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NHS England's decision to forgo commissioning puberty suppressing hormones (PSH) for children and young people, citing insufficient evidence of their safety and clinical effectiveness, follows a comprehensive review conducted by the National Institute for Health and Care Excellence (NICE) in 2020. The clinical report underscores that "PSH treatment options will not be part of routine commissioning" for people under the age of 18 in England grappling with gender incongruence or dysphoria. The NHS England review analysed nine observational studies on Gonadotrophin Releasing Hormone Analogues (GnRHa) and found no statistically significant difference in gender dysphoria, mental health, body image, and psychosocial functioning among children and adolescents treated with GnRHa. Duncan Rudkin, chief executive of the General Pharmaceutical Council (GPhC), acknowledged the challenges faced by pharmacy professionals regarding prescriptions for puberty suppressing hormones, stating:

What are the causes of pubertal gynecomastia? The short answer is hormonal changes. Estrogen is the female hormone and testosterone is the male hormone. All babies have both hormones in small amounts. During puberty, the amount of both hormones increases. Estrogen develops more in women and testosterone develops more in men.

Estradiol test is recommended in cases like women with menstrual abnormalities, abnormal vaginal bleeding, early or delayed puberty, functioning of ovaries and analysis of fertility treatment. In boys, the Estradiol level check is recommended if any of these symptoms appear: delayed puberty, development of breasts or lack of development of penis.

A final review of gender services provided by the NHS has uncovered significant shortcomings, leaving thousands of vulnerable children questioning their gender identity without adequate support. The report, led by Dr. Hilary Cass, a prominent consultant paediatrician, highlights the use of unproven treatments and the detrimental impact of the polarized trans debate on gender care provision. The investigation, commissioned by NHS England in 2020, focused on the Tavistock and Portman NHS mental health trust's gender identity development services (Gids), which treated around 9,000 children and young people between 2009 and 2020. Shockingly, the review found that despite limited evidence of effectiveness and potential health risks, puberty blockers and cross-sex hormones were routinely administered. Dr. Cass emphasized that the "rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown."

Can you imagine a one-year-old with fully developed sexual organs like that of a grown man? No, but it is true. A Delhi based baby's testosterone level is just like a 25-year-old man and has already started getting facial and body hair.

London's Great Ormond Street Hospital and Alder Hey Children's Hospital in Liverpool are poised to introduce groundbreaking gender-related services in England, following the closure of the Gender Identity Development Service (Gids) operated by the Tavistock and Portman NHS Foundation Trust. Amid concerns expressed by hospital executives regarding the closure of Gids, with leaked emails revealing apprehensions about appointment cancellations and inadequate communication with the new services, the National Health Services England (NHSE) has confirmed "its commitment to ensuring continuity of care for patients already accessing endocrine care in GIDS." NHSE's decision to transition to regional services stems from a 2022 interim review, led by Dr. Hilary Cass, which highlighted the need for improved support structures for gender-distressed youth. It emphasized a significant increase in referrals to Gids, surpassing 5,000 in 2021/22, compared to less than 250 a decade ago.