Dear Mr Streeting,
We are writing on behalf of the clinicians, academics and scientists who are seriously concerned about the PATHWAYS puberty blocker trial: both its design and its ethics. We welcome your statements that it is important to have debate about this and listen to all points of view and we hope you will agree to meet a group of clinicians so that we can express more fully our concerns and discuss possible ways forward.
We do not believe the PATHWAYS trial will have any useful outcomes, and subjecting children to significant risk for no benefit is unethical. We explained these concerns in March and April 2025 in a letter to the regulators (HRA and MHRA) and those sponsoring, running and overseeing the trial, which was copied to you, and reiterated them in a letter in December to the same organisations (which we also sent to you) following publication of the trial protocol. We attach both letters.
We are writing to you in your role as Secretary of State for Health, with ultimate responsibility for safety and wellbeing of patients. We are apolitical and have not taken part in any of the political protests that have arisen in response to the trial, as we are fully aware this situation would be a dilemma for whoever was in your position. We know that you rely on the expertise of those who have said the trial is safe and worthwhile, and we understand why you would do so. But doctors and researchers do make mistakes, even with the best of intentions. History shows this to be the case. We believe this is one such situation and that it is necessary to consider the possibility that the PATHWAYS trial is misconceived and will put vulnerable children at risk.
Since the letter we sent to you on 18 December from clinicians concerned about the PATHWAYS puberty blocker we have continued to collect signatures and now send you an updated list of signatories. (Some of the signatories have said they don’t want their names being made public so while we are sending you the full list, we will publish a separate list only of those who have agreed to be public)
The full list contains 384 signatories of current or retired UK clinicians including 220 doctors and surgeons; 19 professors/academics/researchers; 33 nurses and midwives; 59 psychotherapists; 20 clinical psychologists; 20 counsellors; 12 allied health professionals.
We attach the reasons people gave for signing.
We believe there is a way forward: that it should be possible to pause the trial and allow the data linkage study (DLS) to be done. The DLS may show significant medium and long term safety issues which would inform the decision on whether or not to go ahead with the puberty blocker trial, or the design of any further research.
We’d like to bring to your attention the 12 rapid responses to the recent article about the PATHWAYS trial in the British Medical Journal, which made well reasoned arguments about a range of serious problems with the trial.
https://www.bmj.com/content/391/bmj.r2660
One of the rapid responses to the BMJ article explained in scientific terms the potential value of the DLS and refuted the criticisms by the lead PATHWAYS investigator made of the usefulness of the data linkage study. We attach it here.
You recently reiterated the importance of listening to clinicians who had concerns about the trial. We urge you to meet with a group of concerned clinicians to discuss our concerns.
Yours sincerely
Dr Louise Irvine and Dr Stella Kingett
Co-Chairs CAN-SG
Clinicians’ Letter to Wes Streeting and PATHWAYS trial regulators 3 December 2025 with updated (13 Jan 2026) public signature list.