From the letter:
This trial is unethical in principle and unsafe in practice. The multiple foundational flaws in the PATHWAYS study design, along with the conceptual errors on which the entire protocol rests, have already been well documented.”
More importantly, the very notion of a trial designed to test whether it is appropriate to block a child’s development toward healthy adulthood is conceptually flawed. To accept the validity of such a trial is to accept the existence of the transgender child. This is exactly what Harriet Hall described as Tooth Fairy Science, where researchers gather data without ever asking whether the phenomenon under investigation exists at all. The PATHWAYS trial administers a potent endocrine disruptor to healthy adolescents on the basis of a condition that is experienced in the mind rather than rooted in the body. No amount of survey data or bone density measurements can salvage a study whose premise was mistaken from the outset….
The PATHWAYS trial will not “put the issue to bed by establishing whether the drugs are effective,” despite your recent comments in the Sunday Times. We already know that the drugs are effective. Puberty blockers halt the natural process of sexual maturation in adolescence. They stop children from developing into healthy adults. These drugs reliably block puberty, prevent the awakening of reproductive systems, impede the development of sexual function, compromise future fertility, and impair a young person’s capacity to pair bond, to fall in love, and to mature into healthy adulthood. No trial is needed to confirm any of this. We already know this.
The two-year follow-up period cannot capture the long-term consequences, because the very nature of the intervention ensures that the damage unfolds only in adulthood. Short-term satisfaction cannot be allowed to eclipse the well-documented long-term harms. This is precisely why medicine cannot be demand led. Medicine must be guided by first principles that protect the young and the vulnerable from making decisions they cannot possibly comprehend.
The entire field of “gender medicine” is still searching for a cautious route along the same misguided path rather than finding the courage to acknowledge that we took the wrong road. We cannot medicalise identity; an individual’s identity is forged through life’s experiences, not through pills.
I very much doubt that Cass will be persuaded – though it’s certainly worth making the effort with this letter. She won’t want to get involved at this late stage. Which is a shame, as Streeting is using Cass’s authority to justify the trial, claiming, ludicrously, it has “ethics and safety at its heart”.
Which of course is precisely what it doesn’t have. It’s a monstrous stain on the NHS, and on everyone involved.
Mick Hartley 
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