The British Medical Association has formally recommended that 16 and 17 year olds be permitted NHS access to cross-sex hormones, according to a letter sent to NHS England in response to an ongoing consultation. The consultation, reported by the BMJ, concerns a proposal to stop the routine prescription of masculinising and feminising hormones for children and adolescents experiencing gender incongruence or dysphoria.
Current Prescribing Restrictions
Under present NHS rules, new prescriptions of cross-sex hormones for those under 18 are not permitted through the health service, though the same treatments remain obtainable via private prescription. The NHS consultation represents a potential formalisation of that restriction into standing policy.
The BMA's Position
The BMA's letter, signed by Emma Runswick, deputy chair of BMA Council, expressed reservations about the direction of the proposed policy.
We are concerned that this proposal...
The association's recommendation that 16 and 17 year olds should have NHS access to these treatments places it at odds with the trajectory suggested by recent independent reviews of the evidence base.
The Evidence Reviews Behind the Consultation
The NHS consultation was timed to coincide with the publication of an independent review in March, which found the evidence supporting the use of cross-sex hormones in people under 18 to be limited and of weak quality. That review was itself prompted by the landmark Cass Review, a wide-ranging examination of gender identity services for children and young people conducted by paediatrician Hilary Cass and published in April 2024.
The Cass Review raised significant questions about the evidence underpinning gender-related medical interventions in minors, and its findings have since shaped NHS policy discussions in this area. The independent review published in March drew on that foundation to assess the specific question of hormone prescribing for adolescents.
A Contested Policy Landscape
The BMA's intervention highlights the degree of professional disagreement surrounding prescribing policy for this age group. On one side, the independent reviews have pointed to an evidence base characterised as insufficient to support routine clinical use. On the other, the BMA's position reflects concern that restricting access entirely for older adolescents — those aged 16 and 17, who in other medical contexts are generally considered capable of consenting to treatment — may itself carry clinical and welfare implications.
The gap between NHS and private availability adds a further dimension to the debate. Critics of the current arrangement have noted that maintaining access only through private prescription creates a disparity that may disadvantage patients without the financial means to pursue that route.
NHS England has not yet published the outcome of its consultation. The BMA's letter represents one of the formal responses to that process, and the BMJ reported its contents as the consultation period continued.