The NHS Puberty Blocker Trial: Science Built on Make-Believe
The dangerous fantasy fueling the Pathways Trial
In science, first principles are everything. When research begins with a false premise, everything that follows will be flawed. The newly announced NHS PATHWAYS puberty blocker trial looks poised to enter medical history as a textbook example of what happens when an entire study is constructed on a fundamentally mistaken foundation.
Much criticism has already been levelled at the known harms of the drugs, the design of the trial, and its questionable survey-based outcome measures. But these flaws are secondary. The fatal flaw is conceptual: The entire trial rests on a fictional diagnosis.
According to the protocol, the “medical condition” being studied is “gender incongruence,” and the phrase “children and young people with gender incongruence” appears repeatedly throughout the 113-page document.
Yet “gender incongruence” is not a medical condition. The World Health Organization’s International Classification of Diseases (ICD-11) defines it as “a marked and persistent incongruence between an individual’s experienced gender and the assigned sex.” This is transgender identification dressed up in pseudo-medical activist jargon; nothing about it resembles a stable biological disorder.
This vague diagnosis only exists because trans activists pushed for decades to remove all psychiatric terminology — and therefore all meaning — from diagnoses related to transgender identification. Indeed, convincing the WHO to replace “gender identity disorder” (ICD-10) with “gender incongruence” (ICD-11) was their crowning achievement: the moment their depsychopathologization campaign reached its ultimate goal of redefining transgender identities as innate and healthy while clearing the path for on-demand hormonal and surgical interventions.
Astonishingly, the NHS is treating this activist-crafted concept as a legitimate diagnosis upon which to test a potent endocrine disruptor on a healthy group of adolescents.
While the authors of the study protocol studiously avoid the phrase “transgender children,” preferring “children and young people with gender incongruence,” the linguistic gymnastics change nothing. If you accept gender incongruence as a diagnosis, you accept the concept of the transgender child. It’s the same idea in different packaging.
Meaning, the NHS is researching the best way to medicalize “transgender kids.”
The Pathway to Tooth Fairy Science
In fact, this faulty premise makes the PATHWAYS trial a textbook example of what Dr. Harriet Hall called Tooth Fairy Science: research conducted on a phenomenon without ever questioning whether the phenomenon exists. Helen Joyce first applied this concept to gender medicine at the 2024 Genspect conference in Lisbon, and her analysis has never been more relevant.
Hall explained that a researcher could collect data that are reproducible, consistent, and statistically significant on how much money the Tooth Fairy leaves, which coins she prefers, whether she pays more for molars, or when the child leaves a note — but without asking whether the Tooth Fairy exists, the entire endeavour is meaningless.
“You think you have learned something about the Tooth Fairy. But you haven’t,” explained Hall. “Your data has another explanation, parental behavior, that you haven’t even considered. You have deceived yourself by trying to do research on something that doesn’t exist.”
Over the next three years and beyond, the NHS team will gather data on the psychological effects of puberty suppression, track bone density and other physiological changes, and measure body-image satisfaction in adolescents who believe their inner identity does not match their sexed body. They will ask participants how they feel about their genitals and secondary sex characteristics such as chest, facial hair, hips, voice, and they’ll meticulously record every result. And at the end, they will tabulate it all and conclude they have learned something meaningful about “children and young people with gender incongruence.”
But they won’t have. Because they never asked the only question that matters: Is gender incongruence a real medical condition?
When this question is given careful consideration, there is only one possible answer: No.
Remove the empty diagnosis of “gender incongruence,” and the data will no longer reflect the treatment of a legitimate disorder. Instead, any apparent improvements have a far more plausible explanation, one that the NHS researchers don’t seem to be considering: rather than indicating the successful treatment of a medical condition, any positive results could simply reflect the predictable elation distressed adolescents would feel having their identities validated and their fervently held beliefs affirmed.
Inclusion Criteria in a Crystal Ball
Rather fittingly, in order to be included in the Tooth Fairy Science PATHWAYS trial, the young person’s doctor must possess the magical power of being able to see into the future.
“Once doctors have agreed that the young person might benefit from puberty-suppressing hormones,” explains the trial protocol, “the young person and their parent/legal guardian will be told more about the research and what will happen.”
Yet, without a crystal ball, there’s no way to know this. There has never been any way to predict which adolescents will be in the minority that persist in a trans identity into adulthood and which will be in the majority that will desist.
And if you cannot predict persistence, you cannot ethically intervene.
To make matters worse, even if these doctors did get their hands on the necessary crystal ball, the goals of the treatment are still dubious.
Is it really ethical to medically disrupt an essential developmental process just so the young person can mimic a member of the opposite sex more convincingly in adulthood?
How could it ever be justified to turn healthy adolescents into lifelong medical patients, with all the serious health risks that entails?
And what of the cost to their future ability to form intimate relationships, or to become parents one day?
The PATHWAYS trial, with its woefully inadequate two-year follow-up period, will certainly not answer any of these questions. So what then? Do we just continue putting young people on this drastic medical treatment until those long-term results materialise in two or three decades’ time?
Remembering What We’ve Always Known
But that’s not all. The whole experiment becomes even more ethically fraught when you consider all the existing knowledge about child and adolescent development that the PATHWAYS trial, and the entire field of gender-affirming medicine, chooses to ignore.
Decades of high-quality, replicated research tells us with certainty that adolescence is a period defined by experimentation, with young people wildly swinging between different identities almost as often as they change outfits. We know that this life stage is characterised by emotional volatility, when beliefs can be held with fervent passion one minute, only to be discarded and replaced the next. And we understand perfectly well the cognitive immaturity of these youth, for whom long-term risks and the future adult self are unimaginable and alien.
Erik Erikson, James Marcia, and others mapped this terrain decades ago. Therefore, to treat any adolescent identity as a fixed truth requiring medical correction is to ignore the basic foundations of developmental science.
Decent research would begin at the same place as the PATHWAYS trial, with the adolescent’s adoption of a transgender identity and the accompanying diagnosis of “gender incongruence,” but it would travel in the opposite direction.
Instead of accepting a culturally influenced identity as a condition in need of medical treatment, meaningful research would investigate what ordinary developmental struggles, psychiatric comorbidities, or emotional challenges are being misread by so many young people growing up in this era saturated with the messaging of trans activism. It would investigate which cultural messages are disrupting identity formation and distorting the adolescent’s sense of self, driving the widespread adoption of this false identity.
Time to Chart a Different Course
Reading the PATHWAYS protocol leaves one wondering if the NHS has any inkling that it has been duped by trans activism’s politically motivated depsychopathologization campaign. Are the architects of the trial aware that they are dutifully treading a path paved by activists for the sole purpose of getting full, unfettered access to these treatments? Are they aware that they are studying mythical “trans kids”?
Or are they so hopelessly naive that they believe this clinical trial will in some way help the legions of confused youth who’ve had the misfortune to find themselves sucked into the vortex of this culture-bound madness?
In truth, the absence of high-quality research has never been the core problem; it is a secondary concern that has, mistakenly, become the central talking point in this entire medical scandal. The real issue has always been that this medical treatment, for adolescents and adults, has no grounding in objective truth.
From the dangerous fictional concept of “transgender children,” the wholesale rejection of established knowledge about child and adolescent development, and the absurd idea that wanting healthy body parts removed is a sign of good mental health, the entire field of gender medicine is built on nonsensical falsehoods.
The NHS PATHWAYS trial addresses none of this. Instead, it continues in the same direction we’ve been travelling for two decades—searching for a more cautious route while refusing to question the final destination.
What is needed now is the courage to acknowledge that the entire journey has been a catastrophic mistake: a perilous adventure embarked upon with good intentions but resulting in immense harm. It is time to chart a new course grounded in safeguarding and developmental knowledge—one that demands no sacrifice of health, fertility, or body parts, and that protects young people and guides them toward open futures rich with possibilities still theirs to choose.
Mia Hughes is the author of The WPATH Files, and director of Genspect Canada.
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Thank you, Mia, for nailing down the fundamental problem with the trial. I was well aware that it is built on activist narratives and language, but I hadn't boiled that down to the fact that it is built on a faulty premise. Bingo.
It also has no actual control group. The controls receive puberty blockers a year later, but the same data is not collected from other minors, say who don't want puberty blockers or who do not have a parent who consents to puberty blockade. There is no data collected from gender non-conforming, who are likely future gay kids.
They also do not account for the social narrative that if you can't block puberty or access cross sex hormones as a minor, that itself makes that child a suicide risk.
How does such poor research get approved?
It’s odd and not often that I read material on this which is absolutely accurate. You win the grand prize.
1) The correct term for “trans” behavior is sex mimicry. In males and females it happens to avoid male aggression; for males also to enter female enclaves by deception.
A natural behavior, a landmark paper came out on it around 2000:
https://www.cell.com/trends/ecology-evolution/abstract/S0169-5347(01)02134-6
2) The term for what happens to children is neotenic reproductive skew.
Some animals have a behavior of stressing or giving off pheromones to non-dominants in a group to disrupt their GnRH hormonal axis and halt ovulation and spermatogenesis.
In humans, where children have unexpected sex traits, social groups stress and bully them and eventually proceed with identical GnRH suppression as in other animals. Only in animals, once dominants are removed the GnRH axis bounces back.
In humans, disrupting the GnRH axis at the beginning of puberty can induce not only permanent sterility, but also a permanent sexless juvenile dependency on adults for life.
These are accurate, biological terms for the human behavior of “trans” and “affirmation”.
[There is a third behavior called predatory brood parasitism in which mimicry of females allows males to create empathic deception to enter social groups helping marginal individuals. Once accepted, they parasitize the original function taking resources to support mimicry and eliminating the original group focus. Females, lesbians, gays, all are pushed out leaving the group to support male mimics. Think of that if you even wonder why womens’s studies became gender studies, or how gay and lesbian have been removed from gay and lesbian politics, or how women have been sidelined in reproductive services to provide hormones for trans and for women to be called uterus-haters.]
There is little benign about sex mimicry. It is indeed natural, like lying, deception, and stealing.