The prescribing of puberty blockers and cross-sex hormones to under-18s with gender dysphoria has been paused in Scotland for all new patients. 

In a joint statement, NHS Greater Glasgow and Clyde and NHS Lothian - which oversee Scotland's Young Person Gender Service - said the treatments were being suspended as a result of the Cass Review, published on April 10, which criticised the "remarkably weak" evidence base for medical interventions in children and adolescents. 

Dr Hilary Cass said randomised clinical trials were needed, and that the "toxicity" of the debate around gender had hampered clinicians from raising concerns. 


Both health boards have contacted all affected patients this week "to advise that the prescription of puberty hormone suppressants and gender affirming hormones to young people has been paused following the research findings of NHS England and the publication of the Cass Review". 

The decision does not affect existing patients, who will continue to be "monitored".

This is understood to cover a very small number of patients.

Puberty blockers stop physical changes such as breast development or facial hair. 

They have long been available on the NHS in cases where children go into puberty prematurely - at eight or nine - but their use to delay normal-onset puberty has been controversial. 

Testosterone or oestrogen has also been made available to patients aged 16 and 17 wishing to transition.

The change in NHS stance does not affect clinics in the private sector, which can continue to prescribe the drugs "off-label" for self-funding patients. 

The health boards had already deferred starting new patients on these treatments in mid-March this year pending the outcome of the Cass Review and in response to the position taken by NHS England, where the prescribing of puberty blockers to under-18s to delay the onset of normal puberty was banned in March except in the context of research trials. 

The pause will remain in place while NHSGGC "works with the Scottish Government to engage in research with NHS England that will generate evidence of safety and long-term impact for therapies".

The statement added: "Existing patients who are currently receiving hormone suppressants or gender affirming hormones are not affected by this pause.

"These patients will continue on treatment with close monitoring and support, as they wish to and as guided by individual clinical assessments within each service."

The Herald: The Sandyford in Glasgow, where the NHS gender service is basedThe Sandyford in Glasgow, where the NHS gender service is based (Image: PA)

Dr Emilia Crighton, director of public health at NHSGGC, said: “The findings informing the Cass Review are important, and we have reviewed the impact on our clinical pathways.

"The next step from here is to work with the Scottish Government and academic partners to generate evidence that enables us to deliver safe care for our patients.

“We echo the views of Dr Hilary Cass that toxicity around public debate is impacting the lives of young people seeking the care of our service and does not serve the teams working hard to care and support them.

“We understand the distress that gender incongruence can cause and, while all referrals to endocrinology are paused, we will continue to give anyone who is referred into the Young People Gender Service the psychological support that they require while we review the pathways in line with the findings.”

Tracey Gillies, executive medical director at NHS Lothian, said: “The Cass Review is a significant piece of work into how the NHS can better support children and young people who present with gender dysphoria.

"Patient safety must always be our priority and it is right that we pause this treatment to allow more research to be carried out."

Scottish Conservative deputy leader Meghan Gallacher said the decision was "long overdue".

She added: “The SNP Government have been dragged kicking and screaming towards taking the necessary action to safeguard vulnerable youngsters after days of shameful silence and dithering in response to the Cass Review – presumably to placate the gender zealots in the Scottish Greens."

Scottish Labour health spokeswoman, Jackie Baillie, welcomed the decision.

She said: “The guiding principle for all actions must be to ensure that young people with gender dysphoria get safe treatment.

“The messaging from the Scottish Government on the Cass report has been all over the place - leaving the public without clarity on this vital issue."

Vic Valentine, of Scottish Trans and the Equality Network (STEN), said the pause would  "harm trans children and young people".

A statement from STEN said: "This decision has been taken within the context where the reality of trans people's experiences and lives is questioned almost daily in some of the media and some political circles.

"This makes us worry that the decision has been influenced by that context rather than solely through consideration of the best interests of trans children and young people."

Scottish Health Secretary Neil Gray said it was right for the decision to be made by clinicians rather than politicians.

He added: "We have been clear it is for clinicians and health boards to make decisions about clinical pathways, and that these decisions should be made carefully and based on the best evidence available.

"This is what both health boards have done and their position is supported by the chief medical officer.

"More broadly, the Cass Review's final report and findings are being closely considered by both the Scottish Government and health boards, in the context of how such healthcare can be best delivered in Scotland."