Transgender rights advocates in the U.K. are blasting two recently announced research studies on the effects of puberty blockers on trans young people as unethical and biased.

In the wake of the widely criticized Cass Review and the U.K. government’s subsequent decision to ban puberty blocking medication for the treatment of gender dysphoria in minors, National Health Service (NHS) researchers announced two studies on the drugs’ effects on young people in November.

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According to The Guardian, one of the two studies, the Pathways Trial, will randomly divide some 226 participants between the ages of 10 and 16 into two groups. One will receive puberty blocking medication immediately, while the second will receive the medication after a year. Participants’ quality of life, emotional well-being, and physical development will be compared to those of a third group, which will not receive puberty blockers.

Medical journal The BMJ notes that the study has been approved by a research ethics committee and received regulatory approval from the Health Research Authority (HRA) and the Medicines Healthcare Products Regulatory Authority (MHRA).

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But the Pathways Trial has nonetheless received widespread criticism, both from advocates for and against gender-affirming care for minors.

In a November 22 statement, Chay Brown, healthcare director for U.K. trans rights nonprofit TransActual, said that the study “is the result of an ideological view at the very top of the NHS that being trans is a ‘less desirable outcome.’”

In the same press release, TransActual reiterated its position that the U.K. Department of Health and Social Care’s decision to ban puberty blockers for trans minors, but not for the treatment of conditions like precocious puberty in cisgender minors, is “discriminatory” and not based in actual scientific evidence. The group argues that the study represents an “unambiguously a violation of medical ethics,” as it is currently the only way for young people experiencing gender dysphoria in U.K. to access the medication they need.

“It is unconscionable to coerce young people into participating and, for half of the cohort, delay the care they’ve been assessed as needing,” Brown said. “It is and will be for a long time to come the only means that young people have of accessing puberty blockers through the NHS, and it is strictly capped at 226 regardless of how many would benefit from the care.”

Similarly, the World Professional Associations for Transgender Health (WPATH) and its European and U.S. counterparts EPATH and USPATH released a joint statement earlier this month outlining five ethical concerns about the Pathways Trial. These included the risk of coercion and compromised informed consent, and delayed access to medically necessary care for participants.

According to The BMJ, the study has also been criticized for lacking a placebo group, which limits researchers’ ability to determine whether any observable effects can be attributed to medication.

TransActual also noted the high potential for bias in the study, headed by researchers at King’s College London, due to its senior personnel. The group noted that Deputy Chief Investigator Dr. Michael Absoud has links to The Society for Evidence-Based Gender Medicine (SEGM), a Southern Poverty Law Center-designated anti-LGBTQ+ hate group.

“We fear this study is designed from the outset to arrive at a specific conclusion, and so will not generate good scientific evidence. Indeed, it cannot while it operates in such a coercive manner, inducing desperate trans people to perform whichever version of trans-ness a panel of doctors will accept,” TransActual’s press release reads.

“Like the Cass Review before it, the trial is in all likelihood an elaborate pantomime to generate a false sense of scientific legitimacy for what is purely a moral panic about gender related healthcare – with the enthusiastic collaboration of most of the UK’s politicians and news outlets,” TransActual wrote.

At the same time, The BMJ notes that the hashtag #StopTheTrial has been shared thousands of times on social media by people who oppose treating gender dysphoria in minors with puberty blockers. In November, U.K. Conservative Party leader Kemi Badenoch sent a letter to health secretary Wes Streeting describing the trial as “activist ideology masquerading as research,” according to the medical journal.

Responding to criticisms, Dr. Hilary Cass, lead author on the Cass Review, told The BMJ that the study “would allow researchers to gather evidence safely within a structured study, rather than leaving young people to experiment on themselves.”

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