The UK's Pathways Trial for puberty-blocking drugs now has a minimum participation age of 11. After being paused in February 2026, when the Medicines and Healthcare products Regulatory Agency raised safety concerns and suggested a minimum age of 14, the researchers at King's College London have worked through a strengthened protocol. The first children are expected to be recruited in August, though legal action by clinicians and campaigners questioning the trial's safety and ethics may push that back further. No child can take part without parental consent, and every participant must demonstrate a genuine understanding of the intervention and its possible risks and benefits.

I am glad the trial is moving forward. The young people caught in the gap since the 2024 ban have been waiting a long time, and Stonewall is right that many have been left in emotional and physical distress. Every month matters when you are 13 and your body is changing in ways that cause you real suffering.

But there is something in this story that I cannot let pass, because it tells us something about how we arrived here and where the responsibility actually sits.

The "charlatans" comment

Hilary Cass has told the BBC that the trial is "vital", or "we're going to have ongoing charlatans just handing out inappropriate drugs", pointing specifically at private and online providers. I have read that sentence several times now, and each time it bothers me more.

The sequence of events is this. The UK banned puberty blockers for under-18s in 2024, largely on the basis of the Cass Review. NHS waiting lists were already running into years before the ban. After it, thousands of young people had nowhere to turn within the public system. Private providers, including online providers, stepped in. Some of those providers are highly experienced clinicians working carefully within international standards of care. Many of the families who found their way to them did so in desperation, having exhausted every public route.

To call those providers "charlatans" is not a carefully considered clinical observation. It is a sweeping, unfounded accusation aimed at a diverse group of practitioners, some of whom have been doing this work with skill and compassion for many years. It also, rather conveniently, deflects attention from the policy that created the vacuum in the first place.

Who actually created this situation?

If the concern is that young people are accessing puberty blockers through unregulated or unsafe channels, the answer to that is not to dismiss the experienced clinicians who have been filling a gap the NHS left open. The answer is to restore timely, properly resourced access within established clinical services so that families do not feel they have to go elsewhere.

The Cass Review concluded that gender medicine had been operating on "shaky foundations". That finding has been widely challenged by international experts, and the review's methodology has faced serious criticism from researchers in the field. But even if you accept its conclusions entirely, the response it generated, an outright ban, with no alternative pathway for the young people already in the system, was not a cautious or careful intervention. It was an abrupt closure that caused measurable harm to real children, and the families affected have been saying so ever since.

The Pathways Trial is an attempt to rebuild an evidence base for a treatment that was never as poorly evidenced as the Cass Review suggested. That is a worthwhile aim. But the framing that positions the trial as the only legitimate alternative to dangerous quackery is neither accurate nor fair.

What the trial's new safeguards actually tell us

The updated protocol does reflect serious, careful thought. Setting a minimum age of 11 for birth-registered females and 12 for birth-registered males, strengthening guidance on when treatment should be stopped, improving information about fertility preservation, these are the right things to attend to in a well-designed trial. The researchers say there are no major changes to the overall design or conduct, and that they welcome scrutiny when children are involved. I respect that.

The legal proceedings expected before August will provide further scrutiny, and Professor Sir Jonathan Montgomery is right that if there are legal issues the regulators have missed, everyone benefits from having them clarified quickly. The trial should be robust. The young people who might enter it deserve nothing less.

The real priority

What I keep coming back to is this: the primary aim should be to ensure that young people who need gender-affirming care can access it within established clinical standards, as quickly as possible. A trial that takes years to produce findings is not an answer to a child who needs support now. The charlatans framing does not help that child. It muddies the waters and makes it harder, not easier, to build the kind of trusted, accessible clinical infrastructure that actually protects young people.

There are excellent clinicians working hard to provide safe, evidence-informed care to trans young people in the UK and elsewhere, including through private practice. They are not charlatans. They are people who refused to abandon their patients when the system did.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a gender specialist, medical educator, and advocate, and the founder of GenderGP. She writes about gender identity, trans healthcare, and the lives of trans people and their families.