When the evidence doesn't add up: why Gender Plus commissioned an independent review
By the Gender Plus Senior Leadership team
When Wes Streeting, former Secretary of State for Health and Social Care, announced that a review of access to gender-affirming hormones for those aged 16 and 17 would be undertaken, we were deeply concerned.
We have watched, over recent years, as access to transgender healthcare on the NHS has been progressively restricted. In each case, the justification has followed a familiar pattern: a review of the evidence, a conclusion that the evidence is insufficient, and a restriction of care. To the neutral observer this may seem a reasonable process, however, to those with expertise in the field, a worrying misrepresentation of the science is apparent. We were concerned that this would follow that same pattern - and that real young people would pay the price while the process played out.
The Gender Plus Hormone Clinic is the only CQC Outstanding-rated provider of gender-affirming care to trans people from the age of 16. We work directly with this patient cohort every day. We have outcome data, clinical insights, and real-world evidence that we believed could meaningfully contribute to the review process.
So we tried to be part of it.
We approached Mr Streeting in person at the NHS England LGBT+ Health Annual Conference in September 2025. We followed up by email, as directed by him at the event. When that yielded no results we published an open letter setting out our position and reiterating our offer. At every stage, we made clear that we were not seeking to obstruct the process - we were seeking to contribute to it. We wanted the review to be informed by the best possible evidence, including evidence from a clinical setting with direct experience of this patient group.
Mr Streeting and his team did not engage.
Six months later, the NHS paused new prescriptions of gender-affirming hormones to 16 and 17 year olds. The review that informed that decision concluded that the evidence was insufficient to support their use. It was a review to which we had been unable to contribute and the conclusion went against everything we knew about our understanding of the evidence base and decades of experience in the field.
In response we commissioned Dr Gideon Meyerowitz-Katz MPH PhD, an independent epidemiologist with expertise in the critical appraisal of health research, to review the 10 systematic reviews produced by NHS body Solutions for Public Health - the evidence base behind the decision to pause prescribing. We asked him to assess, independently and without influence from us, whether those reviews represented a sound basis for policy. His findings raise serious concerns.
Dr Meyerowitz-Katz found that the questions being asked in the reviews were so narrow, that despite plenty of research existing, none of it fit the specific parameters set - ruling out most of the research available before the project even began. For example all of the evidence generated by UK gender services was excluded from these reviews, conducted to inform UK policy. The review authors even noted that their findings have limited relevance to the UK - a conclusion made inevitable by their own design. Key research was discarded on technical grounds, including the largest study on mental health outcomes in this patient group. And there was no public record of how any of these decisions were made. Dr Meyerowitz-Katz conclusion is unambiguous:
the NHS should not rely on these reviews to guide clinical or policy decisions.
We want to be clear about what this is and what it is not. This is not a claim that gender-affirming hormones are without risk, or that clinical caution is never warranted. It is a challenge to the evidence review process being used to justify a specific policy decision - a challenge made by an independent expert who has examined that evidence in detail.
We remain committed to working constructively with the NHS. We believe that independent providers and the NHS should be partners in delivering care to this underserved community, and that the best decisions are made when all available evidence is considered. That is precisely why we are publishing this expert assessment: not to undermine the consultation process, but to ensure it is informed by the scrutiny it deserves.
The consultation closes on June 7th. We are calling on NHS England to consider Dr Meyerowitz-Katz's findings before any permanent decision is made.
