The National Institute for Health and Care Research (NIHR) has announced a significant £10 million investment into a PATHWAYS (Puberty suppression And Transitional Healthcare with Adaptive Youth Services) project, aimed at developing and evaluating interventions for individuals experiencing gender-related distress.
The study includes the following threads:
PATHWAYS Engagement – This advises the research team on how to study gender incongruence. The funding notification claims that “Young people with gender incongruence and their parents have already influenced the research ideas and now we will ask advisory groups to further guide the research team throughout the study.” However, we must question the impartiality of this because Our Duty was not consulted despite its leadership in understanding transgender ideation and in parent representation.
PATHWAYS Horizon – This will include all young people attending a UK NHS Gender Service who want to take part, and their parents. However, the study’s reliance on participants from Gender Clinics excludes the perspectives of well-informed parents who are deliberately avoiding these services due to their lack of safeguarding. With the NHS conducting a thousand mastectomies a year, sensible parents are doing their best to steer their children away from it. The study would benefit from engagement with Our Duty, which represents the voices of parents who have first-hand experience of the harms caused by such services.
PATHWAYS Trial – This is the puberty blocker experiment, which shall (if granted ethical approval) run for two years, doing nothing for the advancement of knowledge and plenty to harm vulnerable adolescents. A genuine research approach would acknowledge Our Duty’s concerns regarding the impossibility of conducting an ethical trial in this context.
PATHWAYS Connect – This studies whether using puberty blockers (GnRHa) affects young people’s thinking (cognition) and brain development. It includes all the young people in the PATHWAYS Trial and some of those in PATHWAYS Horizon. Given the long-term cognitive and psychological effects of social and medical transition, unbiased interpretation of any findings is essential.
PATHWAYS Voices – This involves speaking to young people about their experiences of living with gender incongruence and of their care in NHS Gender Services. At Our Duty, we believe these voices are detrimental to any advancement in understanding because the patients are driven not by a healthcare need, but by a harmful ideation. The inclusion of non-affirming parental insight would help shift the focus toward a broader understanding of the social context that contributes to transgender ideation.
As Our Duty has repeatedly pointed out, any approach that fails to critically assess the fundamental assumptions underlying “gender identity” risks reinforcing harmful ideologies rather than addressing the root causes of adolescent distress. Below, we examine the key elements of this project and the flawed premises it is built upon.
Trial and Ethics: The Fundamental Problem
One of the most concerning aspects of the PATHWAYS project is the implicit assumption that there is an ethical way to conduct clinical trials on puberty blockers. As Our Duty has extensively detailed (see The Impossibility of an Ethical Clinical Trial on Puberty Blockers), there is no ethical framework within which puberty blockers can be trialled, given the established risks, lack of long-term benefit, and the absence of truly informed consent from minors.
The PATHWAYS project claims to seek “effective interventions,” but it appears to be operating under the erroneous belief that “affirmative” treatments—including medical interventions—are a necessary and ethical path forward. This is despite mounting evidence, including from detransitioners, that such interventions often cause irreversible harm and do not resolve the underlying mental health issues adolescents face.
“Voices” and the Missing Perspective of Parents
A notable aspect of PATHWAYS is its emphasis on listening to “patients,” but the voices that matter most in adolescent care are those of parents, not just those experiencing gender-related distress. Adolescents, by definition, lack the full capacity to make life-altering medical decisions, and yet PATHWAYS appears to prioritise subjective self-perception over parental safeguarding. The failure to engage meaningfully with the concerns of parents—many of whom have watched their children spiral into transgender ideation after exposure to online influences—suggests that this project is starting from a deeply flawed foundation.
Our Duty has documented the lifecycle of transgender ideation, highlighting how social factors play a dominant role in shaping an adolescent’s self-concept. The reality is that “gender identity” is not an innate trait but a socially constructed belief system, often reinforced by external validation from activists, educators, and medical professionals who are ideologically committed to affirmation at all costs.
A pathway that prioritises parental involvement and focuses on removing societal indoctrination provides a fundamentally safer and more ethical approach. By steering young people away from harmful medical interventions and instead addressing the root causes of their distress, this approach is far superior to any framework that includes the possibility of unnecessary and irreversible medicalisation.
A Waste of £10 Million?
The sheer scale of funding allocated to PATHWAYS is staggering, particularly given the project’s apparent failure to acknowledge the fundamental flaws in gender ideology. Rather than spending £10 million investigating ways to medicalise children further, resources should be directed toward understanding why so many young people are being drawn into the transgender belief system in the first place. Addressing underlying issues such as Indoctrination within the education system, autism, trauma, social isolation, and online influence would be a far more productive use of taxpayer money.
Instead of perpetuating an approach that has already led to significant harm, the NIHR should be focusing on the well-documented risks of social transition, puberty blockers, and cross-sex hormones. A truly responsible research initiative would examine why so many detransitioners regret their medical interventions and work to prevent further cases of unnecessary and harmful treatments.
Ensuring the inclusion of critical perspectives in the research process would allow for a far more balanced and ethically sound approach, keeping safeguarding, rather than ideology, as the focus.
Conclusion: A Project in the Wrong Direction
The NIHR’s PATHWAYS project, rather than offering a genuine solution, appears to be reinforcing a harmful and discredited approach. Unless it begins from the correct premise—that gender identity ideology is leading adolescents down a dangerous path—it is unlikely to yield any results that genuinely benefit those in distress.
Parents, not ideologically driven researchers, must be central to any discussions about adolescent well-being. And until public funding is directed toward dismantling rather than reinforcing transgender ideology, we can expect to see further wasted resources and, tragically, more young lives disrupted by unnecessary medical interventions.
A truly responsible study would recognise parental safeguarding as central to protecting vulnerable adolescents, ensuring their well-being is not sacrificed to ideological commitments.
Associated Press Release:
NIHR’s £10M PATHWAYS Project: A Flawed Approach That Ignores Key Safeguarding Concerns
