“NHS England named Anne in its guidance on hormone care for young people, but we’re not going anywhere” by Lizzie Jordan

On Thursday 12th March, NHS England published updated guidance to primary care about unregulated providers supplying hormone medications to transgender children and young people. Anne has been named in that guidance. I will not stay silent.

This guidance is harmful, and I am naming it as such

Let me be clear: this guidance does not protect children. It removes access to care from some of the most vulnerable young people in the UK: trans+ young people who, in many cases, have nowhere else to turn. It does this, not on the basis of sound clinical evidence, but as part of a sustained, politically driven effort to eliminate gender-affirming care from the healthcare landscape, step by step. Today’s guidance is another manoeuvre to achieve that, and I refuse to pretend otherwise.

The NHS has failed trans+ young people systematically for decades, through underfunded services, catastrophic waiting times, and a clinical culture that too often treated trans+ identities as problems to be investigated rather than lives to be supported. The NHS did not build the modern standard of care for trans+ young people.

Clinicians, researchers, and healthcare providers across the world did, and many of the foremost expert gender-affirming practitioners today work outside the NHS and outside the UK.

Global expertise in trans+ healthcare doesn’t stop at the UK border

NHS England’s guidance implies, without evidence, that a clinician based overseas is inherently less trustworthy, less skilled, or less safe than one based in the UK. This is wrong. Medical expertise does not end at the borders of England.

The clinicians who provide care through Anne are qualified, registered professionals. They are registered with the appropriate regulatory bodies in their own countries and have the relevant specialist expertise to deliver this care. The suggestion that their qualifications are somehow less valid than those of an NHS GP is not a clinical position. It is an institutional prejudice dressed up as patient safety.

Countries register clinicians differently, but the UK does not hold a monopoly on expertise in gender-affirming care, including its evidence base and clinical protocols. To dismiss international clinicians as categorically unsafe is to dismiss the global medical community that has, in many instances, led the way on trans+ healthcare, precisely because the NHS refused to.

This guidance is the result of political decisions, not new clinical evidence

The decisions that have led to today’s guidance (the Cass Review, the ban on puberty blockers, the pause on hormone treatment for 16 and 17-year-olds, and the pause and cancellation of the Pathways trial) share something in common. None of them arose from a sudden body of new evidence. All of them arose from a political environment in which trans+ people have been made a target, and in which those in power have applied a standard of proof to trans+ healthcare that is not applied to any comparable area of medicine.

The MHRA official who triggered the pause of the Pathways trial had a documented history of anti-trans posts on social media. The independent review into exogenous hormones used methodological approaches, including a 97% exclusion rate for relevant studies, which leading research methodologists have described as “egregious and unconscionable.”

The same treatments that the NHS now claims lack sufficient evidence have been used safely for decades, and the evidence for them includes a study of 315 participants published in the New England Journal of Medicine, finding significant reductions in depression and suicidality.

When politics shapes clinical decisions, patients are harmed. Trans+ young people in the UK are being harmed, right now, by these decisions. I will not be complicit in describing that harm as a neutral, evidence-based process.

Anne members receive evidence-based care delivered by qualified experts

The care Anne facilitates is grounded in the international evidence base and the standards of leading international organisations (including WPATH, EPATH, and USPATH) which have formally criticised the Cass Review’s methodology and the approach taken by NHS England.

Every clinician providing care through Anne holds the relevant qualifications, experience and professional registrations to deliver gender-affirming care and is accountable to their professional regulatory body. I am proud of the care our clinicians provide and proud of the trust that trans+ young people and their families place in us.

Anne operates within the law, and I am not afraid to say so. The clinicians Anne works with prescribe lawfully and in accordance with their professional obligations. Where legislation governs what can and cannot be prescribed, our clinicians follow it. I will not apologise for continuing to support people to access care within those boundaries when the NHS has chosen to leave trans+ young people without options.

To our community: I’m here, and Anne is not going anywhere

I know that this guidance will cause fear and distress for trans+ young people and their families. I want to be clear: Anne is not going anywhere. Anne will continue to provide access to affirming, expert, compassionate care to trans+ people of all ages.

I will keep speaking plainly about institutional failures. I will keep advocating for a healthcare system that treats every trans+ person with the dignity and respect they deserve, regardless of what NHS England publishes.

Healthcare decisions must be made by qualified clinicians, guided by international evidence, and centred on the wellbeing of patients. Not by politicians. Not by officials with documented anti-trans views. Not by evidence reviews designed to exclude the very research they were meant to assess.

Trans+ young people deserve better. I will keep working every day to make sure they get it.

Take a look at our long read on how the NHS is failing trans+ young people, and what it means for families in the UK