A large-scale UK study will track hundreds of children and young people with gender incongruence over several years, including some who take puberty-blocking drugs and some who do not, to provide the first comprehensive evidence on the benefits, risks, and developmental outcomes of these treatments. This matters because there is currently no robust, long-term evidence base to guide clinicians, families, and young people making decisions about puberty suppression. The care is controversial, and the lack of data leaves families and doctors navigating high-stakes choices without clear information on what happens to cognition, brain development, mental health, and social wellbeing over time. If the research succeeds, it will give healthcare professionals and families concrete, evidence-based answers about the short- and medium-term effects of GnRHa treatment, alongside a detailed picture of how all young people attending gender services—whether or not they seek medical intervention—develop. The findings will directly inform clinical guidelines, patient information materials, and shared decision-making in NHS gender services. The programme also builds a foundation for longer-term follow-up studies, so future decisions will rest on data rather than assumption.
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Gender incongruence is characterised by a marked and persistent incongruence between an individual’s experienced gender and assigned sex. The PATHWAYS research programme aims to provide a holistic evidence base about the care needs and development of children and young people (CYP) with gender incongruence. This evidence will guide health-care professionals and inform children and young people (CYP) and their parents/caretakers on the benefits and risks of gonadotropin releasing hormone analogues (GnRHa), alongside other interventions, in the management of gender incongruence. Specifically the study will : • Determine the short/medium-term benefits and risks of GnRHa for puberty suppression in CYP with gender incongruence. • Understand the care needs and holistic developmental trajectories of all CYP attending Gender Services, including those who are and are not seeking medical interventions. • Continue to involve young people and their parents in designing, implementing and interpreting the research to ensure this study addresses their needs and informs a longer-term follow-up study. The programme will comprise inter-related studies, involving CYP from the new Gender Services: • PATHWAYS Trial is a trial of GnRHa amongst CYP. • PATHWAYS Horizon is a longitudinal observational study of CYP attending the Gender Services, charting their development over time. • PATHWAYS Connect links the longitudinal trajectories of cognition and brain development in CYP attending the services, including those who are and are not receiving GnRHa. • PATHWAYS Voices uses longitudinal qualitative interviews to explore the needs and care experiences of CYP and their families and how these change over treatment. • PATHWAYS Engagement is an advisory group of young people/adults with experience of gender incongruence and parents who will advise on all aspects of the programme, including outcome measures, patient involvement in research and strategies for long-term patient engagement, interpretation and communication of findings. The research team will work closely with the advisory boards and wider community to ensure all the findings are accessible and clearly communicated to patients, families and the lay public, alongside dissemination to the scientific community.
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