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.]

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.

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.

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.

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 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.

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.

Will the hon. Gentleman give way?

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.

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.