then Secretary of State for Health due to an unacceptable safety risk, with their use limited to clinical trial settings. Polling by Whitestone Insight in ’25 showed that the public do not support a trial, with 67% of respondents agreeing that puberty blockers should never be given to under-18s, even as part of a clinical trial. That figure was 70% among parents of children under 18.

Like his predecessor, the Secretary of State has declared that he is uneasy allowing this trial to proceed, and cites clinical advice and a need for scientific evidence as a cover to allow him to support it. I have worked with many scientists, and we should be wary of thinking that all scientists are working for the betterment of the world. There were clinicians who said that the drug thalidomide was safe and clinicians who promoted lobotomies as a breakthrough mental health treatment. There were also clinicians who assured parents that puberty blockers were safe and reversible. It was in the name of science that clinicians prescribed puberty blockers to children at the Tavistock clinic for more than a decade, with an estimated 2,000 children receiving these powerful drugs. Where are these children now? How have they got on?

More importantly, I believe that as Members of Parliament, we have an overriding moral responsibility to protect the most vulnerable in our society, especially children. In our induction as MPs, we were told that we had a duty to speak out when things were wrong. It is clear to me that allowing possibly irreversible medical research to be carried out on 11-year old girls and 12-year old boys, when we know that some of these children at least will reconcile themselves to their biological sex at birth, is completely inhumane and uncivilised. Many of us feel uncomfortable about using beagles for medical research. How on earth can it be right to use children for irreversible and life changing medical research?

The journey from childhood to adulthood is challenging for many, difficult for some, and tortuous for a few. Through that journey, the support of older people, who are often parents, loved ones, people who care, is critically important. For those who suffer from gender dysphoria, that journey is all the more challenging. Many people—perhaps all of us in this Chamber—will have struggled with the emerging sexuality that is part of the journey to adulthood, but most people who suffer from dysphoria cope with it as they go through puberty. Indeed, the evidence—and there has been much talk of evidence in this debate—shows that medical intervention in those cases would not only be unnecessary but profoundly damaging.

Yet at the Tavistock clinic, the horrors of which I first highlighted in 2019, thousands of children were prescribed life altering drugs. Indeed, it is more shocking still: more than 70 children aged three and four were sent to that clinic, and 382 children aged six and under were referred. The Government are fond, now, of speaking about the Cass review commissioned by. the previous Government, but the review was not welcomed by the Minister and the trans lobby. When it was commissioned, it was regarded with horror by those who presumably now support this trial.

The Cass review found that doctors must be extremely cautious about giving trans drugs to under-18s—not 11, 12 or 13-year olds, but people under 18. It found that doctors must be able to “refer to the longer term benefits and risks”

of treatment options; that young children should have therapy before they are allowed to socially transition; that many parents expressed concern about their child being socially transitioned and affirmed in their expressed gender without parental involvement; that too many decisions about changing gender have been rushed, with too little consideration given to whether children might regret their actions later in life; and that childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender change.

As many as two thirds of those referred had suffered neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. Those are the vulnerable children who went to the Tavistock clinic, which was closed after pressure from those who understood the horrors that took place there. When it was opened, of course—

Will the right hon. Gentleman give way?

I will in a moment, when I have made an attack on the liberal bourgeoisie, which the hon. Gentleman might want to hear. When the Tavistock clinic was opened, it was seen as an emblem of progress by the liberal bourgeoisie. Now, of course, we know that it was the embodiment of wickedness. On that note, I give way to him.

I am part of the liberal working class. This debate is not about the Tavistock clinic. The right hon. Gentleman has just quoted Baroness Cass, but one thing he has not said is that she recommended that the clinical trial go ahead. She said recently that she supports the trial because she thinks there will be real benefits to it. Rather than talking about Tavistock, will he address what Baroness Cass, who he quotes extensively, thinks about this trial that we are debating?

Baroness Cass certainly wanted to gather more evidence. The evidence we have shows the damage that puberty blockers can do. We know that the substantial science suggests that they affect bone maturation, cerebral capacity and, of course, fertility. It is certain that there is no compelling evidence that puberty blockers have a beneficial effect. That is why she sought more evidence, as she concluded that there was no compelling evidence that they have a beneficial effect.

As another member of the liberal working class, I wonder whether the right hon. Member has the experience that many of us in this place have of talking to constituents, friends and family who have children who have struggled with their gender identity and have benefited from puberty blockers. While he says that there is no evidence, many of us have direct experience of seeing the benefits in action.

That experience clearly contradicts the Cass review’s findings, but it is for the hon. Lady to have that debate, no doubt, with Dr Cass.

What is certain is that we have no indication from the Government about what success in the trial will look like. When challenged on that subject, answer came there none. How will we gauge whether the trial is a success or a failure? Are these children really guinea pigs to be used to provide the evidence that the hon. Lady says is already freely available in her anecdotal experience of communicating with her constituents and others?

We know that there is certainly evidence from other countries. Have the Government looked to draw on that, rather than engaging in this dangerous trial? We know that there is evidence too from the 2,000 or more children who went through Tavistock. Some have suggested that we should look at the data already available rather than putting any more children at risk. Yet despite the Secretary of State’s agonised decision—I do not intend that to be sarcastic or pejorative; I appreciate that the Secretary of State was completely straightforward about how difficult it was to make the decision—the trial goes ahead. I accept that there are additional safeguards—this is not Tavistock; it is something different—but none the less it brings immense risk alongside the determination to try to gain facts. Instead, let us look at Finland and Denmark and at other countries that have already gathered evidence. Let us look at what we know of those who have already been through this process.

G. K. Chesterton said: “children are innocent and love justice”.

I fear that this trial will steal their innocence and deny them justice. I hope that even at this late stage the Government, recognising that, will abandon this awful trial and save innocent children from that fate.

We come to the wind ups; I invite the shadow Secretary of State.

This has been an important debate. It has been a difficult debate, but a necessary one none the less. There are some subjects in public life where the easiest course is silence, where every word is weighed, where motives are questioned and where hon. Members may be tempted to step back rather than step forward, but when the subject is the safety of children, silence is not an option.

Children and young people are at the centre of the debate. They are not slogans or political symbols to be used by either side of any argument; they are children, and often vulnerable children experiencing distress that can be profound, complex and deeply painful. They need kindness, patience and support from adults who listen and act responsibly. They need services that are timely, professional and compassionate. Compassion is measured not by how quickly we medicalise a child’s distress but by whether we protect the child’s future and respond to their present pain. That is the heart of the debate.

Sadly, those of us who are concerned about this trial are often labelled as transphobic. Personally, I find that offensive. Child safety matters to me, and so does equality for trans people, but we have to think about children. The Government ask the House to accept that the Pathways trial is the responsible way to build evidence. Ministers say that it is a carefully controlled study, that safeguards have been strengthened and that only a small number of children will be involved. But the question before us is not whether research matters—of course it does—but whether this particular trial involving children as young as 11 and 12 is the right and ethical way to proceed. We on the Conservative Benches do not believe that it is. My position is rooted in a simple principle: when evidence is uncertain, risks may be lifelong. When the patient is a child, the burden of proof must be exceptionally high. That is not ideology; that is good medicine.

The Cass review changed the debate because it brought clarity to a field that had been allowed to drift for too long. It found weak evidence, poor data, inadequate follow up and a service model that too often failed to look at the whole child. It was the previous Government who treated those findings with the seriousness that they deserved. The routine prescription of puberty blockers on the NHS was ended because the evidence did not justify the practice. That was not a rejection of vulnerable young people; it was an act of safeguarding.

The Government now say that this trial is different. They say that it is not routine prescribing and that there will be monitoring, consent, assessment and withdrawal criteria. Yet process cannot answer the central moral question: can a child, at the start of puberty, truly understand the impact of interrupting that stage? Can an 11-year old meaningfully consider questions of fertility, bone development, cognitive effects, sexual function and future regret? Can a parent, faced with a distressed child and a desperate sense of need for relief, rationally navigate the uncertainty without enormous pressure? Those are not abstract questions; they go to the integrity of consent itself.

In most areas of medicine, when the risks are serious and the benefits uncertain, we become more cautious, not less. We do not reassure ourselves merely because the cohort is small, or say that because only a limited number of children may be exposed, the ethical concern is reduced. For each child in the trial, the consequences are enormous and personal. For each family, the decision is life altering. For each future adult, the question may one day be, “Did the people in authority protect me properly?”

The Secretary of State has said he feels “discomfort and unease”. I welcome that honesty, and I believe it to be heartfelt. Yet discomfort in this area should not be something that Ministers try to manage away; it should make them stop and think again. Unease is sometimes the proper response of conscience. The Government point to safeguards, but safeguards are not the same as certainty. Monitoring every three months may identify some problems, but it cannot guarantee that long term harm will not emerge years later. Objective withdrawal criteria may be better than vague discretion, but they do not remove the risk of treating a child unnecessarily in the first place.

The Government have still not answered a fundamental question: why proceed now before the existing evidence has been fully examined? There are children and young people who were treated under previous services. There is data that may help us to understand outcomes. There is a Tavistock related evidence base that should be completed and analysed before more children are exposed to puberty blockers in a new trial. Surely the first duty is to learn from what has already happened and therefore potentially identify wherever there may be gaps. That is not obstruction; it is responsibility.

The Government must not ignore the wider context. Many children who experience gender distress also have other needs: mental health difficulties, autism, trauma, family pressures, anxiety, depression, eating disorders or safeguarding concerns. Dr Cass was clear that services must look at the whole child and not just one aspect of identity. We should not accept a system that is slow to provide holistic support but prepared to move ahead with powerful medical intervention under the banner of research.

The House must be honest about the tone of this debate. There will be young people listening who will be feeling frightened by it. There will be parents listening who feel judged. There will be clinicians listening who are trying to do their best in a difficult and contested area. Let us be clear: our concern is not with the dignity of any child—their dignity is beyond question. Our concern is with the decisions made by adults in positions of power. Children deserve adults who can hold two truths at once: that their distress must be taken seriously, and that serious distress does not automatically justify experimental medical treatment.

I am slightly confused because we know that the young people in this trial will already have all those other things in place. The Minister has been clear about the talking therapies, for example, and about the time period. It takes two years in the gender system before anyone can access this trial. I am worried that it is slightly disingenuous to suggest that these children are going to be popped straight on to a trial without everything else being in place. Could the right hon. Gentleman just clarify that he understands that?

I can assure the hon. Lady that I have given this an enormous amount of consideration. I understand what she is saying, but my argument is that we already have a set of data on children who have gone through some of these experiences, and that needs to be looked at. Having spoken to some of them, I do not want to see others experience it.

rose—

I am going to continue because I want to give the Minister the opportunity to respond.

The Secretary of State says that this trial will help settle the evidence, but a trial that follows children for a limited period cannot by itself settle questions that may only become clear in adulthood. It cannot fully answer the questions of what a child will think at 25, 35 or 45 about decisions that were made at 11 or 12. When I was in my teens, struggling with my sexuality, it was complex enough. It was emotionally draining. It was scary. I cannot imagine how much harder that would have been if someone had added to the mix by telling me that maybe it was not my sexuality but my gender. This is why we must listen to people like Keira Bell.

We must not confuse the creation of some evidence with the resolution of all uncertainty. The Opposition’s approach is careful, proportionate and child centred. We must pause this trial, complete the analysis of existing data, publish a full account of the known risks and unknowns and strengthen non medical support. Then, and only then, should we consider what further research should be ethically justified. This is not abandonment; it is protection.

The first responsibility of any health system is not to validate every proposed treatment, but to ask whether that treatment is safe, necessary and in the long term interests of the patient. When the patient is a child, that responsibility is heavier still. We owe these young people more than good intentions. We owe them caution. We owe them honesty. We owe them services that see them in the round, and we owe them the humility to admit that when the evidence is uncertain, the answer is not to press ahead and hope; the answer is to pause, learn and protect. For those reasons, I urge the House to support this motion.

I would like to start by declaring an interest, because my son Milo, of whom I am extremely proud, is a trans man.

I have listened to colleagues very carefully over the course of our proceedings. There have been some truly heartfelt speeches, and this strength of feeling is certainly warranted wherever children are concerned. The Government welcome this scrutiny, and I want to thank Members from all sides of the House for the constructive tone and substance of this debate.

I am not the Minister who is responsible for leading on this policy in the Department for Health and Social Care. Nevertheless, I feel a great deal of responsibility for the health and wellbeing of children in our country. As the Minister of State for Care, I am, for example, responsible for making sure children at end of life are receiving the right palliative and end of life care. And tooth decay, for example, has an appalling effect on children’s wellbeing. When it comes to gender incongruence, I cannot help but think of those children suffering in great distress, who may even be watching our proceedings this evening, and I want them to know that all of us in this Chamber want what is best for them. We might disagree about how we get there, but I do not doubt the sincerity of anyone who has spoken today.

Fundamentally, our approach on this side of the House is to be led by the evidence, and on this I pay tribute to Dr Hilary Cass, who has taken on one of the most sensitive and polarising issues of our times with such courage and professionalism.

The shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson)—I hugely respect her expertise as a paediatrician—has said that our decisions could be motivated by “fear and hostility”, but that is not a charge that anyone could level at Dr Cass, who has shown the utmost courage and professionalism from the moment that she was appointed. It was on the strength of her independence and integrity that the previous Conservative Government, of which the hon. Lady was of course a member, accepted her recommendations. One of those recommendations was for a regulated, robustly safeguarded trial. Yesterday, Dr Cass said that she is “absolutely convinced that more children will be harmed if we don’t do the trial than if we do.”

I commend the Minister on an excellent and brave speech. When the Cass report came out, I was criticised for not accepting it in full, and now the very same people who said that to me are not accepting the Cass report in full. Does he agree that that is hypocrisy, and that those people should stick to their word?

I know that feelings on these matters are strong and heartfelt. If the Conservative party has changed its position and is putting forward its arguments with sincerity and honour, that is a perfectly acceptable position to take, but I simply remind the House of the journey that the party has been on.

The Cass review also suggested a clinical trial for cross sex hormones. On that basis, will the Government launch a clinical trial on cross sex hormones as well?

This is a debate about hormones for suppressing puberty, and is related to the matter that the hon. Lady raises, but it is important that we get the sequencing right. Let us look at the trial and the evidence. That is part of the process of understanding the milestones and the forks in the road faced by children who are experiencing gender incongruence. Let us do this one step at a time.

We are proceeding carefully, cautiously and under the mantra that the safety and wellbeing of children are non negotiable, and with clarity that a robustly scrutinised trial with rigorous safeguards is the only way of establishing a robust evidence base for puberty suppressing hormones.

Many hon. Members have asked about safeguards, so let me remind the House what they are. A child can participate only with the consent of a parent or guardian and the child’s own consent or assent, and only if they have had a diagnosis of gender incongruence for at least two years; if they are of stable physical and mental health; if they are not subject to any safeguarding concerns; if they and their parents demonstrate sufficient understanding of the nature of the treatment, including its potential advantages and disadvantages; if they have been deemed clinically appropriate by both their NHS care team and the national multidisciplinary team; and if they are already accessing NHS gender services, including participation in a tailored package of psychosocial care.

Will the Minister at least commit to looking again at the experience of Finland and Denmark, whose evidence has led them to now emphasise counselling rather than medical intervention?

A little later, I will go through all the different work that is going on. This is absolutely not happening in isolation; we are taking into account a range of other studies.

Some colleagues have raised the work of the MHRA in strengthening the safeguards for young people involved in the trial. The MHRA has been engaged in a scientific dialogue with the trial sponsors, and it was the outcome of that process that led the MHRA, as an independent body, to publish the updated protocol last week. We welcome the changes, because they show that the MHRA is taking its job seriously and that the system is working as intended. We cannot cut corners when it comes to the safety and wellbeing of children, and the safeguards are now in place to guarantee greater monitoring and clinical reassessment, including objective criteria for withdrawing children and young people from the trial entirely. I remind colleagues that the bar to qualify for the trial is extremely high, with only a small number of young people expected to meet the strict criteria.

Some other colleagues—I turn now to the point made by the right hon. Member for South Holland and The Deepings (Sir John Hayes)—have queried the need to have a clinical trial when a number of children have already taken puberty blockers and information is already available. However, Dr Cass concluded that there is not enough evidence about the risks and benefits of those medications. That is why she was so clear in recommending a trial to find that clinical evidence, because that is the basis on which we can take those decisions.

The information in the data linkage study is much more limited than the detailed information that the research team will be able to collect about the relative benefits and risks of puberty suppressing hormones. NHS England is, however, committed to delivering the data linkage study and has taken time to ensure that the data is shared by relevant organisations.

I have been listening to the debate and have not yet heard what the Government will deem to be a measure of success of this puberty blocker trial before it goes ahead. What are the criteria, the measurements, the percentages and the numbers, and what are the timelines over which they will be measured? Can the Minister explain what those are? If someone is unhappy, can they sue the Government?

As the right hon. Lady will know, a lot of this is about the distress and the tremendous mental health pressure that young people going through gender incongruence feel. Clearly, one of the outcomes that we will look for from the trials is an alleviation and an amelioration of those significant mental health issues and distress. Those are the kind of outcomes we want to see to help some of those young people who often end up in awful situations, leading to self harm and other terrible situations.

Some colleagues have asked about the wider support we are providing for children and young people with gender dysphoria and incongruence. I am pleased that the Pathways study is just one part of the wider work being done to ensure that the support is there. For example, Pathways Horizon is an observational study of all children and young people attending NHS children and young people’s specialist gender services. Pathways Connect is a brain imaging study, Pathways Voices will interview young people, and Horizon Intensive is about ensuring that there is a comparison group of 300 participants who are expressing gender incongruence.

Furthermore, NHS England has opened three new children and young people’s gender services in the north west, London and Bristol, with a fourth planned for the east of England this year. I can confirm that the Government aim to have a service in every region of England in the coming years. These services use a different model with multidisciplinary teams, including mental health support and paediatrics, within specialist children’s hospitals to provide holistic care. The new services will increase clinical capacity and reduce waiting times so patients can be seen sooner and closer to home.

I can update the House that waiting lists for children and young people’s gender services have come down since this Government took office. As of April, nearly 3,000 fewer children and young people were on the waiting list compared with September 2024.

This Government stand by the principle that we will always be led by clinical advice and clinical evidence, but that does not mean we take these decisions lightly, and it does not mean that we are abdicating our responsibilities either. My right hon. Friend the Secretary of State has requested monthly updates on the progress of the trial, including any emerging risks. Throughout this process, he has immersed himself in the detail, scrutinised the issue and sought the strongest assurances from his most senior clinical advisers. We have received those assurances and are proceeding on the basis of evidence, not ideology.

I end with regret that it appears that the cross party consensus on Dr Cass’s expert review has been lost, but also with hope that colleagues can get behind Dr Cass’s work again. We will move forward on the basis of taking decisions based on the expertise of clinical and medical professionals, and acting within clearly defined safeguards and robust oversight, including in this House, to provide the best quality of healthcare and support for all children and young people to access what they need.

On one level, this is a specific debate about a specific issue, but when we zoom out, we see that it goes to the heart of what our NHS is about, which is how best to do the greatest possible good for the greatest possible number of people. When we look at this through that basic ethical prism, there can be no doubt that this Government’s position is the right one. A small cohort of vulnerable children are struggling, and it is our job to help them—it really is as simple as that. I therefore urge colleagues to oppose the Opposition’s motion.

Question put.

39|18:59|112|283|The House divided:|Question accordingly negatived.||0|0