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The United Kingdom has just banned the last available facet of medical gender transitioning for minors: cross-sex hormones as a treatment for gender dysphoria for 16- and 17-year-olds. After comprehensively reviewing the evidence around cross-sex hormones for minors, the National Health Service concluded, “there is not enough evidence to support the safety or clinical effectiveness of feminising and masculinising medicines to make the treatment routinely available to children and young people at this time.”
This is but the latest development in the United Kingdom’s ongoing public policy debate about medical transitioning for minors that has led to a full ban on the practice. It’s also one that Canada should follow.
Before the Cass Report, an independent investigation into pediatric gender medicine, the United Kingdom had no firm age restrictions for puberty blockers and cross-sex hormones. The country’s Gender Identity Development Service routinely prescribed puberty blockers at the onset of puberty. Cross-sex hormones, if desired, were prescribed starting at age 16 and gender surgeries, if desired, were offered only to adults past age 18.
The interim Cass Review in February 2022 and the final Cass Review in April 2024 questioned this approach, citing the lack of evidence to support these medical transitions. The government responded to puberty blockers and cross-sex hormones separately.
Regarding puberty blockers, the government issued a temporary three-month ban on using these drugs to treat gender dysphoria in May 2024. This temporary ban was extended in August and then in November before the government made the ban on puberty blockers indefinite in December. The only exceptions to this ban were for those already on puberty-blockers or those enrolled in the upcoming PATHWAYS clinical trial.
The PATHWAYS trial was designed to study how puberty blockers would impact the physical, social, and emotional well-being of children with gender dysphoria. Since all the evidence around puberty blockers to treat gender dysphoria was of low quality or low certainty, the UK planned a study to yield high-quality and high-certainty evidence. Would puberty blockers alleviate gender dysphoria? Or would they cause harm?
PATHWAYS was intended to be the first randomized controlled trial to study these outcomes. One group of gender dysphoric kids would be given puberty blockers immediately, and another group would be given puberty blockers twelve months later. The impacts of the puberty blockers would be assessed by comparing the two groups for the first twelve months (i.e. before the second group received their puberty blockers).
Although the desire for better evidence is laudable, the study design was not. Both sides of the issue argued that this study would harm children. The pro-transitioning side argued that withholding puberty blockers would harm the gender dysphoric children, forcing them to go through puberty against their will. The pro-let-kids-be side argued that giving any children puberty blockers would cause harm and that the study would only allow outcomes for the first twelve months to be collected. Fundamentally, the trial would treat children as lab rats, receiving ethically and medically dubious treatment so that the medical establishment could learn more about the effects of puberty blockers.
In response to these criticisms, the government announced in February 2026 that the PATHWAYS trial would be paused until these concerns could be resolved.
On the cross-sex hormone front, the UK government initially restricted cross-sex hormones to those over the age of 16 in June 2023. Although they explored whether it would be appropriate to allow children under 16 to take cross-sex hormones, the government reiterated in March 2024 that 16 should be the minimum age to receive cross-sex hormones. Persistent gender dysphoria was then a prerequisite, and a multi-disciplinary team had to endorse a referral for cross-sex hormones for 16- and 17-year-olds.
But the government’s latest decision on March 9, 2026, raises the floor even further, banning new prescriptions for cross-sex hormones for 16- and 17-year-olds. However, the National Health Service has opened up a 90-day consultation period to see if there is any evidence, impacts, or policy alternatives that they might have missed. The feedback on this policy could still lead to another policy revision this summer. But given the rigorous review the UK has already undertaken on the evidence regarding cross-sex hormones for minors, it would take significant new information for them to change their policy.
All of this stands in stark contrast to the approach to medical transitioning in Canada. Only Alberta bans all forms of medical transitioning below the age of 16 and only allows 16- and 17-year-olds to access puberty blockers and cross-sex hormones with parental, physician and psychologist approval. Every other Canadian province has ignored the growing consensus that little high-quality evidence supports medical transitioning for minors.
That needs to change. Every Canadian province needs to get serious about critically evaluating “gender-affirming care” and consider severely restricting these interventions.