Clinical Advisory Network on Sex and Gender
Concerns have arisen regarding the PATHWAYS Trial Participant Information Sheets, which do not meet Health Research Authority standards. Issues include insufficient risk disclosure, misrepresentation of treatment outcomes, and a lack of clear, accessible information for parents and young participants. This undermines informed consent for the trial involving puberty blockers.
The American Society of Plastic Surgeons recommends delaying gender-affirming surgery for patients under 19, citing insufficient evidence regarding benefits versus risks. The statement highlights ethical concerns over adolescent decision-making and the irreversible consequences of such procedures, asserting the need for a more cautious approach amid ongoing uncertainties in this area.
A panel of experts has raised ethical concerns over a UK clinical trial of puberty blockers for children with gender distress, warning it poses significant risks to healthy development. They advocate for prioritising non-pharmaceutical research to better understand long-term outcomes before proceeding with the trial, which has faced substantial opposition and criticism.
380 clinicians, academics, and scientists express significant concern about the ethical implications and design of the PATHWAYS puberty blocker trial. They argue it poses risks to children without beneficial outcomes. The group requests a meeting with Secretary of State for Health, Mr Streeting, to discuss pausing the trial pending further safety research.
Clinicians gave their reasons for signing the open letter to Wes Streeting, Secretary of State for Health, and to the PATHWAYS trial regulators (HRA and MHRA) in December 2025. The signatories and comments were updated in a follow up email to Wes Streeting on 13 January 2026. Harm/Risk I agree with the reasoning in the […]
On December 2, 2025, concerns regarding the PATHWAYS trial on puberty suppression for gender incongruence in children were raised by CAN-SG. They requested a pause in recruitment for peer review due to potential risks and methodological issues, emphasizing the need for transparency and safety. The Health Research Authority acknowledged this letter and promised a response.
Senior managers in UK universities are urged to foster healthier academic cultures regarding discussions on sex and gender, following concerns raised during a CAN-SG webinar. Experts highlighted the oppressive climate faced by academics, with significant repercussions for those challenging gender ideologies. Solutions proposed include restoring academic autonomy, prioritizing truth, and implementing consequences for disruptive activism, ensuring diverse viewpoints are protected.
This was the central question that experts debated at a special CAN-SG webinar earlier this week (16th Sept) and their answer was a resounding ‘no’. They agreed that the government’s plan to run a clinical trial on children with gender distress to determine whether puberty blockers (PBs) are safe raises too many ethical and methodological problems […]
Hannah Barnes’ article reveals the NHS’s failure to address concerns about Dr. Sam Hall’s prescribing practices for under-18s at Brighton’s WellBN clinic, despite local and national health authorities’ longstanding awareness of issues. Ignored complaints, inadequate investigations, and continued hormone prescriptions raise fears among families and advocates, leading to calls for an independent inquiry into safeguarding failures.
Maia Poet, a 26-year-old independent writer, examines the relationship between autism and gender dysphoria, arguing it often reflects untreated neurodevelopmental distress. During her speech at the European Society for Child and Adolescent Psychiatry, Maia explores the metaphor of being “born in the wrong body” and the feelings of disembodiment many neurodiverse young people experience. She argues that the diagnosis of gender dysphoria may overlook the true needs of neurodiverse youth, and advocates a psycho-social approach instead of medical intervention.
The US Supreme Court upheld a Tennessee law banning puberty blockers and cross-sex hormones for minors, aligning with a growing trend toward cautious treatment in some European countries. The ruling in US v Skrmetti, passed by a 6-3 majority, dismissed claims that the law discriminated based on sex, emphasizing that treatments were distinguished by medical condition, not biological sex. The court highlighted risks associated with gender medicalisation, citing evidence of regret among detransitioners and questioning the maturity of minors to consent to irreversible procedures. The decision reinforces state authority in regulating treatments deemed harmful and raises concerns about the lack of robust medical evidence supporting such interventions for youth.
Diagnosis is a complex topic. At its most basic level, it is the process of identifying a disease, condition, or injury based on a patient’s symptoms and medical history, along with physical examination and tests where appropriate. Given a diagnosis, a clinician may then be able to identify the correct course of treatment, understand the likely […]
On May 1, the US Department of Health and Human Services released “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” which was commissioned by a Trump administration Executive Order. This comprehensive review assesses current evidence on treating paediatric gender dysphoria, emphasizing the importance of compassionate, evidence-based care tailored to children’s and adolescents’ needs. It highlights the risks of paediatric medical transitions, questioning their benefits and critiquing the “gender-affirming” model of care used in the US. The review also discusses ethical considerations, advocating for psychotherapy as a safer alternative. It aims to inform policymakers, clinicians, and families amid growing international concern about paediatric medical transitions.
The Sullivan Review (2025) evaluates the recording of sex and gender identity in public data, highlighting issues with inaccurate data collection practices across institutions like the NHS and Police Scotland. It calls for separate recording of biological sex to ensure reliable statistics for policymaking, research, and addressing inequalities. Immediate action is recommended for accurate data practices.
The report “Incoherent and Unsafe” critiques the NHS’s handling of sex and gender data, highlighting inconsistencies that endanger patient care and medical research. It emphasises the need for standardised definitions, improved data collection, and comprehensive training for staff to prioritise patient safety and ensure compliance with data standards.
On March 6, 2025, the Clinical Advisory Group on Sex and Gender (CAN-SG) hosted a panel to review the progress following Dr. Hilary Cass’s 2024 review of gender identity services for children. The Cass Review highlighted the weak evidence supporting medical interventions for gender dysphoria and emphasised psychological therapy as the preferred management approach. Hannah Barnes discussed the history and closure of the Gender Identity Development Service (GIDS), pointing out missed opportunities and the lack of meaningful patient data. Other panelists emphasised the need for psychotherapy, addressing misinformation, and ensuring ethical considerations in treatment pathways for young patients, while acknowledging the challenges of implementing the Review’s recommendations.
Professor Sallie Baxendale discusses the susceptibility of doctors’ thinking to biases when evaluating treatment effectiveness, potentially overlooking harmful effects. She emphasizes that cognitive biases lead clinicians to misinterpret evidence, perpetuating harmful practices. By recognizing these distortions, doctors can enhance decision-making and better safeguard their patients’ health.
The UK government has indefinitely banned the private prescribing of puberty blockers for young people under 18, citing safety risks. Although the ban closes loopholes for private prescriptions, concerns persist about the efficacy and ethics of clinical trials of puberty blockers. Prioritising other research avenues is essential for developing better and safer strategies for helping children presenting with gender dysphoria.
Candidates in the general election can be asked important questions related to sex and gender in healthcare, such as their views on the Cass Review and proposed Conversion Practices legislation. Other relevant topics include self-ID legislation, gender identity teaching in schools, changes to the NHS Constitution, and the need for accurate language and data collection in healthcare. Contact your local candidates at: whocanivotefor.co.uk.
The UK Council for Psychotherapy (UKCP) withdrew from the Memorandum of Understanding on Conversion Therapy due to concerns about its implications for children and lack of consultation with relevant bodies. After a “vote of no confidence” petition, UKCP will hold an election for members to decide the fate of the Board of Trustees. Measures are being taken to develop new guidelines and address concerns in collaboration with other organizations.
Introduction Dr Hilary Cass, former President of the Royal College of Paediatrics and Child Health, was asked by NHS England and NHS Improvement to chair an independent review and make recommendations on how to improve services for children and young people experiencing issues with their gender identity or gender incongruence, and ensure that the best […]
First Do No Harm Critical perspectives on sex and gender in healthcare With over 150 attendees, and hundreds from across the world joining the livestream, #FirstDoNoHarm was a resounding success. The sold-out event platformed and hosted clinicians and patients from around the UK, Europe and the US. In the media THE BMJ I The Telegraph […]
We’ve just uploaded our recent webinar on childhood social transition. The context for this webinar is the recent guidance from the government to schools on social transition, and the current public consultation on the matter. This consultation will run until the 12 March. We hope that after listening to the webinar people may feel inspired […]
Professor Sallie Baxendale’s article in Unherd discusses her challenges in publishing a paper on puberty blockers’ impact on cognitive function. Despite facing rejection from three journals, her paper has now been published in a well-respected peer reviewed journal, shedding light on the minimal evidence and concerns about the impact of puberty blockers. Prof Baxendale’s Unherd article sheds light on issues in the peer review process.
This is a brief overview of some of CAN-SG’s activities in 2023 The group has grown to over 100 healthcare professionals with members across many specialities including medicine, nursing, psychiatry, psychology and psychotherapy, general practice, occupational therapy, speech and language therapy, radiology and radiography, midwifery and surgery. Hundreds of people have signed our Declaration and […]
James Esses, trainee psychotherapist, had taken UKCP to court for discrimination against him for expressing gender critical beliefs which led to him being expelled from his psychotherapy training course. (You can get more information about his case here.) Today Esses announced he had reached a settlement with UKCP and, although he was not able to reveal […]
Following recent case law, and the publication of the interim Cass Review report, the UK Council for Psychotherapy (UKCP) is today issuing a statement on the law regarding gender-critical views and its implications for the practice of psychotherapy and psychotherapeutic counselling. This statement is also being made to highlight the fact that exploratory therapy must not be […]
CAN-SG’s submission to NHS England’s consultation on interim clinical policy on use of puberty suppressing hormones for children and young people with gender dysphoria/gender incongruence CAN -SG has submitted its response to the NHS England consultation. The consultation closes on 1 November. Anyone who has an interest in this policy can contribute to the consultation. […]
In May 2023 a group of doctors and therapists who are members of CAN-SG gave evidence to two cross party groups of parliamentarians, both MPs and Peers, about the risks of including gender identity in legislation to ban conversion practices, especially for the clinical care of gender questioning children and young people. The bill has […]
By Stella O’Malley:- When journalist Hannah Barnes carried out an exposé on the Tavistock for Newsnight in 2019, she was so shocked at what was uncovered that she took time out from working at the BBC to write her book, Time To Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for […]
The World Professional Association for Transgender Health (WPATH) recently published its eighth Standards of Care document (SoC8). It characterises surgery and hormonal interventions for those with a marked sense of gender incongruence as “medically necessary”. It includes a new category of ‘eunuch’ within its remit. Although SOC8 originally specified age limits for surgical and hormonal […]
The current law in Scotland requires applicants who wish to change gender to be aged 18 or over, to provide evidence of a diagnosis of gender dysphoria with assessment by a gender recognition panel, and to have lived in their acquired gender for at least two years. They have to make a declaration that they […]
Response to the Interim Service Specification for Specialist Gender Dysphoria Services for Children and Young People – Public Consultation
The NHS confederation is launching a tender to create a practical guide to “model meaningful trans and non-binary allyship”. The confederation is a membership organisation that brings together various healthcare systems throughout the UK. It represents its members’ interests, and exerts considerable influence on government. This invitation takes a very particular position with regards to […]
GLADD is the UK’s association of LGBTQ+ doctors, dentists, medical and dental students. All medical schools throughout the UK have been sent a copy of GLADD’s charter relating to the so called ‘conversion therapy ban’. It was co-authored with Lancaster University, and the document has been endorsed by Dr Michael Brady, national LGBT Advisor at […]
Informed consent is the bedrock of medical practice and indicates the explicit permission a patient gives for a specified medical intervention. Consent can only be granted following discussions about the anticipated consequences of the proposed treatment, potential risks and benefits, and the outcomes of alternative treatments including no treatment. The courts regard notions of consent […]