Overview
- The High Court dismissed a legal challenge on Friday, July 31, 2026, ruling that the trial’s approval process and design were lawful and had no realistic prospect of success.
- PATHWAYS will aim to recruit roughly 220 young people with persistent gender incongruence and randomise half to start puberty‑suppressing treatment immediately and half to start after one year.
- UK regulators and NHS England approved the trial design and safeguards, which include strict eligibility checks, informed assent from participants, parental consent, and ongoing physical and mental health monitoring.
- The legal bid was brought by the Bayswater Support Group, James Esses and Keira Bell who argued the trial risked long‑term physical and mental harm and lacked proper ethical protections, and they have said they may seek to appeal.
- Outside this trial, puberty blockers remain unavailable for new under‑18 patients under current NHS policy, and PATHWAYS was commissioned to fill the evidence gap identified by the 2024 Cass review so clinicians can better weigh benefits and harms.