Funding for the long awaited study on puberty blockers was announced this week, with £10 million pounds designated for a study running until 2031.

The study team at a glance appears to be fully cis, with no trans leadership. At least one senior leader attended a conference of a known anti-trans hate group. None of the leaders of this study bothered to attend with the WPATH global conference on trans healthcare that happened at a similar time.

The study aligns with and is embedded in new children’s gender services, designed in response to the Cass Review. Those services are deeply unethical and harmful, using staff selected for having no background in trans healthcare, trained according training materials steeped in pathologisation and misinformation.

Those service are deeply unethical and harmful with us already hearing regular negative reports of intimidating approaches to care, children being assessed by 5 or six professionals.

The research is by design unethical and coercive, with participation expected to be mandatory for all seeking to access healthcare.

The trial is by design unethical and coercive, putting youth at random into wings of puberty blocker or denial of puberty blocker, when forcing a youth who is distressed about puberty through an unwanted puberty for the sake of an unneeded trial is deeply unethical and cruel.

I expect more horrors will be revealed whenever we find out the inclusion criteria for the study. I expect the exclusion criteria will be used to exclude certain groups of trans youth. The fact it is being kept ultra secret is another red flag.  

The trial is by design likely to fail, with a strong impulse for those in the non-healthcare wing of the study to drop out, either to access healthcare outside of the study, or because there is no benefit and significant ongoing harm to being a such a study without accessing healthcare.

The study is certain to provide rubbish data – as per the Cass Review cis professionals with no experience and no inclination to listen to trans people or learn from existing research tend to focus on and measure the wrong things – measuring what is of concern to transphobic cis people rather than what is of use in improving outcomes for trans youth.

The study is deeply unethical for having no trans leadership – cis professionals particularly in the NHS continue to fail trans communities.

The study shows significant signs of having a semblance of youth engagement, with zero youth power. That is unacceptable.

The whole thing is deeply harmful and unethical, drawing its basis from the Cass Review, already one of the most critiqued healthcare reports, which will one day be viewed as a flagship example of bigotry driving healthcare policy.

Several people have asked if I will be volunteering to be on any lived experience panels or similar linked to this study. I have not been asked (and do not expect to be).

My answer would be very clear.

No.

No I will not in any way collaborate with a deeply harmful and unethical process.

No I have no faith at all that voices speaking up for trans youth healthcare rights will be listened to.

No I will not be complicit in providing any veneer of ‘inclusion’ to a process that is deeply cis-supremacist, unethical and harmful.

Others have asked me if trans youth or families should engage in the research governance, consultation and ‘accountability’ structures.

My advice would be – No.

Time and again I’ve seen people give the benefit of the doubt to processes like this, and be deeply burned. I’ve seen trans kids try their best to influence and be ignored and side-lined. Consultation without influence or power is not a genuine consultation.

Folks want to hope for the best. They hope that they can make a difference. They think it is better to be in the room than out of it. I strongly disagree.

Do not allow your hope, your faith in people being willing to learn, to persuade you to engage with a service and system set up intentionally to cause harm. Do not allow yourself to be a tool for their system.

I have not been asked by trans and LGBT civil society whether they should engage.

I was extremely disappointed throughout the Cass Review process to be continually reassured by figures in trans and LGBT civil society that engagement with the Cass Review was worthwhile, that they were having influence, that they were adding value.

As many of us outside of positions of (relative) power said would happen from the start, trans engagement in the Cass Review process was callously utilised to provide a veneer of inclusion and consultation to a process that was by design cis-supremacist and toxic.

The Cass Review has even been described as a process with ‘extensive’ youth and family and lived experience consultation. But consultation, as we saw with the Cass Review, as we saw with every NHS review related to trans healthcare I’ve engaged with for years, does not mean influence.

I will have no patience for any folks who in 2025 naively stumble into roles that provide a veneer of trans engagement to this harmful NHS trial. At the start of the Cass Review a position of ‘giving the benefit of the doubt’ to a review designed to intentionally exclude trans people was barely tenable. Those giving reassurances and the benefit of the doubt in the latter years of the Cass Review were something other than naïve.

There is no space for trans and LGBT civil society pretending to be naïve about the harm and unethical nature of this current study.

I hope for at least some solidarity with trans kids.

I hope that the least we can do is not engage with and lend any form of trans community support through participation in abusive practices.

I hope we can focus efforts on resistance from the outside. On supporting trans adolescents to continue to resist the harms that are foisted upon them, including resisting the harms of this trial and the associated study.

That will be my focus. Damage limitation from the outside.

Whilst continuing to speak up about the harms inherent in any process that is designed in this manner. Setting a clear expectation that crumbs and consultation from the outside is by definition not good enough.

We need trans leadership in trans children’s healthcare, in all trans healthcare. Nothing about us without us, and that means with genuine influence and power across healthcare design and management structures, not relegation to ‘lived experience’ panels that have no power to change and hold to account the fundamental and intentional failings of the whole approach.

We need depathologisation as a core principle. We need affirmative healthcare.  

Research should uphold children’s rights. Research should not cause harm.

Healthcare ethics Professor Simona Giordano testified recently to the Women’s and Equality Committee on the harms of this proposed study, noting that in this study “there is a risk that NHS England will violate fundamental principles contained in virtually all declarations and conventions on human rights as they apply to participation in research”.

The Welsh Children’s commissioner recently flagged similar concerns.

Not wanting to participate in research that breaks basic principles of healthcare and research ethics should not be a radical position. It should be the basic starting position for anyone who has any care for trans children.