PARLIAMENTARY DEBATE
Puberty Suppressants Trial - 17 December 2025 (Commons/Commons Chamber)

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the pathways puberty blockers trial.

Let me just start by acknowledging the sensitivities around this issue and the strong beliefs held around this House. For all the division and divided opinion, I believe that there is a determination shared by everyone in this House to do the right thing by a vulnerable group of children and young people. It is for those reasons that I am taking the course of action that I am. Put simply, that is to follow expert clinical advice and take an evidence-led approach.

The Cass review found shocking levels of unprofessionalism, a lack of clinical oversight and puberty blockers prescribed to children without sufficient evidence that doing so was safe or beneficial to those children and young people. What Dr Hilary Cass uncovered was a scandal. That is why, on coming to office, I made the temporary ban brought in by my predecessor, the right hon. Member for Louth and Horncastle (Victoria Atkins), a permanent one. Dr Cass also recommended a thorough study to establish how best to support children and young people who suffer gender incongruence. That is the pathways study.

The study has four main parts, one of which is the clinical trial to study the effects of puberty-suppressing hormones on young people’s physical, social and emotional wellbeing. The other aspects of the pathways study will track the physical, social and emotional wellbeing of all young people attending UK NHS gender services. It will look at young people’s thinking and brain development, following both those who are and are not taking puberty-suppressing hormones, and it will gather evidence directly from young people, parents and staff about their experiences of living with gender incongruence.

The bar for the trial to be approved was extremely high and oversight will be rigorous. Children cannot consent to being on the trial, so places will require parental consent, as well as the assent of young people. It is because protecting and promoting the health and wellbeing of affected young people is our primary concern that there are also strict eligibility criteria in place to join the pathways clinical trial. As such, the number of young people who would expect to qualify for the trial will also be low. Participants must undergo thorough mental and physical assessments and will be followed over a number of years with regular wellbeing checks. Puberty blockers have also been used to delay puberty in children and young people who start puberty much too early. Use in those cases has been extensively tested and has met strict safety requirements for that use.

The study is led by King’s College London and the South London and Maudsley NHS foundation trust. It has been carefully checked by independent scientists who advise the National Institute for Health and Care Research and by the Medicines and Healthcare products Regulatory Agency, and received approval from a research ethics committee. I am treading cautiously in this area because the safety of children must come first.

I must first declare my interest as a consultant paediatrician who has looked after children with gender dysphoria in the past and is likely to do so in the future. We must remember that we are talking about vulnerable children.

The first and most obvious question is: why? Why have this Government chosen to fund experiments with puberty blockers on physically healthy children? Despite saying he was comfortable with this trial in a briefing to MPs, the Secretary of State told the media on Friday and the Select Committee this morning that he is in fact uncomfortable with it. Why is it even being considered before the data linkage study is complete?

Some 9,000 children went through the Tavistock clinic, and many of them came out regretting being encouraged to irreversibly damage their bodies. We should look carefully at those outcomes before we make the same mistakes. What steps is the Secretary of State taking to secure the data from the Tavistock and have it analysed? What steps is he taking to hold to account those obstructing access to data linkage information? What assessment has he made of the motivations of those obstructing that data, when this is a study to safeguard children?

And what of the trial itself? We know that 226 children will go through this trial. Is that a limit or a target? Those children will be randomised to get puberty blockers now or in a year’s time, and all will be analysed at two years. They will still be children. They might be only 11 years old. How can the results demonstrate a meaningful outcome? The control group is not properly randomised, but chosen from the Horizon intensive trial group. Is the Secretary of State concerned that this will introduce bias?

The criteria for getting puberty blockers in this trial require just one parent to consent and the clinician to think that it will benefit the child, but on what basis will the clinician decide? The Cass review said that the vast majority of children with gender dysphoria would recover, with only a few persisting with trans identities into adulthood. It is not possible to predict which those children will be, so does the Secretary of State accept that the vast majority of children in this, his Streeting trial, who will be given drugs will be physically healthy children whose distress would get better without any puberty blockers, and that the vast majority of the children in this trial are therefore being unnecessarily experimented on with risky medications under his leadership?

The shadow Minister asks, “Why?” There is a simple answer. It is because this was recommended by Dr Cass in the Cass review, which was commissioned by my predecessor, Sir Sajid Javid. I think that was the right thing to do, and it is why, when my predecessor brought forward the Cass review, I supported it in opposition. I certainly did not try to play politics with an extremely vulnerable group of children and young people.

I will tell the hon. Lady why. It is because, under the previous Government, those puberty-suppressing hormones were prescribed without proper oversight, supervision or safety, yet we did not hear a peep about that fact for years until Dr Cass, commissioned by Sir Sajid Javid—who deserves enormous credit—did the study, which was published and widely supported and which contained this recommendation. The Conservatives may have changed their tune in opposition, but I remember what they said in government when they published the Cass review and supported its recommendations, so I think their response now is a real shame.

The shadow Minister accuses me of inconsistency, so let me be clear. Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that. Am I uncomfortable about puberty-suppressing hormones for this group of young people for this particular condition? Yes, I am—because of risks. It is why I was also uncomfortable when I upheld the temporary ban by my predecessor and then put in place a permanent ban. The reason I was uncomfortable with that, too, is because I had to look children and young people, and their parents, in the eye when they told me in no uncertain terms that that decision was harmful to them, as have many other clinicians who have opposed that decision.

Whatever my discomfort in this extremely sensitive area, the reason that I have made this decision is that I am following clinical advice and, as Health Secretary, it is my responsibility to follow expert advice. Had the Tavistock clinic faced such challenge and scrutiny a decade ago, we would not be in this mess. The Conservatives were right to commission the Cass review and they were right to accept its recommendations. I accept that there is now a difference on this particular recommendation, but I would urge Members not to walk away from the cross-party consensus we built behind that approach but to build on the work that Dr Cass has done.

Let me turn to the important questions raised by shadow Minister. There will be two groups within the trial, as well as a further control group of children and young people with gender incongruence who do not receive puberty-suppressing hormones. At least 226 participants are required in order to detect a statistically significant difference between the two treatment groups. However, this is not a target and no young person will find themselves on this trial because there is a drive to make sure that a certain number of young people are participating. In order for anyone to participate in this trial, it has to have the most robust clinical oversight from clinicians within the service, as well as national oversight and the consent of parents. It is only where young people will be deemed to benefit that they will be on this programme.

The shadow Minister asks about the data linkage study. That is important. The data linkage study will be undertaken, but when it is completed it will not provide us with the same evidence as this clinical trial. That is why Dr Cass made a distinction between this trial and the data linkage study.

The hon. Lady also asks about the motivations of those who withheld data. That is an extremely important question. It is utterly appalling that anyone in a position of responsibility in the NHS withheld data on a very vulnerable group of children and young people. I accept that there were many well-meaning people involved in these services at the Tavistock clinic, but the fact that Dr Cass found such a lack of rigour, such a lack of standards and such a lack of proper oversight is disgraceful. It is the clinicians who are well meaning and ideologically driven who have given me the most cause for concern in this whole debacle and who have done more harm to children, young people and the trans community than most other people who have taken part in this debate.

I appreciate the work that Dr Cass has done, and I am glad that she is in the other place, bringing welcome scrutiny. Were she not supportive of this approach, I might think again, but she has made her recommendation and given her support. I am following clinical advice. It is not comfortable, but I do believe it is the right thing to do, on balance.

I call Health and Social Care Committee member Danny Beales.

The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?

The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.

I call the Liberal Democrat spokesperson; you have one minute.

I hope that everyone in this House can agree that medical treatment should always follow the evidence on safety and effectiveness. It is right that expert clinicians are building this evidence base and therefore right that the Government are seeking to run this trial, because it should be led by evidence and not by ideology.

Given that the numbers on the trial will be very small and the waiting list for talking therapies, which are so important for children and their parents, is very long, with hundreds of thousands waiting, can the Secretary of State explain how he will increase access to NHS talking therapies so people can get the help they need and deserve? In a field with so little research, will he confirm if the pathways trial will look at international best practice in order to take learnings from abroad?

I can absolutely assure the hon. Member that we are doing that wider research and that of course we will take into account high-quality international evidence, as well as the research we are undertaking domestically. It is so important that we recognise that, for many young people with gender incongruence, even if approved, puberty blockers will never be the right medication. One of the things I have been most saddened by in the discourse among adults in this debate, many of whom should know better, is the elevation of puberty blockers to the status they have received in public discourse and debate; many young people out there think not only is this the gold standard of care, but that it is the only care available, and, of course, that is not true.

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 in 2026. We 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 good clinical care. The new services will increase capacity and reduce waiting times so that patients can be seen sooner and closer to home. We have also commissioned additional support for young people waiting to be seen through local children and young people’s mental health services.

I thank my right hon. Friend for his leadership. As a former children’s services manager, I am concerned that credible safeguarding warnings from clinicians and academics about puberty suppression in children are not being heard. Will the Secretary of State meet those experts and review the younger age limit for participation in this trial, given that children as young as 10 are currently set to be involved?

Let me reassure my hon. Friend and the House that I am absolutely open to receiving representations and evidence from clinicians involved in the care of children and young people, with insight, expertise and data, including those who might be critical of the approach that the trial team is setting out or, indeed, critical that the Cass review included this recommendation. That is important because the many things that have gone horribly wrong in this area have included the silencing of whistleblowers and the silencing of rigorous debate and discussion.

We have to have this debate with due care and sensitivity for young people in this vulnerable group in particular and for the wider trans community, who feel extremely vulnerable in this country at the moment, including as a result of decisions I have taken as the Health and Social Care Secretary. We have to consider all of that in the round, but we must make sure that at all times we are following the evidence, that we are open to scrutiny and challenge, and that where we are making these finely balanced judgments, we are doing so with rigorous debate, testing the arguments, the evidence and the data. That is why I welcome the urgent question and this discussion.

I call Health and Social Care Committee member Joe Robertson.

The Secretary of State said earlier that there is an extremely high bar for him stepping in and stopping these tests using puberty blockers. What bar could be higher than a Government protecting children from being tested on with drugs specifically to stop or alter their sexual development? There is not a unified clinical view on this. It is his choice; he is the Secretary of State. These tests are on him.

I certainly do not need to be told what my responsibilities are on this. I always take responsibility for the decisions I take. I acknowledge the extent to which the hon. Gentleman and members of his party seek to weaponise this issue, and to personalise it. [Interruption.] We can simply refer back to his question and to the shadow Minister’s reference to the “Streeting trial”—if that is not personalising, I do not know what is.

I’ll tell you what: I will take an evidence-based approach. I have done that on this issue from day one. Had the Conservatives done so, we would never have seen the Tavistock scandal. We would never have seen puberty blockers dished out willy-nilly to children and young people in this vulnerable patient group. I have sought at all times, including when I sat on the Opposition Benches, to treat this debate with the care, sensitivity and humility it deserves, and not to be tribal in my interactions. I only wish this Conservative Opposition would take the same approach.

We are only at the start of this urgent question, so I ask Members to reduce the temperature in the Chamber.

I thank my right hon. Friend for the care and sensitivity he has taken to this subject all along. It has been an undeniably difficult year for transgender people in Britain. I have spoken to young trans people who have been pushed to the brink of suicide by what they hear—that they do not have a right to exist, that they do not deserve rights, that they are legitimate targets for ridicule. We all in this House have a responsibility to lower the temperature and focus on their welfare, health and dignity.

King’s College operates the highest standards of safety. Does the Secretary of State agree that its expertise and rigour will support the wellbeing of participants and ensure that we get the robust evidence we need and that vulnerable children are no longer treated as political punchbags?

My hon. Friend is absolutely right that we must engage with due care and sensitivity on this issue. I can share with the House that these exchanges, Government policy, what is said by me and others, are followed extremely closely by this group of children and young people, who are extremely online, and by the wider LGBT+ community. My hon. Friend is right that trans people are often at the wrong end of the statistics as victims of hate crime, discrimination and mental ill health. We must always tread carefully when talking about suicide in this context, and bear in mind the warnings of the Government’s adviser on suicide prevention, Professor Louis Appleby, and the way in which that issue has been deployed irresponsibly by critics of the ban on puberty blockers that was put in place—we bear all those things in mind. I do think we have a high-quality trial set up. I do have confidence in the clinicians. We have had a cross-party briefing from the clinical team. I am happy to repeat that exercise, to keep coming back to the House and to arrange briefings for MPs and peers on a cross-party basis so that we can follow this closely, as we should.

I welcome the care with which the right hon. Member has approached much of this, and I appreciate that he has before him some very difficult decisions, especially because of the way the report was written. But I must come back to the simple truth that these are very young children, and decisions will be made for them—I appreciate by parents, taking that element of consent—that are genuinely irreversible. Whatever happens, we will see eight, nine, 10-year-olds grow up to be 18, 20, 25-year-olds—at least we hope we will—who have effectively been experimented on. Some of those children will resent greatly not just the system and their parents, but those who allowed this to happen, and here I identify the Department for Health and Social Care, not necessarily the Secretary of State himself. What provision is he putting in place to ensure that should those children wish to bring legal action against the Department, against those who took these decisions at a time when they were not able to give any form of informed consent, they will be able to have redress and their day in court?

I first thank the right hon. Member for the way in which he puts his concerns. I know he is concerned about this trial and that he has stated publicly his opposition to it, and I enormously respect the way in which he has done that. These are finely balanced judgments, and I acknowledge that.

The Cass review found that puberty blockers have been prescribed routinely without good evidence for their safety or effectiveness, and that is why a clinical trial was proposed. They are licensed and used safely in much younger children for precocious puberty or in older adults for certain cancers. For adolescents, the interaction with all the different processes of puberty may be very significant, which is why more evidence and a better understanding of their impact is needed in this patient group. Anyone on the trial can choose to stop taking puberty-suppressing hormones and leave the trial at any time; they do not need to give a reason. If a young person decides to stop taking puberty-suppressing hormones, their care in the NHS, including the gender service, will not change in any other way, and their doctors will explain to them and their parents or guardians what treatment options are available.

I know that there are concerns about the longer-term impacts on fertility. Prospective participants will be given comprehensive information on the advantages and potential risks of the hormones, including details about preserving fertility. Doctors will explain the possible long-term consequences and available options. Young people will also be offered consultation with a fertility specialist. The young person and their parent or guardian must clearly demonstrate a full understanding of all these issues—only then, after that, would a clinician sign off on admission to the trial.

Order. I ask colleagues to keep their questions short and the Secretary of State to keep his responses on point. I call Health and Social Care Committee member, Josh Fenton-Glynn.

I hope we can all agree that the young people involved should not be used by anyone as a political football. Can my right hon. Friend please assure me that the process and trial will be clinically led, not defined by rhetoric—in this place or anywhere else?

I can certainly give my hon. Friend that assurance.

I also welcome the tone and sensitivity that the right hon. Gentleman has taken on this issue—not just today, but throughout. We all recognise that we should be led by evidence, which is absolutely vital. The trans community is a reality. They feel very vulnerable and very attacked. People who have been on the medications for some time are now concerned that they may no longer be available. What can the right hon. Gentleman tell us to reassure those people that they will be safe?

As I reported when we put in place the permanent ban, there have been arrangements for people who were previously being prescribed puberty blockers. People who wanted to access them, but could not once the ban came in, have not been able to do so through authorised means.

I recognised when I took the decision, and as a result of representations I have received, both directly and in writing, that it caused considerable pain and distress to a very vulnerable group of children and young people and to the people who care very much about them. I have not been indifferent to that; I have taken it very much into consideration. However, with respect to all the people I have met, no amount of political pressure should move a Health Secretary away from the clinical advice and expert opinion that should underpin these sorts of decisions.

I welcome the trial. I commend the Secretary of State for following clinical advice and the Government for trying to build a consensus for one of the most minoritised communities in our country.

May I ask the Secretary of State—a man who I know to have empathy and thoughtfulness—to speak directly to trans people who will be watching this debate? At this Christmas time, they may be struggling with estrangement from family and with other difficulties. Can he speak to the dignity and worth to which they are entitled, and send a message that this House has their back?

I am grateful to my hon. Friend for that question. I recognise that the decision I took, within days of coming into this office, was received by trans people in particular, and the wider LGBT+ community, as a negative decision that detrimentally impacted their rights and identity. That is why it was an uncomfortable decision for me to take; I knew how it would be received and had to balance up the risk. I believed—and still believe, by the way—that it was the right thing to do, for the right reasons: a clinically led decision.

When it comes to the care and health of children and young people in particular, I make no apology for exercising extreme caution. I do want trans people in our country to know that this Government respect them and their identity, and want them to live with dignity, safety and inclusion. That is the approach that the Government are taking. I realise that decisions that I have personally taken have not been received in that way. That has not been comfortable for me, but I do believe it has been the right thing to do.

If we were resting this judgment on purely clinical evidence, we would tell every child that whatever sex they were was immutable and could not be changed, and that if they took these puberty blockers they might well find that they had irreversibly changed the course of their lives. How is a child of 10 or 11 going to be capable of making that judgment?

Whatever the Cass review says, in the end this is the Secretary of State’s judgment. I remember the covid inquiry repeatedly saying that it was wrong for Ministers to hide behind “the science”. Equally, there is no single clinical advice on this question: clinicians are as divided as the rest of society. We rely on the Secretary of State’s judgment. I am afraid that I think he has got it wrong.

I thank the right hon. Gentleman for his question and for how he puts his criticism, too. As I said earlier, and for the avoidance of doubt, I know what my responsibilities are. I understand the decisions that I take in this office and that I am accountable for those decisions. I do not resile from that. I am following clinical advice; I think that is the right thing to do in this area.

On the question of sex, the right hon. Gentleman is right: sex is immutable. Even if there has been treatment with hormones or surgery, underlying biology none the less means that trans women, for example, would still need to be screened and treated bearing in mind their biological sex, and the opposite is true for trans men. We have to draw that distinction between biological sex and gender identity.

Whatever my discomfort and personal views about this particular trial or about the notion of young people using puberty blockers in this way, I cannot ignore, and should convey faithfully to the House, conversations that I have had with trans young people and adults. They have described in powerful and unforgettable terms not just the life changing, but the life enhancing experience that they have had. I am thinking particularly of the university student I met; if she walked into this Chamber now, we would assume that she was born female. She is living her best life and described in very powerful and unforgettable terms the impact that treatment has had for her and her quality of life. At the same time, I think of high-profile cases such as Keira Bell’s. That is why we have to tread extremely carefully in this area, to follow evidence and to build an evidence base. It is also why these are such finely balanced judgements and why I can be simultaneously uncomfortable with the permanent ban that I put in place and uncomfortable with the clinical trial. I hope that I have reassured people that I think very deeply about these issues before taking decisions.

As the Health Secretary has said, this is a deeply troubling time for the trans community; I have heard that loudly from my trans constituents who have come to surgeries and from my postbag, too. When suicide rates among trans people are much higher than among the general population, we know where denying that they exist or denying them life-saving healthcare lead. What reassurances can the Secretary of State give my trans constituents and the families who support them? They are extremely worried that they will not be able to access the healthcare that they need.

I am grateful to my hon. Friend for his question. The reassurance that we can provide trans people in our country is that we are committed to making sure that they have access to the highest quality, evidence-based healthcare. That does not just apply in the case of children and young people; I also hope to report to the House before the Christmas recess the work undertaken in the Levy review into adult services. We are committed to making sure that we provide high-quality care to a particular vulnerable group of children and young people.

Although I disagreed with the permanent ban, it is to the Secretary of State’s credit that he has been very clear about all the competing issues that he is balancing to make his decisions, and I appreciate that. There are young people who are hoping to be part of the clinical trial and to receive puberty blockers, whether that will genuinely make a difference to their lives or they believe that it will make a difference to their lives. How will he ensure that appropriate support is given to those young people who do not get to be part of the trial, when they have been hoping that it will change their lives?

I am grateful to the hon. Member for the way that she asks her question, as a critic of some of the decisions that I have taken in this space. The reassurance that I can offer is that the study will look at the holistic care that this group of children and young people receives, and ensure that wider evidence-led therapeutic support, including mental health support, is available, so that regardless of whether a young person receives puberty blockers, they will certainly receive that wider range of support.

I appreciate the science-based approach taken by the Secretary of State. We use puberty blockers for many different conditions, so will the trial look at the data that has been amassed from the use of puberty blockers for other conditions? I wish to state on the record that puberty blockers are reversible. The evidence shows that when people stop taking them, they stop working—that is the science behind them. Finally, young people in my constituency are more likely to age out of gender services than to get their first appointment, so what are we doing to shorten the waiting time, not just for puberty blockers but for the whole range of services provided to trans children by the NHS?

Order. If hon. Members do not keep their questions short, I will not get everybody in. The answers need to be just as short.

I will try to do that, Madam Deputy Speaker.

We will ensure that young people get good access to wider evidence-led support. I have had to wrestle with the fact that some trans people enter adulthood without ever receiving any sort of healthcare, and I have been heavily criticised by those people in particular for some of the decisions that I have taken. We are working to reduce waiting times, as I have described.

My hon. Friend says that puberty blockers are reversible. We hear contrary views about that from Members across the House, some of whom say that puberty blockers are irreversible. The truth is that the evidence in this area is mixed, which is why we need to build a stronger evidence base.

The Secretary of State deserves our sympathy for having to negotiate such an ethical minefield. Will he tell us whether the data exists from all the people who had puberty blockers under the old regime? He mentioned having met one person for whom they had worked well and one person for whom they were a disaster. Surely it should be possible to do a systematic survey of the dozens, if not hundreds, of people who went through that. Might that be a more constructive and less dangerous way forward?

The right hon. Member is right that we need that data linkage study. That will happen, but it will not produce the same evidence base as a clinical trial, and that is the distinction between the two. It is frankly a disgrace that people have sought to withhold that kind of data and it is really important that we get this right.

I appreciate the right hon. Member’s sympathy. I have wrestled with this issue probably more than any other ethical decision that I have had to make in this office. I do not seek any pity or sympathy for doing so—it is the job that I signed up to and a job that I love doing. I have taken great care and sensitivity in this area because of the particular vulnerability of this group of children and young people.

It is fair to say that the recommendations of the Cass review were not welcomed by everyone—not least by all members of the LGBT+ community—but the Conservative party commissioned the review and accepted its findings, and the Labour party supported the review and supported its findings. Does the Secretary of State share my concern that there are those who would now seek to cherry pick which of the findings they agree with and which they do not? Is it not the case that an independent review with such serious and important findings should be accepted in its entirety?

When it was published—I was in the Chamber at the time—there was an overwhelming consensus in the House. There were some people who criticised and challenged the Cass review at the time, including some outside the House in the LGBT community. I have always supported the Cass review, which was led by one of our country’s best paediatricians. Because of that, I am proceeding in the way that I am, which is the way that Dr Cass—now Baroness Cass—recommended. I will continue to follow the evidence and implement the Cass review comprehensively.

A survey published today by Transgender Trend shows overwhelming public support for non-intrusive medical approaches for under-16s with gender dysmorphia. The public want this state-sponsored child abuse stopped, so will the Secretary of State represent the will of the people, stop the trial and instead introduce statutory legislation to access the evidence data from the 2,000 children and young people already given puberty blockers through the Tavistock scandal?

I will take the hon. Member’s question in three parts. First, the opinion polling that she mentions shows that people in this country are overwhelmingly kind, and they want to ensure that trans people, and LGBT people more broadly, are treated with kindness, compassion and inclusion. Secondly, I do not dismiss the opinion polling that shows that a majority are against this kind of trial. Thirdly, the reason I am doing this is that I have to think about this extremely small group of people. I do not know what it is like to walk in their shoes and I have to think very carefully about what is in their best interests. The best way to do that is to build the evidence base that we need to provide high-quality healthcare. I strongly, strongly do not agree with her characterisation of this study, which is in itself irresponsible.

Some of the political debate around this subject has saddened me, not least the way that trans people’s reality and experience has been denied. We even have evidence of British trans people from the 4th century—they have existed forever. Will the Secretary of State confirm that the trial is a real attempt to get a proper evidence base for treatment for young people that is really needed?

My hon. Friend is correct that the study is about building the right evidence so that we get high-quality, safe healthcare for this vulnerable group of children and young people.

Children struggling with gender dysphoria and their families are trying to find their way through very difficult and often distressing times. We should be helping them, not experimenting on them. Should we not be following the example of other European countries, such as Denmark and Finland, which have shifted their policies towards counselling rather than medical interventions?

I assure the hon. Member that as part of this study, and as part of the roll-out of services across the country, we are focusing on the therapeutic support that she describes. We are implementing the Cass review, which recommended this particular trial for this particular purpose, and we will follow the evidence. Of course we look at what other countries are doing, why they are doing it and what research emerges.

I have immense respect for my right hon. Friend, in particular for his commitment to equal access to healthcare. Will he say a little more about the mental health support available for children and young people involved in the trial, those who will not be able to be in the trial, those who are currently receiving puberty blockers, and those for whom the ban is causing immense stress or worse?

My hon. Friend is absolutely right. Regardless of whether people are receiving this medication or not, we need to ensure that they receive the right therapeutic support to enable them to have healthy, happy childhoods and to understand themselves, the world they live in and how they relate to it in a way that does not cause them distress or harm. That is my objective in this process.

For young people questioning their gender, the pathways trial is currently the only route by which they are allowed to access puberty blockers, which are a treatment that can provide vital respite from the anguish of going through puberty in a body that does not match your gender, before long-term decisions may or may not be made as an adult. I therefore welcome the announcement of the trial, while recognising that significant barriers to entry remain. How will the Secretary of State ensure that as many young people as need to can access the trial, including those who need to access puberty blockers as part of support to improve their mental health?

I do not doubt the hon. Member’s sincerity and integrity on this issue, but I say to her respectfully that when she talks about barriers to entry, those “barriers” are safety and clinical oversight, as well as parental consent and the assent of the young person. I do not believe that those are barriers; I believe that those are necessary bars for participation in this trial.

May I associate myself with the comments of other Members who have said that we are talking about humans who deserve to be treated with dignity? As a former Crown prosecutor, I firmly believe that evidence is hugely important, and the Cass review said that there is not enough evidence at present that puberty blockers are safe. Does the Secretary of State agree that the responsible thing for the Government to do is not simply to ignore the plight of such young people, but to conduct the clinical trial to obtain the robust evidence needed to direct policy going forward?

My hon. Friend is absolutely right. Given that I work for a former Crown prosecutor, I could not possibly disagree with her on evidence.

I thank the Secretary of State for his response to the urgent question. One thing we should all agree on is that the human rights of all, including trans people, must be protected and delivered by the Government and supported by us all. The reason we are here today is to discuss the risks and potential adverse consequences of the proposed pathways trial. The trial compares the timing of treatment initiation, rather than using a placebo. There is no arm that provides psychotherapy as a treatment option without puberty blockers, and there is no arm to assess children who do not receive any of those options. Will the Secretary of State consider ensuring that all the various arms and channels are tested as part of this trial to get a complete picture, rather than a partial picture, which may be misleading?

May I thank the hon. Member for the way in which he put his question? It is so important to emphasise that right across this House, there are many people who oppose this trial, but who do want to see trans people well supported and protected and to respect their identities. That is important for everyone to bear in mind.

The hon. Member talks about placebo. For obvious reasons in this case, a placebo would not be appropriate, because it would be very obvious whether a young person was receiving the real medication or the placebo, but the trial design has included a control group. The way in which the trial is established will help us to distinguish between the benefits of receiving or not receiving this particular medication, and there will be really close oversight of the impact on development, but he is right that we need to judge these things on the question of risk. That is what led Dr Cass to make her recommendation, and that is why I support it.

I welcome the Secretary of State’s answers today and his ongoing support for the Cass review. From his previous answers, it is clear that he has seen public opinion. Is he prepared to call an independent clinical review, given the high degree of public concern about the trial?

I am very happy to receive further clinical representations on this issue and to hear from experts on it. I hope the public will understand why, on this particular issue, I am not simply led by opinion polling. I have to follow the clinical advice and evidence, particularly given the enormous risks that surround these children and young people, including the risks that weighed on my shoulders and conscience when I denied access to puberty blockers by upholding the temporary ban and then making it permanent.

It is nigh-on child abuse to give children puberty blockers. This trial will take confused little minds and vulnerable children and place them on a medical pathway with profound, life-altering consequences. Childhood is a time of uncertainty, yet the state is intervening with drugs that many former patients now say they were never even capable of consenting to. How can this Government justify experimenting on children, rather than prioritising safeguarding, evidence and psychological support?

The hon. Lady has offered a political opinion, not a clinical judgment. By that logic, we would not have any medicine for children and young people; we would never have undertaken clinical trials or studies, because we would have judged that children and young people could not take part in them. That is objectively not a sensible position.

I understand the sensitivity surrounding this issue, and the hon. Lady is right to say that people in our country have received life-changing clinical interventions that they later regretted. As part of that regret, they have shared that they did not feel, at the time, that they were making or could have made an informed decision. That is why this trial is set up in such a way that it has such strong clinical oversight locally as well as nationally. It cannot happen without not just the assent of a young person but the consent of their parent or guardian. Those are important protections and safeguards. I do not share the hon. Lady’s characterisation of the trial.

I support the pathways clinical trial, but it is clear that many, many young people presenting with gender incongruence will not be able to access it, for whatever reason. I am concerned about the mental health of those who will not be able to access the clinical trial. What additional support can the Secretary of State provide for those people, particularly around their mental health?

The study includes a lot of research around wider therapeutic support and interventions, including mental health support. We are rolling out more clinics and services across the country to bring that care closer to home.

We need a short question. I call Jim Shannon.

May I thank the Secretary of State for all that he does? He deserves credit. A mother from my constituency phoned me this morning and said:

“Why is money being spent on this pathway when my child has been waiting for clinical support for 3 years and the waiting list is so long she may be moved to adult treatment? Why is Government prioritising the tiny few over the many? With our children’s mental health services at breaking point and parents at their wits end trying to get their child diagnosed”,

how do the Government look in the eyes of the parents with rare diseases whose drugs are not funded by the NHS when they are funding this trial?

I say respectfully to the hon. Gentleman, whom I like very much, and to his constituent, that it is because I have also had to look into the eyes of people in this community who have not received the right care and seen the deleterious impact it has had on their mental health and wellbeing. I have had to deal with parents who have suffered loss and bereavement. We have to make sure that we are doing the right thing by everyone. This should not be an either/or choice.

I call Samantha Niblett for a short question.

Trans people do not wake up at 18 suddenly trans; it starts before then. When we talk about protecting children, it means protecting trans children so that they can transition into adulthood knowing that they had parents and doctors who advocated for their needs. But this trial is not a prison sentence, so will the Secretary of State talk about whether people are entitled to withdraw from it if they change their mind?

They certainly can, and if they withdraw, they will still get the wider therapeutic support they deserve.

We are talking here about physically healthy primary school-age children being injected with drugs to stop them growing up. There is nothing medically wrong with these children; what they need is love, support and compassion to help them to accept their healthy bodies. They are perfect just the way they are.

The Health Secretary says that he is “uncomfortable” with this experiment, and his instincts are correct. In the haunting words of Keira Bell, a courageous young woman and a victim of the Tavistock scandal:

“I was an unhappy girl who needed help. Instead, I was treated like an experiment.”

When these children who are now going to be experimented on become adults, they will want to know who did this to them. This time, the truth will be that this was state-sanctioned, out in the open and—I am afraid to say—at the Health Secretary’s say-so. I am begging the Health Secretary to use his power as the politician in charge to do what he must know is right and stop this.

I wish I had certainty on this issue, and in some ways I envy my hon. Friend for his certainty. Having occasionally found myself to be a lonely voice in my party when sat on the Opposition Benches, I respect the fact that it is not easy to be a minority, dissenting voice, especially when one feels so strongly about an issue. I respect my hon. Friend’s position, even though I disagree with it—I do think this trial is the right thing to do. He is right that we need love, compassion and empathy for these young people; we also need to understand what health and care support will produce the best outcomes for them, which is what the trial is about.

I can certainly promise my hon. Friend that we will keep the House regularly updated. The risks he has described have weighed heavily on my conscience when putting in place a permanent ban on puberty blockers; I have understood the risk involved, and the vulnerability of this particular group of children and young people. I also meant to say, in response to my hon. Friend the Member for Pendle and Clitheroe (Jonathan Hinder), that the parents of trans young people love their children very much. That has been at the heart of so many of the representations I have received, from parents as well as from young people.

The Conservative party welcomed the Cass review on its publication, including its clear recommendation that this trial take place. Eight years ago, the then leader of the Conservative party supported self-ID and declared that trans women are women; now, we have dog-whistle statements such as, “If we leave these children alone, many will get over it,” which the shadow Minister said just yesterday in Westminster Hall. Does the Secretary of State agree that a rigorous clinical trial is the only way we will get the impartial evidence he needs to make informed decisions on gender-affirming care for trans young people?

I absolutely agree with my hon. Friend that we need a strong evidence base, that we need to conduct these conversations with great care, consideration and compassion, and that we need to recognise the vulnerability of this particular group of children and young people, and the fear that so many trans people in our country feel about whether this is a country that accepts and respects them. The political climate has changed since we made all the progress we have made on LGBT equality over the last 20 or 30 years, but do I think the character of this country has changed? Do I think we are less inclusive, less respectful, less loving or less caring? Absolutely not—those are the hallmarks of this country and of the British people. We might be having a debate about the efficacy of this trial, but I think the overwhelming majority of people in this House are doing so in the spirit of wanting trans people to live healthy, happy lives in which they feel safe, included and respected in our country.