The care and treatment of children and adolescents in relation to their gender identity in the UK

Background Paper

Exploratory project

This project will explore the ethical, social, and legal issues associated with the care and treatment of children and adolescents in relation to their gender identity.
A transfeminine non binary person and transmasculine gender nonconforming person looking at a phone and laughing

The call for evidence has now closed, but if you'd like to submit evidence to this project, please email

The call for evidence will be followed by more focused and targeted engagement with relevant groups and individuals - through meetings, interviews, and other events and activities.

These activities will take place over the space of many months. Our aim is to conclude the project and produce a final report in 2022.

About the Nuffield Council on Bioethics

The Nuffield Council on Bioethics is an independent body that examines and advises on ethical issues arising from developments in bioscience and health. We aim to inform policy and public debate through timely consideration of the ethical questions raised by biological and medical research so that the benefits to society are realised in a way that is consistent with public values.

In late 2019, the Nuffield Council on Bioethics held a series of exploratory meetings with people and representatives of people with experience of gender identity services, medical practitioners, academics, and researchers to understand the ethical challenges in the care and treatment of young people in relation to their gender identity. This exploratory work raised a number of ethical issues about how gender diverse and gender incongruent children and adolescents under the age of 18 should be cared for, which we believe warrant more discussion and consideration.

The aim of this project is to carry out a more in-depth review of some of those issues. Our conclusions will inform practitioners and policy-makers and, ultimately, help improve the well-being of gender diverse and gender incongruent children and adolescents by ensuring they receive ethical, appropriate, and high-quality care. We hope that, as the UK’s independent ethics body, we can make a valuable contribution to how these issues are discussed and considered.

About this call for evidence

This call for evidence is an open call for views on some of the issues we want to explore in more detail, including:

  • the nature of gender dysphoria and how this affects approaches to care and treatment;
  • the social context within which gender dysphoria exists;
  • whether there is adequate evidence on the safety and effectiveness of puberty blockers and cross-sex hormones to support treatment;
  • current approaches to care and treatment, including the purpose of puberty blockers, the gender affirmative approach, and social transition;
  • how to consider the benefits and harms of treatment and non-treatment in decision-making; and
  • the ability of children and adolescents to consent to medical interventions for gender dysphoria.

This call for evidence is not concerned with the wider gender identity debate as it relates to questions of self-identification, nor issues about the care and treatment of young adults/adults aged 18 and over. A review of the current provision of gender identity services for children and young people is the subject of a separate independent review commissioned by NHS England.

You can download the call for evidence as a PDF, word version, and/or read the call online. The call for evidence is split into the following sections:

Section 1 - The nature of gender dysphoria

Section 2 - The social context

Section 3 - Research evidence

Section 4 - Approaches to care and treatment

Section 5 - Understanding benefit and harm

Section 6 - Consent and capacity

Section 7 - Other

Who we want to hear from

We would like to hear from as many people and organisations as possible who have an interest in the care and treatment of children and adolescents in relation to their gender identity, and this call for evidence is open to anyone who wishes to respond. In particular, we would like to hear from anyone with personal experience of using gender identity services or supporting someone to use those services.

The responses to this call for evidence will form an important step in our evidence gathering and play a significant role in influencing this project and its final conclusions. We will also be undertaking a number of other evidence-gathering exercises to ensure we hear from a diverse range of people. Please contact us by emailing if you would like to be involved in any further opportunities to contribute, or to alert us to other people or organisations who may be interested in this work.

How to respond

Please complete and return the call for evidence document to by Friday 14 May 2021. Responses will be handled confidentially, and we will not publish your name without express permission.

We have outlined questions grouped under six key themes, alongside a very brief overview of some of the views expressed in the literature. You are welcome to respond to as many, or as few, of the questions as you wish. You will have the opportunity to comment on any other relevant issues you would like to draw to the attention of the Council in the final open-ended section.

A note on terminology

We recognise that the language used in this area is complex, and that not everyone agrees on the ‘correct’ terminology or how it is used. Throughout this call for evidence we use ‘trans’ and ‘transgender’ interchangeably as an umbrella term for anyone whose gender identity does not correspond with their birth sex. We also use the phrase ‘gender diverse’ to refer to children and adolescents whose gender identity may be different in a variety of ways from their birth sex - this includes people who have been diagnosed with gender dysphoria and gender incongruence. The gender diverse young people we met with through our initial exploratory work told us they preferred this as a collective term.