Overview

• The observational Pathways Horizon project will invite all under-18s referred to NHS Children and Young People’s Gender Services—including toddlers—to enrol from autumn 2025.
• Up to 3,000 participants and their parents will complete annual questionnaires on gender identity, wellbeing, mental and physical health for several years.
• Study data will be linked to NHS health and school records to build evidence on outcomes and inform personalised care strategies.
• The research responds to the Cass Review’s finding of insufficient data on gender-affirming interventions and aims to assess the impact of different support types.
• While puberty blockers remain banned outside trials pending approval, three specialist NHS gender hubs are operational with plans to expand to eight regional centres.