In 2024, following a four-year systematic evidence review headed by pediatrician Hilary Cass (aka the "Cass Review”), the U.K. government banned puberty blockers for all youth outside of clinical trials (see below). In 2026, the National Health Service (NHS) halted opposite-sex hormones for minors after a review found that “the available evidence did not support their use.” Related surgeries are also not performed by the NHS.The Cass Review concluded that puberty blockers carry “significant risks,” while evidence for their mental health benefits is “remarkably weak.” Both Conservative and Labour governments endorsed the restrictions. Still, Dr. Cass recommended a clinical trial to further study the effects of the drugs and on August 1, 2026, the Pathways clinical trial, run by researchers at Kings College London, began recruiting adolescents as young as age 11.The trial was supposed to begin early in 2026, but the U.K.’s Medicines and Healthcare Products Regulatory Agency (MHRA) put it on hold, citing “unquantified risk of long-term biological harm” from puberty blockers, including sterility. The MHRA lifted the hold after trial protocols were modified, but a legal challenge further delayed the launch until the U.K.’s High Court ruled that the trial could go forward. Despite the warnings of her systematic evidence review, Dr. Cass framed the trial as harm reduction, saying without it gender distressed children would seek puberty blockers from “dangerous and unregulated routes.”What is not known is what will happen to the trial subjects after several years on puberty blockers. In almost all cases, patients whose puberty has been blocked go on to take opposite-sex hormones, but these drugs were halted for patients under 18 in 2026. (Minors already prescribed these hormones may continue to receive them, but their treatment must be reviewed individually with clinicians.)Critics of the Pathways trial point out that given the known risks of puberty blockers, researchers should look first to the medical records of the thousands of young patients treated by the now-closed Tavistock Gender Identity Disorder clinic. These records were requested by the NHS immediately following the Cass Review, but six of the seven NHS adult gender clinics where the patients are presumably now being treated refused to hand over their records and still have not done so.

Ireland does not provide publicly funded hormones and surgeries for gender-distressed youth under 18. Some interventions, however, are available through private clinicians. Historically, Irish practitioners referred patients who wanted medical interventions to England’s Tavistock Clinic. Following the Cass Review (see United Kingdom), that clinic closed.

Hormones and surgeries for minors are strictly limited to exceptional cases. After opening its gender clinic in 2011, practitioners found that most of their patients were teen-aged girls with pubertal or post-pubertal onset gender dysphoria and many psychiatric co-morbidities. Clinicians reported that their patients with significant mental illness did not improve after the gender interventions. After conducting a systematic evidence review, in 2020 Finland prioritized psychotherapy over hormones and surgeries to treat young people with gender distress.

Since 2022, Swedish health authorities have advised clinicians to limit puberty blockers, opposite-sex hormones and mastectomies to exceptional cases. This guidance followed a systematic evidence review that found low quality evidence for the benefits of youth gender “transition.” Sweden’s National Board of Health and Welfare concluded that “the risks of puberty suppressing treatment and gender-affirming hormonal treatment currently outweigh the possible benefits.”

Although pediatric gender interventions are still available in Norway, in 2023 the Norwegian Healthcare Investigation Board, an independent government agency, called for a revision of national guidelines to treat gender dysphoria. The panel said the evidence base for puberty blockers, opposite-sex hormones and surgeries is lacking, particularly with respect to long-term outcomes. It recommended that the interventions for children and adolescents be defined as experimental.

Denmark has quietly changed policy and now emphasizes psychological care for gender-distressed youth over medical interventions.* At its peak in 2018, Danish clinicians prescribed hormonal interventions to 67% of youth who presented to gender clinics. In 2022, only 10% of youth received such treatment, according to a report prepared by Danish health authorities. The report noted the changing patient profile in recent years—more female with a higher proportion of psychiatric disorders, including anxiety, self-harm and suicidal ideation. This and transition regret, the report said, had led to greater caution. * In Danish; requires free translation app.

In 2022, the French National Academy of Medicine urged “great caution” in prescribing medical interventions for gender-distressed youth. A press release stated, “The Academy draws attention to the fact that hormonal and surgical treatments carry health risks and have permanent effects, and that it is not possible to distinguish a durable trans identity from a passing phase of an adolescent's development.” The Academy attributed the soaring numbers of young people claiming a trans identity to social influences. In 2024, the French Senate voted for a bill that would prohibit puberty blockers and opposite-sex hormones for minors, but the legislation was not enacted.

Italy’s cabinet, led by prime minister Giorgia Meloni, has endorsed draft legislation to tighten controls on medical interventions for gender-distressed minors. The law still needs parliamentary approval. In 2023 the Italian Psychoanalytic Society wrote to the prime minister expressing “great concern” over puberty blockers. In 2024, Italy’s National Bioethics Committee recommended that puberty blockers for gender dysphoria be used only after psychotherapy or psychiatric interventions have failed—and only within the context of clinical research trials. Pending enactment of the new legislation, the main clinic dispensing puberty blockers in Italy has reportedly imposed a de facto ban on new prescriptions.

Chile is engaged in heated debate over pediatric gender medicine. In 2024, the country’s main gender clinic reportedly stopped providing puberty blockers and hormones to new minor patients. That same year, both houses of the country’s legislature voted to ban public funding for new prescriptions of puberty blockers and opposite-sex hormones for youth. However, Chile’s Constitutional Court later struck down this legislation. Since then, a special investigative commission in the lower house of congress has called for prohibiting hormonal treatment for minors.

New Zealand is banning new prescriptions of puberty blockers, starting December 19, 2025. Health Minister Simeon Brown said his ministry had found a “lack of high-quality evidence that demonstrates the benefits or risks” of the drugs to treat gender dysphoria. The drugs, known as gonadotropin-releasing hormone agonists, will still be available to current users and to patients with precocious puberty, endometriosis or prostate cancer.

In April 2025, Brazil’s Federal Council of Medicine (CFM) banned puberty blockers, restricted hormone therapy until age 18, and delayed gender-affirming surgeries until age 21. However, in June 2026, a federal court issued a ruling authorizing the use of hormone blockers by a 13-year natal male.  According to legal documents, the child has "identified as a girl" since age seven and the patient’s family argued that the child would face psychological harm due to the bodily changes of puberty. The judge who granted the request stressed that the child was enrolled in a rigorous monitoring protocol. This, the judge said, would mitigate potential harm from the endocrine disruptor.