New plans, labeled an 'immediate priority' by health officials, will allow General Practitioners (GPs) to specialize in 'gender medicine' and prescribe hormone-altering drugs on the National Health Service (NHS). This significant shift follows a comprehensive review of NHS adult transgender clinics conducted by Dr. David Levy, a consultant in general medicine. The review revealed that existing services are severely strained, struggling to meet escalating demand and burdened by exceptionally long waiting lists.

Under the proposed framework, GPs who have received specialized training would be authorized to prescribe cross-sex hormones. This would occur after patients have undergone a year of dedicated specialist care, thereby alleviating the need for continuous oversight from specialized clinics. Dr. Levy highlighted the necessity of developing 'local hormone-prescribing pilots' to ease the pressure on overstretched services, especially given that many patients require lifelong hormonal treatment. In response to these findings, NHS leaders have committed to facilitating a new GP role focused on 'gender medicine,' intended to provide leadership and foster knowledge-sharing across primary care networks nationwide.

The plans also encompass crucial changes to how patients access these services. Trans patients will no longer be permitted to self-refer to specialist clinics, must be 18 years of age or older to be eligible for treatment, and may be discharged back to their GP for ongoing care sooner than before. The impetus for this review stemmed from concerns regarding teenagers falling into a gap between children's and adult services. The review's findings were stark: 25 percent of all referrals to adult gender clinics are for patients aged 17 to 19, with more than half of all patients being under 25. The majority of these younger patients were born female.

Furthermore, the review uncovered that approximately half of these patients present with co-existing conditions, such as autism or attention deficit hyperactivity disorder (ADHD). This is often accompanied by a 'broader range of biopsychosocial issues,' including various mental health problems, experiences of trauma, or childhood abuse, a marked difference from patient profiles observed in the past. Dr. Levy recommended that psychiatric assessments should be conducted face-to-face and advocated for a 'national complexity measure' to gain a better understanding of the impact of these co-existing conditions.

The surge in demand is evident in referral numbers, which have doubled from roughly 5,000 in 2022–23 to 10,000 in 2024–25. Dr. Levy cautioned that the actual number of individuals awaiting a first appointment could be substantially higher than the estimated 40,000, with some projected waiting times potentially exceeding 15 years. This unprecedented demand, coupled with the clinics' failure to expand commensurately, places patients at serious risk, according to the review.

A critical aspect of the NHS's response to the lack of evidence on the long-term outcomes of prescribing powerful hormone-altering drugs to children is the planning of a puberty-blocker trial. If approved, these drugs, which pause the physical changes of puberty, could be administered to participating children as early as January next year. However, this proposal has met with significant opposition from some healthcare professionals, who have described the trial as 'ethically unjustifiable' and warned of the potential for 'grave physical harm' to vulnerable children. Critics have also highlighted the risks of permanent damage to fertility and sexual function.

Health Secretary Wes Streeting has expressed his personal struggle with the decision to allow the trial, stating that children cannot consent to taking such drugs. Last year, Streeting implemented a permanent ban on the routine use of puberty blockers for children, citing a major review that found insufficient evidence regarding their safety or effectiveness. Responding to the report, Professor James Palmer, national medical director for specialised services at NHS England, acknowledged the urgent need for improvement in adult gender services. He emphasized that too many patients endure excessively long waits for care, experience inconsistent quality, and that equitable access to care must be ensured regardless of location. Professor Palmer affirmed that NHS England has already increased investment and opened new clinics, and will utilize the report's recommendations to further enhance services across the NHS.