Caution is not cruelty: what is compassion in the puberty blockers debate?

NHS England has announced a new clinical trial to assess the risks and claimed benefits of puberty blockers. While presented as a way to strengthen the evidence base, the trial raises serious ethical concerns, asking children to bear potentially lifelong consequences and prioritising medical intervention over alternative forms of care. As Christians, we cannot afford to separate truth and grace in our response. 

Do you remember being 10 years old? For many, these are carefree days to spend with friends and family. Almost all of us were reliant on others to protect us from choices we were not ready to make. The same is no less true of children who struggle with gender dysphoria. 

The Cass Review, led by Dr Hilary Cass and commissioned by NHS England, marked a turning point in paediatric gender services. It found the evidence for medical interventions such as puberty blockers to be weak and insufficient, raising major safeguarding concerns. These findings led to the closure of the largest paediatric gender clinic in the world, the Tavistock Gender Identity Development Service (GIDS), whose referrals rose from around 100 in 2009-10 to nearly 8,000 by 2024 before its model of care was judged unsafe.

Sponsored

In response, the secretary of state for health, Wes Streeting, banned the routine prescription of puberty blockers in December 2024, acknowledging unresolved physical and psychological risks . However, the newly announced PATHWAYS study appears to undermine that caution, enrolling 226 children and young people to receive puberty blockers while monitoring mental health, cognitive and physical outcomes.

It is important to be clear about what compassion requires here. Children who struggle with their gender identity are not problems to be solved; they are gifts to be loved. Many families feel frightened, isolated and exhausted regarding the public debate, which can be harsh, polarised and reduce real children to abstract symbols. The welfare of the children we are discussing should be our focus – not winning arguments.

As those with concerns, our focus is also not against all child drug trials. Clinical research involving children is sometimes tragically necessary, particularly where children suffer from life-threatening or terminal illnesses. Gender dysphoria, however, is neither terminal nor life-threatening in itself. Any ethical trial involving children must carefully weigh risk, the child’s capacity to consent, and whether the existing evidence base justifies exposing children to harm. On each of these criteria, the PATHWAYS study falls short:

1. Risks to the child

Claire Coutinho, the shadow equalities minister, has described the trial as ​“state-sanctioned chemical castration of children”. While some may find this language uncomfortable, it reflects a real concern: many children who receive puberty blockers are likely to experience permanent infertility. Although blockers are often described as ​“fully reversible”, this is only true in a limited sense. The vast majority of children who take them go on to receive cross-sex hormones.

We must also listen to those who say, ​“This happened to me, and it harmed me.” Keira Bell, who brought a legal challenge against the Tavistock clinic, has publicly described being prescribed puberty blockers at 16, testosterone at 17, and undergoing a double mastectomy at 20, before later detransitioning. She has explained that her distress stemmed from anxiety, depression and unresolved trauma rather than a settled desire to transition. Such testimonies were long dismissed but have gained renewed recognition following the Cass Review.

2. Child consent 

Former labour MP Rosie Duffield recently wrote to Wes Streeting, seeking reassurance about the trial’s parameters. In his response, Streeting acknowledged fears that puberty blockers could act as ​“the starting point of a medical pathway with no off-ramp”. Previous data strongly suggest this is the case, with most children proceeding from blockers to lifelong hormone treatment.

While the trial requires ​“informed consent”, including the ability to repeat back stated risks, it is unrealistic to expect children to grasp concepts such as lifelong infertility or sexual dysfunction in a meaningful way. Society already recognises limits on children’s capacity to consent: we do not allow them to vote, drink alcohol or marry. We do so precisely because we understand that some decisions are too weighty and irreversible to place on young shoulders.

There is a live parliamentary petition that calls for the cancellation of the puberty blocker trials, which has received over 100,000 signatures. It will be debated in parliament in the coming weeks. 

3. The existing evidence base 

Although described as a randomised controlled trial, PATHWAYS does not include a true control group. Children will be assigned either to immediate treatment or to delayed treatment after a year. Every participant will ultimately receive puberty blockers. As a result, it cannot adequately assess whether puberty blockers themselves are beneficial or harmful compared to non-medicinal alternatives such as psychological support alone.

Previous evidence already made serious concerns clear. A 2021 Tavistock study found no improvement in psychological functioning among children taking puberty blockers, while also noting that ​“anticipated adverse events were common”. 

What should compassion look like?

Christian compassion does not mean avoiding hard questions. It means asking them with humility, resisting caricature and keeping the welfare of the child firmly in view. The past decade has shown that polarisation is a poor substitute for wisdom. The Cass Review has reopened an essential question: what genuinely helps children with gender dysphoria to flourish? Our task is to protect children, tell the truth about the evidence and offer compassion that is real rather than performative.

Jesus’ words are both sobering and instructive: ​“If anyone causes one of these little ones who believe in me to stumble, it would be better for them to have a large millstone hung around their neck.” (Matthew 18:6) They remind us that justice and compassion are not opposites. Especially when it comes to children, they must belong together.