"Why Wes Streeting changed his mind on cross-sex hormones"
The evidence that shifted the governmentâs position on providing the treatment to children is revealed here by Hannah Barnes for The New Statesman, 27 May 2025
"One of the reasons I spoke out. I saw first hand the terrible medical damage done to the young East German girls fed testosterone during their puberty for sporting advantage. Many died very young, ALL are very ill."It emerged last week that the Health Secretary was âactively reviewingâ whether to restrict or ban the prescription of cross-sex hormones to children who want to transition to another gender. On 28 April, a group of clinical specialists was established to explore the issue, including NHS England specialist commissioners and paediatric endocrinologists, some of whom prescribed the drugs to children attending the now closed Gender Identity Development Service (Gids) at the Tavistock clinic.
The development was revealed at the High Court, where judges were deciding whether to allow a judicial review which criticised Wes Streetingâs failure to restrict the medications already. The New Statesman can exclusively reveal the contents of the expert clinical reports which persuaded the government to change direction.
The legal case was brought by two parents and Keira Bell, who was prescribed both puberty blockers and cross-sex hormones (testosterone) after being assessed by Gids. They claimed that it was âirrationalâ for Streeting to have banned the prescription of puberty blockers for children outside of an NHS research trial, while placing no restrictions on hormones. There were health and safety concerns pertaining to both, they argued and, if anything, hormones posed the greater risk to young people.
Cross-sex hormones â or masculinising and feminising hormones â are given to people who identify as a gender that is different to their biological sex. The drugs bring about largely irreversible physical changes to the body that are associated with their preferred gender. For example, the use of testosterone in females lowers the voice to a male pitch, promotes the growth of facial and body hair, and changes the muscle and fat distribution. Oestrogen is used by biological males seeking a more feminine body.
In a witness statement, Bell told the court, âI made an ill-considered decision as a teenager. A lot of teenagers do. However, this one was encouraged and set in stone by professionals in the largest health institution in this country, permanently deteriorating my whole life and wellbeing.â Bell had previously taken legal action against the Tavistock and Portman NHS Foundation Trust in 2020, arguing that it was not possible for children with gender-related distress to consent to treatment with puberty blockers.
Lady Justice Whipple dismissed the application for a judicial review, saying that âthe case had moved on substantiallyâ following the establishment of the new working group. The governmentâs lawyer, Iain Steele, argued that the decision to seek âclinical and expert advice from NHS Englandâ was based on new, expert evidence provided by the claimants. The New Statesman can reveal that these two reports were provided by European doctors who have directly worked with hundreds of gender-questioning children. They warn of severe health risks associated with prescribing hormones to children and evidence of serious health difficulties for those on hormones for extended periods of time.
In one report, Professor Riittakerttu Kaltiala, chief psychiatrist at one of the two government approved paediatric gender clinics in Finland, described how the services had dramatically changed their clinical protocols over the last decade because of âgrowing concern about the harms of transition on vulnerable young patientsâ. Hormone treatment for under-18s is only considered âwith extreme caution and⌠in rare casesâ. Those who identify as non-binary â neither male nor female â would not be eligible at all, because of a lack of research.
Kaltiala, who has personally assessed more than 500 adolescents, explained that alongside a significant change in the âprofile and volume of those seeking support for gender related distressâ, she and her team started seeing âcases of previous patients coming back and telling us they regretted their transitionâ â often referred to as âdetransitionersâ. She is âincreasingly concernedâ that regret is far more widespread than suggested by older studies, which do not reflect the current patient group of largely adolescent females with multiple other difficulties. Two recent studies have suggested that between 20 and 30 per cent of those who initiated hormonal gender reassignment discontinued hormonal treatment in four to five years, Kaltiala noted.
The main focus of both reports is the health risks posed to young people by early hormone use. In the second, paediatric endocrinologist Professor Dr Jovanna Dahlgren, who established one of Swedenâs three units that assess children with gender-related distress, described how Swedenâs doctors are advised to no longer prescribe hormones to those under 18. Instead, they focus on other difficulties a young person is facing, provide psychological support, and look for other medical ways to relieve distress.
âCross sex hormone treatment affects each of the cells of the body,â Dahlgren explained. Research showed trans women (ânatal malesâ) have a substantially higher risk of ischemic stroke, venous thromboembolism (VTE) â which includes deep vein thrombosis and pulmonary embolism â and heart attacks. After eight years of oestrogen use, trans women had a risk of VTE nearly 17 times higher than other biological males, and 13.7 times than biological women. Studies have also suggested that females who take testosterone, have an increased risk of heart attacks.
Seemingly most relevant to Wes Streetingâs decision-making, is the outlined additional danger of starting hormone treatments while still in childhood. âIf the treatment is started in young years, many years with daily treatment with cross sex hormones will increase the risk of cardiovascular disease⌠and stroke⌠[and] can decrease fertility, impair liver function and increase the risk of cancer in both genders,â hormone expert Dahlgren wrote. She also noted the lack of long-term data: âThe consequences of prescribing cross sex hormones in individuals under the age of 18 years are that the body and the brain are permanently marked/changed with both known and more unforeseen consequences.â
As well as bringing about the physical changes the young person wants, testosterone use can â she says â impact on bone mineral density, the heart and âseveral structures of the brainâ. The treatment will, âin other words influence processing, emotions, consolidation of information and spatial memoryâ. Female sexual function is also affected, while oestrogen use in males impairs sperm quality, and thus, fertility. âThe risks of [cross-sex hormone] treatment are greater if treatment commences prior to the conclusion of puberty,â Dahlgren argued. Hormone use accelerates bone maturation, meaning that if a child hasnât completed puberty, but takes hormones, it will âaccelerate the bone ageâ, and contribute to a shorter adult height. ... ..cont / For Finlandâs Riittakerttu Kaltiala, the use of cross-sex hormones, âis not safe to any minorsâ. The psychiatrist is explicitly critical of NHS Englandâs current stance (which is under review) of allowing hormones to be prescribed to 16- and 17-year-olds. âI have seen the NHS Clinical Commissioning Policy Prescribing of Gender Affirming Hormones which implies that CSH treatment has been evidenced as safe for treatment for over 16-year-oldsâ, writes Kaltiala. âThe evidence relied upon in the policy does not support that conclusion. It is not possible to conclude that treatment with cross sex hormones is safe for under 18-year-olds, and having reached age 16 makes no difference to this,â she said.
Existing research does not verify âthe assumed psychosocial and mental health benefits of cross-sex hormones initiated during developmental yearsâ either, she argued. Gender medicine seems to be acting outside of medical norms: âNo other medical field performs irreversible treatments before the age of 25 years in Swedenâ, Prof Dahlgren said, adding that she is ânot awareâ of any condition in children that needs cross-sex hormone treatment. âHowever,â she also wrote, âsome disorders of sex development (DSD) may need complementary sex hormone treatment.â Both expert reports were highly critical of the model provided by overseas prescribers of hormones. It was âunsafe and irresponsibleâ, Kaltiala said.
The NHSE specialist working group is now tasked with looking at many of the issues raised by these two leaders in European youth gender care. It will assess the potential harm caused by continued use of unregulated hormones coming from private providers against any potential harm caused by imposing restrictions on their supply; it will seek to identity any alternative drugs that prescribers might look to use in the event of restrictions being introduced. It will also investigate any other uses for cross-sex hormones â besides gender incongruence â in young people under 18. A final report is expected in July. Depending on what it concludes, it is possible that restrictions could follow soon after."