Clinical Advisory Network on Sex and Gender
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 […]
Signatories were asked to give their reasons for signing the open letter that was sent to Wes Streeting, Secretary of State for Health, and to the PATHWAYS trial regulators 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 […]
We’re collecting signatures from clinicians for this open letter. Please add your name here: Sign the letter to Wes Streeting Mr Wes StreetingSecretary of State for Health and Social Care Copied to Dr Hilary Cass Dear Mr Streeting, We are writing as a group of clinicians, academics and researchers, many of whom treat children and […]
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.
NHS England are currently consulting on a draft service specification for the new youth gender clinics set up in response to the Cass Review. The deadline is 2 November. A service specification is important because it sets out what a service should provide and eligibility for access to the service. It is meant to be […]
A free online webinar on October 28, 2025, discusses obstacles faced by researchers in sex and gender due to pressures on academic freedom. Panelists, including experts in medicine, sociology, psychology, and philosophy, will share experiences and explore solutions.
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 […]
The webinar on September 16, 2025, focuses on the ethics and challenges of a clinical trial for puberty blockers in children referred to youth gender clinics. Experts will discuss ideas about alternative research methods that could better improve care for children and young people with gender related distress.
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.
Rachel Cashman highlights the severe conflict of interest in the NHS Sussex investigation into inappropriate prescribing practices for minors. She argues for an independent inquiry, citing previous failures in safeguarding and leadership within NHS governing bodies. The urgency lies in restoring public trust and ensuring child safety over ideological conflicts.
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.
Mr Joseph Chrysostom MBBS, MS (General Surgery), Fellow of the Royal College of Surgeons Edinburgh is a retired Associate Specialist in A&E, working in a university health board in South Wales. His professional interests lie in the emergency initial management and resuscitation of surgical patients and major trauma cases. He is also an Advanced Trauma […]
It’s good to hear that there will be a review of private prescribing of cross sex hormones for under 18s, but what is long overdue is a review of prescribing to under 18s within the NHS. It is scandalous that the current NHS policy to prescribe these has not been updated since the Cass Review finding of no good quality evidence of benefit, as well as increasing concerns about irreversible and harmful long term effects.
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.
The Australian Doctors Federation urges health professional bodies to reconsider the “gender affirmative treatment” model for youth, citing evidence from reviews like the UK Cass Review. Concerns about puberty blockers and hormone treatments’ risks have led several countries to restrict their use. The Federation advocates for psychosocial support as the first-line intervention.
The recent Supreme Court ruling on the meaning of “sex” in the Equality Act 2010 will have a significant influence on healthcare policy in the UK. The judgment defined “man,” “woman,” and “sex” in legal terms as referring to biological sex, prompting NHS organisations to revisit their policies, particularly regarding same-sex accommodation and patient care. The government is expected to publish accompanying guidance to align practices with these legal clarifications.
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 National Institute of Health and Care Research (NIHR) is funding the PATHWAYS trial on puberty blockers for children with gender incongruence, pending ethical approval. CAN-SG opposes the trial, citing serious ethical concerns, including unclear benefits and potential harms such as injury to fertility and cognitive development. The UK regulations mandate a trial only if its benefits outweigh its risks and emphasize the protection of vulnerable groups. CAN-SG argues that more research is needed on psychosocial interventions before considering puberty blockers, aligning with recommendations from the Cass Review. CAN-SG has written to the trialists, the oversight board and the regulators to express concerns, seeking proper ethical oversight.
CAN-SG has urged UK medical schools to reassess support for the GLADD charter, which endorses six commitments against LGBTQ+ conversion practices. Concerns focus on the potential criminalization of exploratory therapies for gender dysphoria, highlighted in the Cass Review. It advocates for open discussion in the medical field without chilling effects from policies or external charters.
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.
This article by Dr David Bell and Dr Sinead Helyar examines concerns regarding a proposed clinical trial of puberty blockers (PBs) for children with gender dysphoria. It argues that a PB trial would pose unacceptable risks and contravene ethical standards. The authors advocate alternative avenues for research and safer treatment methods for this vulnerable group of children.
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.
Professor Sallie Baxendale, Professor of Clinical Neuropsychology, will discuss adolescent brain development and its influence on decision-making, in her presentation on 27 November. She will focus on informed consent for medical treatments, applying lessons from neuroscience to clinical practices for young people, including those struggling with their gender identity. The webinar is free.
In July, the British Medical Association (BMA) Council voted to oppose the Cass Review recommendations on transgender healthcare for children and young people, prompting an open letter signed by over 1000 members criticising this decision. The BMA reversed its decision in September, adopting a position of “neutrality”.
Prevention of harm especially to children and young people is one of the most important aims of all health professionals. The death by suicide of a young person is a tragedy and the ripples of effect of such a profoundly shocking event have been estimated to affect many dozens of people in each case. Health […]
The World Professional Association for Transgender Health (WPATH) has suppressed evidence that contradicts its policies, influenced by activist clinicians. Unsealed documents reveal WPATH’s efforts to control Johns Hopkins University’s research findings and remove age thresholds for treatments. WPATH’s guidelines lack rigour and evidence transparency, and its influence in the World Health Organization transgender guideline development group poses reputational risk to WHO. The revelations suggest a need for health providers to disassociate from WPATH’s influence to avoid potential harm and legal issues.
The World Professional Organisation for Transgender Health (WPATH) faces allegations of research malfeasance, prompting concerns about its influence on the World Health Organisation’s (WHO) transgender health guideline development group. CAN-SG wrote to WHO urging it to suspend the guideline development process, citing a serious reputational risk.
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.
There are four official consultations on sex and gender issues initiated under the current government. Deadlines for contribution are before the general election. The first is about data, statistics, and research on sex and gender, with a deadline of 1 July. The other three consultations are also important, with deadlines in June and July 2024. You can contribute to inform the next government about public views and experiences on these issues.
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 […]
The recent decision by NHS England to ban routine use of puberty blockers is a positive step to protect children. Concerns remain about private providers, cross-sex hormones for 16-18 year olds, lack of research, and care for detransitioners. We hope the Cass final report will provide further clarity, but regardless of what is in the final review, the principle of evidence-based care for gender questioning youth has been established by Cass.
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 […]
Recently released documentation of internal discussions between members of the World Professional Association for Transgender Health, including authors of WPATH’s Standards of Care, reveal profound ignorance and lack of concern for the harms and lack of evidence for gender medical and surgical interventions, and a shocking disregard for medial ethics. The WPATH Files Leaked internal […]
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.
Clinical, educational & safeguarding perspectives Wed 31 Jan 2024 7:00 PM – 8:15 PM GMT Online, Zoom Register Now! The Clinical Advisory Network On Sex & Gender welcomes you to the third in our series of interactive webinars. These webinars will begin to cover the scope of our concerns and our work in the field of sex and gender in health care. Our […]
The review of the literature found that no well-designed studies have ever been conducted to properly assess the impact of puberty blockers on cognitive function.
Our current understanding of the importance of puberty in the development of cognitive function, animal studies and very limited data from human studies do not support the notion that puberty blockers have no impact on cognitive development or that any effects are reversible.
Indeed, the evidence to date points in the other direction.
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 […]
A group of professionals in Scotland formed ScotPAG to address the impact of gender ideology in public services. They aim to understand the situation, engage with authorities, and raise awareness. Facing challenges from professional bodies and government, they plan to use FOI requests and build alliances to push for transparency and influence policy.
BREAKING Extended deadline for feedback on development of a WHO guideline on the health of trans and gender diverse people. Submissions now close 2 Feb 2024 In June 2023, the World Health Organisation (WHO) announced it was planning to develop a guideline on the health of trans and gender diverse people; a further notice on 18 December […]
A recent documentary aired by Ireland’s national broadcaster RTÉ brought to light concerns raised by leading doctors of Ireland’s Adult National Gender Service (NGS) regarding the treatment of Irish children with gender dysphoria. Their concerns have largely been ignored. Dr Moran and Prof O’Shea have lodged a formal complaint against the HSE with the health standards watchdog in Ireland(HIQA) alleging that the HSE have directed children from Ireland to gender clinics abroad which adhere to a model of care which can harm children, an allegation which the HSE firmly denies.
Dr. Jane Martin discusses the UK government’s promise to issue guidance for teachers on supporting children dealing with gender identity issues. She explains the complex issue of “social transition”, which is increasingly prevalent in children today. This shift can lead to more invasive and irreversible medical decisions later on. She criticizes educational materials endorsing gender ideology, stating they capitalize on the younger children’s suggestibility and difficulty discerning reality from fantasy. She highlights concerns about the potential for social pressure and suggests the process of persuasion towards social transition amounts to grooming and child exploitation.
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 […]
The United Kingdom Council for Psychotherapy has recognised therapists with ‘gender critical’ views, who aim to help clients resolve their gender related distress psychologically rather than through invasive medical treatments. They acknowledge these views are protected by law. Amid major shifts towards ‘gender critical’ therapeutic approaches for children and young adults with gender dysphoria, a proposed bill banning ‘conversion therapy’ raises concerns of criminalising these ‘exploratory therapies’. Critics claim the bill would leave gender affirmative therapy as the sole legal option, despite its potential physical and mental health risks, and could discourage therapists from treating individuals with gender dysphoria.
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 […]
Medical, legal, and cultural debate over the practice of youth gender transitions has come to the birthplace of the Dutch Protocol The following is an extract from an article on the Society for Evidence Based Gender Medicine’s website about the beginnings of discussion and debate in the Netherlands about the practice of gender transition in […]
This paper by Professor David Pilgrim, Department of Psychology at University of Southampton, is a timely examination of the history of two distinct current clinical positions, that could help us understand and contextualise concerns about legislation to include gender identity in a ban on “conversion therapy”. The first is from those advocating an ‘affirmative approach’ […]
Against the weaponisation of youthful suffering An article by a child psychiatrist on the abuse of “suicide risk” in promoting medical intervention for children who identify as trans was recently published in The Critic. The author wrote: When a child identifies as trans, the spectre of suicide is frequently raised by campaigners — sometimes in […]
A recent review paper by Halasz and Amos in the journal Australasian Psychiatry, gives a history of the GIDS service at the Tavistock centre from its inception in 1989 to its closure in 2022 and compares “gender-affirming” and “comprehensive care” approaches. The term “gender-affirming care” refers to social, medical and surgical interventions that change the […]
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. […]
Clinical Advisory Network On Sex & Gender welcomes you to the first in our series of interactive webinars. These webinars will begin to cover the scope of our concerns and our work in the field of sex and gender in health care. Louise Irvine GP and Co-chair of Clinical Advisory Network on Sex and Gender. […]
The Clinical Advisory Network on Sex and Gender has submitted its response to NHS England’s consultation on its interim clinical policy for puberty suppressing hormones. We welcome the proposal to end the routine prescription of puberty suppressing hormones (PSH) to children and young people with gender dysphoria or gender incongruence and to focus on psychosocial […]
As a cautionary tale of what happens when we lose sight of ‘primum non nocere’ (first do no harm) as our guiding principle in medicine, the story of epilepsy surgery is exemplary.
This article appeared on the website of the Society for Evidence Based Gender Medicine and is reproduced here with their permission. segm.org 17 Aug 2023 The journal of the Danish Medical Association “Ugeskrift for Læger” confirms the change has occurred quietly but resolutely A major medical journal Ugeskrift for Læger, the Journal of the Danish Medical Association, […]
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 […]
Kilarney April 2023 Review by Robin Ion I spent four days at the end of April 2023 at the Genspect Bigger Picture conference in Kilarney, Ireland. The aim of the event was to promote exploration of how best to support people who experience gender dysphoria, including those who have regrets about social and/or medical transition […]
A response from the Clinical Advisory Network on Sex and Gender to Dr Helen Webberley’s open letter to Dr Hilary Cass, Chair of the Independent Review of Gender Identity Services for Children and Young PeopleC Dr Helen Webberley’s challenge to Dr Hilary Cass recycles the inaccuracies and misconceptions that have resulted in far too many […]
The Women’s Rights Network (WRN) reviewed police data revealing 6,539 reported cases of sexual assault in UK hospitals from 2019 to 2022. The WRN’s report suggests that NHS Trusts are failing in their duty to protect patients and staff due to inadequate data on sexual offences. The report recommends more comprehensive data collection and improved safety measures, including single-sex exemptions for hospital wards. The goal is to better understand and address the causes of hospital-based violence leading to a safer environment.
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 […]
This is an open letter to the NHS chief executives and chief nursing officers of the four UK nations, as well as relevant ministers, calling for the reinstatement of language that uses the word “woman” in NHS communications about women’s health. Please sign our letter to NHS chiefs – all are welcome to sign: To: […]
On 27 January 2023 The Guardian newspaper published the following letter by Dr David Bell, former staff governor at the Tavistock and Portman NHS foundation trust, on its Gender Identity Development Service. https://www.theguardian.com/society/2023/jan/27/gender-identity-treatment-needs-greater-caution When considering the interim report by Dr Hilary Cass on gender identity services for children and young people, your article overemphasises the […]
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
Dear Editor, The Clinical Advisory Network on Sex and Gender (CAN-SG) (1), a group of UK and Ireland based clinicians calling for greater understanding of the effects of sex and gender in healthcare, welcomes Dr Hilary Cass’s interim report and recommendations (2). Serious concerns about the Tavistock Gender Identity Development Service (GIDS) were raised by […]
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 […]
The closure of the Gender Identity Development Service (GIDS) at the Tavistock has attracted significant public and media attention. Closure resulted from the Cass Review of children and young people’s gender services in England. The interim report recommended a new service model which acknowledges multiple routes in and out of gender dysphoria. Elevated rates of same-sex attraction, autism spectrum disorders, mental health issues, and looked […]
CAN-SG welcome this important intervention by Dr Hilary Cass and support her recommendations that gender questioning young people need a comprehensive patient and family centred service, run by experienced providers of tertiary paediatric care to ensure a focus on child health and development with strong links to mental health services. We support her view that the […]
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 […]
Author David Pilgrim is joined by Pragna Patel of the Southall Black Sisters and Women Against Fundamentalism to discuss the effects of the strong hold taken by identity politics in modern society, in particular online on social media platforms. The pair will consider to what extent these kind of politics have contributed to human flourishing, and discuss whether they have changed […]