As Wes Streeting admits “deep discomfort” yet presses ahead amid cross-party revolt and silenced experts, PATHWAYS sidelines social media influences on vulnerable youth—repackaging a banned treatment
THE RATIONALS
In the dimly lit corridors of Britain’s health policy, where noble intentions frequently collide with uncomfortable truths, a quiet controversy has erupted into open cross-party rebellion. It is January 2026, and the National Health Service stands on the brink of launching the PATHWAYS trial, a £10.7 million initiative designed to evaluate puberty blockers in up to 226 children grappling with gender distress, some potentially as young as eight or ten.
Health Secretary Wes Streeting, that steadfast Labour figure, has openly admitted his “deep discomfort” with the prospect , describing the drugs as interrupting a natural developmental process, yet maintains that he is merely heeding expert guidance to amass the essential data, even as his own party colleague joins the Conservatives in condemnation.
On 1 January 2026, Labour MP Jonathan Hinder and Conservative MP Rebecca Paul jointly condemned the trial in the Daily Express, labelling it a “shameful experiment on children” and arguing that no child can provide informed consent to treatments risking sterilisation, loss of sexual function, and lifelong medical dependency. Emphasising that the matter transcends party politics as one of fundamental “right and wrong,” they urged Streeting to cancel it outright. As of 5 January, however, Streeting’s silence on their plea speaks volumes, prioritising institutional momentum over cross-party instincts on child safeguarding, even as personal reservations appear to yield to the orthodoxies the Cass Review itself condemned.
At first glance, this appears a prudent step forward, especially in the wake of the 2024 Cass Review, which exposed the glaring deficiencies in evidence supporting such treatments. However, a closer examination reveals a more disconcerting picture, one marked by institutional entrenchment, the exclusion of dissenting perspectives, and a study framework that seems ill-equipped to address the profound uncertainties surrounding long-term harms or the underlying drivers of gender dysphoria in young people.
These concerns about the trial’s capacity to deliver meaningful insights echo an earlier examination of its design, which argued that the study’s limited scope ensures it will prove little about enduring risks while deferring accountability to future generations.
To fully appreciate this undercurrent, it is essential to revisit Abigail Shrier’s compelling thesis in her 2020 book Irreversible Damage, which, though met with controversy at its inception, has demonstrated remarkable foresight. Shrier contended that the dramatic uptick in adolescent girls identifying as transgender is not solely a matter of innate biology but rather a socially driven phenomenon, a cultural wave propelled by peer pressures, digital communities, celebrities, influencers, and broader societal influences. Adolescent girls, in particular, appear highly susceptible to these forces during a period of heightened vulnerability to social cues and identity exploration.
This invites us to question whether we are witnessing authentic self-realisation or a more transient, troubling trend amplified by the interconnected world of adolescence. Shrier drew upon and amplified Lisa Littman’s earlier work, in which she introduced the term “rapid-onset gender dysphoria” (ROGD) to describe instances where such distress emerges abruptly in teenagers, often within social circles or following immersion in online forums, framing it as a potential coping mechanism amid emotional vulnerabilities.
Far from limiting her analysis to contagion alone, Shrier also documented the widespread institutional capture of schools, therapeutic associations, medical bodies, and clinics by gender-identity ideology. In these settings, professionals who questioned rapid affirmation risked ostracism or disciplinary action, guidelines shifted toward uncritical medical pathways and parental concerns were frequently dismissed all under the guise of compassion, a propaganda that cast ideological conformity as moral imperative while sidelining evidentiary scrutiny.
Far from originating these ideas, Shrier amplified voices from parents and practitioners, supported by data that challenged conventional wisdom. Historically, gender dysphoria was exceedingly rare before the 2010s, affecting roughly 0.005–0.014 per cent of natal males and 0.002–0.003 per cent of natal females, manifesting primarily in preschool-aged boys who made up 80–90 per cent of clinic referrals. Onset typically occurred between ages three and seven, with only 10–20 per cent persisting into adulthood, many resolved naturally during puberty. Adolescent presentations were virtually nonexistent, and adult prevalence remained stable at 0.3–0.6 per cent in the United States, according to meta-analyses such as those by Gates in 2011 and Flores et al. in 2016.
Yet, from the early 2010s onward, the landscape transformed dramatically. UK referrals escalated from around 100 per year in 2010 to over 2,500 by 2019, with 70 per cent now involving birth-registered females presenting in their teens, frequently accompanied by conditions like autism (up to 35 per cent), anxiety, or depression. As the Cass Review observes, no single factor explains this reversal, likely a complex interplay of reduced stigma enabling more presentations, deteriorating adolescent mental health (particularly among girls), and heightened societal and online awareness of gender identity issues.
This reversal, therefore, demands scrutiny of its origins. Shrier’s contagion hypothesis, informed by Littman’s 2018 survey of parents, where 76.5 per cent disputed their child’s identity and over 85 per cent reported prior trans-identifying friends or intense social media engagement, positions social dynamics as central. Further supporting this perspective, a 2023 analysis by the Society for Evidence-Based Gender Medicine (SEGM) of 1,655 cases linked sudden onset to mental health challenges and digital exposure, while Sapir et al.’s 2023 findings highlighted delayed realisation among females, patterns particularly evident in the post-2010s surge of adolescent presentations.
Critics however, including Turban et al. in 2022 and Bauer et al. in 2022, counter that no disproportionate female increases exist and attribute the rise to diminishing stigma, rejecting ROGD as flawed parental bias or outright fabrication. Amid retracted studies and heated debates, the field’s divisions are stark.
Nevertheless, evidence increasingly points to social media’s role, Littman’s work revealed 63.5 per cent of ROGD cases preceded by heightened platform activity, with influencers promoting rapid affirmation through videos. Detransitioner surveys from 2021 echo this, with 40.6 per cent of natal females attributing influences to online sources. Cass Review testimonies similarly credit YouTube figures for moulding perceptions, further examining social influence in ROGD.
This web extends to celebrities, influencers, and media portrayals, such as Dylan Mulvaney’s widely viewed “Days of Girlhood” TikTok series or Jazz Jennings’s long-running reality programme I Am Jazz, whose narratives create halo effects akin to those observed in self-harm epidemics. Here, Irving Janis’s 1972 model of groupthink proves illuminating, these figures and communities cultivate environments where affirmation is equated with ethical virtue and moral superiority, insulating members from critique and portraying dissenters as regressive or harmful. Facilitators of such groupthink, often viewing their stance as compassionately progressive, may inadvertently draw in impressionable young people, particularly girls and boys seeking belonging amid adolescent turmoil, reinforcing the cycle of identification without critical interrogation.
As Littman’s detransitioners reported pressures from community norms discouraging exploration of alternative explanations, and as Cass highlighted persistent ideological polarisation in the debate on social transitions, analyses in recent years (such as those by Kenny) liken influencers to gatekeepers who stigmatise or vilify dissenters. While rebuttals emphasise supportive networks over contrived isolation, the interplay underscores Shrier’s enduring relevance, particularly as trials like PATHWAYS risk neglecting these psychosocial foundations, prompting reflection on whether child protection is truly prioritised or subordinated to prevailing doctrines.
This tension finds official echo in the Cass Review, an exhaustive inquiry commissioned by NHS England under Dr Hilary Cass’s leadership. Spanning hundreds of pages and synthesising global evidence, it mirrored Shrier’s concerns in a more restrained tone. Cass chronicled the “dramatic increase” in referrals, from under 250 a decade ago to over 3,000 by 2022, with the demographic flip to 70 per cent adolescent females burdened by comorbidities.
She emphasised that dysphoria “is not purely biological but is also shaped by psychological and social factors,” subtly acknowledging contagion through references to societal awareness, online impacts, and peer interactions as pathways for navigating teenage strife. Critically, she deemed the evidence for puberty blockers “remarkably weak,” offering no solid backing for mental health improvements or suicide risk reduction, while highlighting perils like diminished bone density, infertility, and cognitive setbacks.
Despite these revelations, PATHWAYS appears to have absorbed only selectively from Cass’s wisdom. Led by Professor Emily Simonoff at King’s College London, the trial randomises participants to immediate or 12-month-delayed blockers, monitoring aspects like life quality and emotional health over two years, with possible extensions. Eligibility relies on ICD-11’s “gender incongruence” standards, which detractors view as imprecise and anchored in gender stereotypes, such as toy or clothing preferences.
This framework, critics argue, echoes concerns raised by Shrier and Littman that affirmative criteria may capture impressionable young adolescents whose distress emerges rapidly amid social influences, rather than probing whether such incongruence reflects innate identity or transient vulnerabilities amplified by peers and online communities, a selective absorption that honours Cass’s call for scrutiny in rhetoric alone, while perpetuating the echo chambers she condemned.
It is this alleged suppression of alternative perspectives that forms the under-reported crux of the controversy. Clinicians dissenting on grounds akin to Shrier’s contagion warnings claim their input was systematically marginalised in the trial’s planning, sustaining the very institutional capture that Shrier chronicled and Cass critiqued in the Tavistock era.
The Clinical Advisory Network on Sex and Gender (CAN-SG)’s open letter of 18 December 2025, endorsed by over 100 experts including psychiatrists, paediatricians, and psychologists, implored Streeting, “Professionals expressing concern about paediatric gender medicine have been marginalised, including during the development of the PATHWAYS research programme.” They cited “conceptual disagreements and political ‘toxicity’” that suppressed dialogue on social drivers, cautioning that the design overlooks blockers’ potential to solidify distress. Here the irony deepens, a trial billed as “evidence-led” systematically excludes evidence-based sceptics, repeating the silencing Shrier and Cass both decried.
This concern finds further resonance in a 14 December 2025 appeal from 20 clinical psychologists through BPS Watch which detailed a “decade of silencing,” where fears of professional repercussions stifled challenges to “transgenderism” as rooted in psychological, familial, or cultural elements rather than inherent mismatches. They explicitly decry the enduring “ideological capture” beyond Tavistock’s shuttering, a phenomenon Shrier traced to professional bodies and clinics deferring to affirmation as unquestionable doctrine.
Genspect’s 26 November 2025 correspondence amplifies these points, referencing the NHS Early Intervention Study where, after 12 months on blockers, 34 per cent experienced mental health decline, 37 per cent stasis, and self-harm rose. They invoke Shrier-inspired frameworks implicitly, noting that without medical paths, up to 95 per cent of youth reconcile with their bodies post-puberty, often identifying as gay or lesbian, contrasted with 98 per cent on blockers advancing to cross-sex hormones and potential sterilisation.
Taken together, such critiques render PATHWAYS susceptible to proving little of substance. Its brief timeline captures ephemeral improvements but bypasses enduring effects like regret or fertility loss, which Genspect notes often manifest 7–11 years hence. The protocol neglects “detransition” or “regret” metrics, ignoring Cass’s call for tracking former patients. In de-emphasising contagion, the trial fails to investigate psychosocial origins, and assessments on body dissatisfaction and treatment aspirations may inadvertently encourage progression. The delayed arm ultimately receives blockers, and comparisons to the self-selected PATHWAYS Horizon cohort introduce biases. As CAN-SG asserts, the absence of a hypothesis-driven question on blockers’ efficacy mirrors Shrier’s indictment of unquestioning affirmation.
Against these pointed objections, Simonoff defends the trial in the BMJ, stressing its role in isolating pharmacological from therapeutic effects, bolstered by MRI evaluations. Cass concurs, viewing it as vital amid alternatives like black-market sourcing. Yet this defence strikes an ironic note, framing experimental exposure of children as preferable to unregulated sourcing, amid Streeting’s professed discomfort and Cass’s own strictures on weak evidence, as if rebranding a banned treatment as a “trial” absolves its inherent uncertainties.
Opponents , however, advocate prioritising retrospective Tavistock data from 2,000 cases via the delayed Data Linkage Study before new exposures. Streeting has dismissed pauses, citing ethical clearances, but the letters, and now this cross-party parliamentary intervention expose a rift, the “unquestioning affirmative approach” Cass lambasted endures, from Tavistock to PATHWAYS.
This persistence stands in stark contrast to developments elsewhere. Nordic counterparts have illuminated a more precautionary path, following reviews akin to Cass, Finland, Sweden, and Norway curtailed blockers, prioritising social influences and desistance rates while embracing watchful waiting. Britain’s solitary advance, defying similar evidence and domestic revolt, lays bare the propaganda of “progressive necessity” over the precautionary principle. Detransitioner accounts in Genspect’s annexes, poignant tales of forfeited fertility and functionality, add human depth underscoring overlooked stakes.
In the public arena, this merits unflinching exposure, how an entrenched ideology continues to eclipse evidence, sidelining the psychosocial drivers, peer pressures, social media echo chambers, celebrity narratives, and influencer halo effects that Shrier and Littman have persuasively linked to the surge in adolescent gender distress.
In neglecting these influences, PATHWAYS risks affirming potentially transient vulnerabilities in impressionable young people, exposing them to interventions with profound, often irreversible consequences, infertility, diminished sexual function, and lifelong medical dependency, harms that no child, nor indeed many parents fully apprised of the uncertainties, could meaningfully consent to.
The clinicians’ fears, of professional marginalisation and the stifling “political toxicity” that silenced debate during the trial’s development, serve as a stark reminder that institutional capture persists, despite Cass’s revelations. If the Review laid bare these failings, the alleged exclusion of dissenting expertise in PATHWAYS suggests not reform, but re-entrenchment, the same unquestioning affirmative orthodoxy repackaged as rigorous research. As referrals plummet and cross-party voices unite in condemnation, Britain’s solitary advance, defying Nordic precaution and domestic evidence alike, may prove less a watershed than a cautionary tale of ideology prevailing over the safeguarding of vulnerable children, a tale in which Labour’s “progressive” facade crumbles under the weight of its own contradictions.
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This article (£10.7 Million on Children: The NHS Trial Ignoring Cass, Contagion, and Clinician Warnings) was created and published by The Rationals and is republished here under “Fair Use”
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