Three leading trans healthcare organisations have expressed “significant ethical concerns” over the UK’s upcoming puberty blockers trial, which will recruit over 225 young people over the next three years.

The multi-year study, which is part of the PATHWAYS programme, will explore the impact of gender-affirming treatment on young trans people. Outside of this trial, young people in the UK are unable to access puberty blockers.

In a joint statement, EPATH, WPATH and USPATH – three organisations advocating for trans healthcare – said that while they support “rigorous research”, the design of the study raises a number of issues that “conflict with internationally recognized ethical standards for clinical research and adolescent care”.

The first of the group’s concerns is the study’s risk of coercion and how it may compromise the informed consent model.

“The proposed model links access to gender‑affirming care with participation in the study,” the statetment reads. “This structure risks undermining voluntary informed consent by placing young people and their families in a position where declining participation may limit access to clinically indicated treatment.”

The healthcare organisations have also warned that the puberty blockers trial may lead to delayed access to medically necessary care.

They write: “The study design includes delaying or restricting puberty‑blocking treatment for adolescents who meet clinical criteria. Such delays may prioritize research objectives over patient well‑being and contradict established clinical guidelines.”

Additionally, EPATH, WPATH and USPATH have outlined how there are ethical and clinical issues regarding the late initiation of puberty blockers, and urged that the research must not “compromise the health and safety of its participants”.

The groups have also called for the study to integrate trans youth, their families and community stakeholders into the research, as they state, “Patient-reported outcomes and lived experience must be central to ethical and effective study design”.

Finally, the three trans healthcare organisations stressed that no single study should determine access to care.

“The PATHWAYS trial should not be used as the sole basis for national policy decisions. Adolescents who choose not to participate must retain full access to the complete range of evidence‑based gender‑affirming treatments,” the groups said.

You can access EPATH, WPATH and USPATH’s full statement right here.