NHS England: no more routine cross-sex hormones under 18
Since 9 March 2026, cross-sex hormones for people under 18 are no longer a routinely provided treatment at NHS England (source). A consultation on the accompanying new policy ran from 9 March to 7 June 2026 (source).
What NHS England is doing
- Previous policy replaced on 9 March 2026: the 2024 policy allowed restricted use for 16- and 17-year-olds with persistent signs of gender dysphoria, with a national multidisciplinary team having to endorse every referral (source). The new policy position makes feminising and masculinising medicines no longer routinely available to children and young people under 18.
- Existing patients may continue: 16- and 17-year-olds who were already receiving hormones on an NHS prescription on 9 March 2026 may continue if they, their parent or guardian and their clinician in the NHS gender service agree in writing that continuation is in their best interests, after a discussion of the limited evidence on safety, benefits and risks (source). Under the proposal the clinician reviews each case individually.
- Consultation from 9 March to 7 June 2026. Afterwards all responses are considered before the clinical policy is published (source).
This step follows the earlier decision by NHS England to place puberty blockers outside standard care. The broader British shift is described in the article on gender care in the United Kingdom. For the hormones, NHS England refers to evidence reviews: a NICE review from 2021 and later reviews by Solutions for Public Health (2026).
The evidence
"In 2021 an independent evidence review by NICE found that there was very limited evidence about the safety, risks, benefits and outcomes of prescribing these hormones to people under 18." — NHS England, consultation guide (translated)
"NHS England has concluded that there is not enough evidence to support the safety or clinical effectiveness of feminising and masculinising medicines to make the treatment routinely available to children and young people at this time." — NHS England, policy proposition of 9 March 2026 (translated)
Both passages appear in official NHS England documents (consultation guide, policy proposition). According to NHS England, the 2024 policy was a direct response to the final report of the Cass Review; in doing so the organisation committed to a full review.
What this means for the wider debate
Access has also been restricted in Sweden. According to the Dutch Health Council, puberty blockers and gender-affirming hormones for young people in Sweden and England are available only in research settings or in exceptional cases, while care in Germany, Austria, Switzerland, France and Poland has not been restricted but has recently been anchored more firmly (source). What systematic reviews say about the evidence is covered in a separate article.
What this means for the Netherlands
Treatment with puberty blockers for young people was first described in the Netherlands in 1998 and is known internationally as the Dutch Protocol. According to the Health Council, other countries adopted that treatment, referring to the protocol. The Council also writes that in the Netherlands the emphasis is on stepwise exploration of gender identity, with an extensive psychological exploration phase and a multidisciplinary assessment, and that its application turned out differently in England (source). The consequences the Cass Review has had so far for Dutch care, politics and media are documented at trans-nederland.nl.
Conclusion
NHS England states that there is not enough evidence to offer cross-sex hormones routinely to people under 18. Existing patients aged 16 and 17 can continue under conditions. The final clinical policy follows after the responses to the consultation have been considered.