King’s College London’s (KCL) five and a half year ‘PATHWAYS HORIZON’ study has received all necessary regulatory and ethics approvals and will soon begin recruiting participants. Approximately 3,000 transgender children will have their long-term health and happiness tracked in the world’s largest study of its kind.
The study aims to discover how to best support children and young people with gender incongruence – this is when someone feels their gender identity differs from the sex assigned to them at birth.
It is one of four study projects that form the £10.7 million ‘PATHWAYS’ initiative. The funding comes from National Health Service (NHS) England in partnership with the National Institute for Health and Care Research. KCL and the South London and Maudsley NHS Foundation Trust are co-sponsoring the study.
All under-18s referred to specialist NHS gender clinics will have the choice to take part in the study. Participants will respond to annual surveys that monitor their quality of life, body image and gender identity. Researchers will then link national health and education records to the questionnaire results, including investigating the impact of underlying conditions such as Attention Deficit Hyperactivity Disorder (ADHD) or autism.
The study will be observational in nature. This means that researchers will not alter any treatments the participants are receiving, nor provide any additional interventions. It aims to build up a stronger evidence base for the future care of transgender youth.
The researchers will follow participants for five years or, for those who join later, two years. However, the researchers hope to receive new funding to be able to follow the participants into late adolescence and early adult life.
The study was launched in the wake of Hilary Cass’ review of child gender services, published in April 2024. Cass’ report identified that the evidence around gender care for young people was “remarkably weak”. As a result, it advocated for a “full programme of research” into NHS gender services’ care of young people.
Cass further recommended that puberty blockers should only be available under a research protocol. This led to the banning of puberty-blocking drugs for children under 18, except in clinical trials.
Therefore, KCL’s ‘PATHWAYS TRIAL‘, which will study the effects of puberty blockers on young people, will be the only way for young people to receive them. Despite having been planned to begin in 2024, it is still awaiting regulatory approval.
‘PATHWAYS HORIZON’ has received significant media coverage. Major news outlets such as The Times, The New York Times and The Telegraph have all covered its launch.
Professor Emily Simonoff, the Chief Investigator of the study and Professor at KCL, commented that:
“The study will provide a stronger evidence base to allow young people and their families who have support needs related to gender incongruence to make more informed decisions in future, based on what is likely to give them the best wellbeing and health in the longer term.”
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