Anyone reaching out in trust to the NHS should recognise the atrocity that is the King's College London/NHS PATHWAYS puberty blocker trial. Atrocity means ‘repellently evil act’.

The picture of Patti Smith is chosen to jog our memories and free our thoughts. Popular culture has long dallied with sexual ambiguity. Nobody knew quite what David Bowie thought he was; that was the point. A few decades ago, many people felt fairly relaxed about cross-dressing, and neither the law nor medicine was involved. Times change.

The puberty blocker trial, now authorised and proceeding, is not any kind of free play around gender self-presentation. It is chemical. The UK Government and the NHS will experiment on a group of young people aged 11 to 16 to discover if ‘gender incongruence’, described as a medical condition, can be treated using hormone suppressants. 'Gender incongruence' is the preferred term of this trial literature, with 'gender dysphoria' now falling somewhat out of use.

Following the failure of the judicial review intended to stop it, the King's College London/NHS trial will go ahead and inject 226 children with six-month duration shots of substances (gonadotropin-releasing hormone analogues) which will stop pubertal development. If experimenters decide a ‘bad reaction’ is happening, the injection interval may shorten. You read that right: first they will give a long-acting injection, and then if there is an adverse reaction, they will give a shorter-acting one. The children in the trial, for whom £10 million has already been committed in this direction, are being recruited from the gender clinics across the UK which sprang up after the Tavistock closed.

Despite it being described by the researchers as a “randomised controlled study” (RCT), this trial will have no untreated group. An RCT, where one group is treated, and the control group is not treated, is the conventional scientific gold standard. Healing often occurs with placebo, but hard science discounts that and rates only ‘real’ agents and interventions. The so-called control group here will receive the same treatment a year later. In the puberty blocker trial protocol, there is a paragraph on page 27 headed “Rationale for a Randomised Controlled Trial”. However, read closely: the text does not definitively state that this trial an RCT. The first Research Ethics Committee to consider the trial rejected it because there was no control group. According to retired GP Louise Irvin, Russell Viner, Head of the Royal College of Paediatrics and Child Health, then “just went shopping” (at 6:55 in that video) for an ethics committee which would say yes, and found one in University College London.

In 2024, the Cass Report commissioned academics at the University of York to review existing studies on the effect of puberty blockers on gender-troubled youth. The finding was that evidence overall was of poor quality. It seems academic mediocrity itself has justified the current experiment. In fact, the whole span of PATHWAYS’ gender projects — of which the puberty blocker trial is only one — answer the Cass Report's plea for more research and better evidence. Cass is now a gateway (pathway?) to endless gender research.

The guidance notes for participants in the trial begin, “Gender incongruence is when an individual's gender identity does not match their sex at birth”. Away we go. But is this statement testable? Does everybody have a gender identity? How do we know it is ‘present at birth’? The tone throughout aims to educate an ignorant public while introducing us to the burgeoning pseudoscience of gender-related measurement, e.g., the Utrecht Gender Dysphoria Scale and The Parental Attitudes of Gender Expansiveness Scale for Youth.

About 30 psychological and physical measurement tools will be used, including Tanner staging. This is a way to scale pubertal changes by measuring external secondary sex characteristics such as the size of the breasts, genitals, testicular volume, and development of pubic hair. Tanner staging is frequently described as non-invasive, but it is hard to see how that could be the case. The trial cohort and ‘control’ group will have their bodies inspected and assessed. Trial participants as young as 11 will also rate their own bodies by filling in forms recording how happy they are with their genitals, whether they think they possess specific genitals or not, and if they don't, whether they would like to. Not just genitals, but various body parts are itemised in dissociated fashion: shoulders, noses, legs, etc. Psychological assessment is by testing, mostly forms, often multiple choice. Vouchers up to £495 will incentivise this. Is this scientific? It is legal, apparently. Although it would be illegal to incentivise the children to take the puberty blockers, it is legal to incentivise them to fill in the forms and be measured.

Forms will include KIDSCREEN 10, the outcome measure for this trial. It's not possible to convey the nature of the KIDSCREEN questionnaire without directly quoting it. It opens: 'Hello, How are you? How do you feel? This is what we would like you to tell us. Please read every question carefully. What answer comes to your mind first? Choose the box that fits your answer best and cross it. Remember: This is not a test so there are no wrong answers ... nobody who knows you will look at your questionnaire once you have finished it'. 

This could be paraphrased: 'Hello. You don't know who we are but please answer all our questions. No-one who knows you will read the answers'.

Not just the young people, but also their parents or guardians are necessarily heavily targeted by pseudo-objective medical voices. Imagine you are a parent reading this, from the information sheet for parents and carers: 

You and your child have been invited to take part in the PATHWAYS TRIAL because you, your child, your child's care team, the doctors at the Gender Service, as well as a national multi-disciplinary team think that it might be helpful for your child to have treatment with puberty suppressing hormones.

That's a lot of people. In what sense are you parenting your child? Who is your child's “care team”? Are you on that team, or is it separate from you? What is your authority and agency in comparison with this “national multidisciplinary team”? What resources would the average parent be able to draw on to counter the authoritative tone of this statement? And what would be the repercussions of refusing to engage with this trial, given that you have already been preselected as suitable in order to be reading this? Your attitude as a parent is actually one of the things the trial has a “clinical” scale to measure. It is called the Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES-Y) (Adapted) and it asks the young person to agree or disagree, on a scale of five options, with such statements as “My parents advocate for my rights as a gender-expansive/trans child”.

There are moral assumptions implicit within the trial protocol with implications for the relationship between parents and the state. The notes for parents advise contraceptives if their child is likely to be engaged in sexual activity with a person of the “sex opposite to theirs at birth”. These are children aged 11 to 16; if any of them need contraceptives, this is a legal red flag and a safeguarding issue. Incest and paedophilia do exist, as well as sexual exploitation of young people by adults outside the home. It's hard to know in our society how widespread paedophilia really is, but the Epstein files reveal a preference of adult men for sex with young girls. In such a context, contraceptive recommendations from a medical authority flout the laws on consent, implicitly normalising underage sex and casually accepting, or implicitly endorsing, absence of parental or guardian oversight.

There is some kind of acknowledgement of these dangers in the list of reasons why individuals may be excluded from participating, for instance, “People of child-bearing potential who are at risk of pregnancy during the trial”. Won't that be quite a number of the girls in the trial? How will the trial staff know who they are? The ‘control group’ will be maturing naturally, which is unpredictable as noted before, and the sexual activities of all these young people cannot be monitored by the experimenters. In raising the pregnancy concern, the researchers have pointed to an issue here which is inherently unmanageable and one more reason why the trial should cease. Some kinds of home environment will debar participation in this trial, namely “Family/home situation affecting adherence to protocol”. This presumably could be a home in which the parents believe there are only two sexes. The entire project of this trial reduces the influence of parents while at the same time being entirely reliant on parental compliance, since the young people cannot be accessed except through their parents/guardians. It is also the case that the consent of only one parent, and the child, will be sufficient to enter the trial, with a suggestion that conflicts could be resolved through the family courts.

What is grooming, after all? Is it an activity limited to seedy individuals? Or can the state do it? In setting a precedent for experimentation on healthy minors who cannot by definition consent, this trial provides the spin-off of normalising vicarious consent. After what we have lived through in the last few years, we must wonder where else the state might use vicarious consent. Prisons? Psychiatric facilities? Parents, by consenting to this harm on behalf of their children, are betraying them and are ceasing to be parents in any protective sense of the word.

As the title of this piece seeks to underline, if you tolerate this, your children will be first. They will be first because you are pushing them in front of you, into harm's way, to be treated so that they conform (become ‘gender-congruent’). They are likely, based on evidence so far, to become lifelong patient-customers for big pharma. There has been robust, intelligent, and well-organised resistance to this trial. It failed. That tells us where we are. Wes Streeting, our first openly gay prime ministerial aspirant, has spoken in Parliament about gender incongruence. There is nothing gender-incongruent about Wes Streeting.

Being perceived as the opposite sex is a fact of life for some of us, and it is part of life's rich tapestry. Imagine you had never heard of ‘trans’ or anything to do with it, and you read that a group of children in the UK are going to be given harmful drugs because they don't fit gender stereotypes. We need to wake up and see that this trial and 'gender medicine' generally is fully equipped to march in the opposite direction to its freedom claims, not least because it is impossible for any of us who have an NHS number to ever lose it. You cannot leave the NHS. Mengele started with the weak, the frail, the outsiders. The NHS and King's College London are starting with the gender-incongruent, but the medical normalisation is overt. 

Why would they want to do that in this world of free expression? As one Pride marcher said last year, “It's the 21st century, darling. Anybody can be whatever they want”. Why is the state now policing ‘gender incongruence’ simultaneously with other crackdowns on freedom? As Genspect puts it:

Healthcare should aim to strengthen both body and mind. Interventions that permanently alter or weaken the body without resolving psychological distress do not meet this standard and should not be funded through public healthcare systems.

Meanwhile, new statistics from Germany confirm that at least in Germany, gender surgeries are increasing, and patients are getting younger.

Cover image: Patti Smith in 1971. But, now, the state names 'gender incongruence' as a medical condition. Is ‘trans’ the opposite of what it seems? Source: