NHS shake-up would let GPs prescribe transgender hormone treatments

Health officials unveiled an NHS shake-up that would allow GPs to prescribe transgender hormone treatments as part of a broader reorganisation of adult gender services. Under the proposals, specially trained general practitioners would be able to operate in a new role focused on gender medicine and prescribe cross-sex hormone therapies after patients have received a year of specialist care, without ongoing oversight from dedicated clinics. The changes are described as an immediate priority by NHS leadership as they seek to relieve long wait times and growing demand identified in a review led by Dr David Levy, a consultant in general medicine.

National health leaders said the reforms would establish a new GP role dedicated to leadership and knowledge-sharing in primary care in every neighbourhood, aiming to integrate gender care into local services. The access rules for trans patients would also shift: self-referral to adult clinics would no longer be available, eligibility would be limited to adults aged 18 and over, and patients could be discharged back to their GP sooner in some cases. The Levy review was commissioned after concerns that teenagers were slipping between children’s and adult services. It found that a quarter of referrals to adult gender clinics were for patients aged 17 to 19, with more than half of all patients under 25 and a majority born female. It also noted that around half of patients have another condition such as autism or ADHD, alongside a broader set of biopsychosocial issues including mental health problems, trauma or childhood abuse.

The review warned that clinics have not expanded quickly enough to meet rising demand, leaving patients at serious risk. It highlighted a lack of evidence on the long-term outcomes of prescribing powerful hormone-altering drugs to young people and noted that the NHS is planning a puberty-blocker trial as a result. Levy also recommended that psychiatric assessments should be conducted face-to-face and called for a national complexity measure to better understand the impact of co-existing conditions on care.

New referrals to adult clinics have doubled from around 5,000 in 2022–23 to about 10,000 in 2024–25, but the number of people waiting for a first appointment could be far higher than current estimates of about 40,000, with some waits projected to exceed 15 years. NHS England’s national medical director for specialised services, Professor James Palmer, acknowledged the need for improvement, saying that adult gender services must provide equitable, timely care and that investment is already underway to open more clinics and implement the review’s recommendations.

If the puberty-blocker trial proceeds, the drugs could be offered to participating children as early as January next year. However, some healthcare professionals have criticised the plan as ethically unjustifiable and warned of potential grave physical harm, including risks to fertility and sexual function. Health Secretary Wes Streeting has said that children cannot consent to taking puberty blockers and has acknowledged lingering hesitations about moving forward with the trial. He previously announced a permanent ban on the routine use of puberty blockers for children after a major review questioned their safety and efficacy, adding to the ongoing debate over how best to balance access, safety, and long-term outcomes for transgender youth.