High Court refuses permission for a challenge over the Government’s delayed cross-sex hormone decision.
Cross-sex hormones: The High Court has refused permission for a judicial review challenging the Secretary of State for Health and Social Care’s delay in deciding whether to restrict private prescribing of cross-sex hormones to children.
Mr Justice Sheldon made the ruling in proceedings brought by RDS and the Bayswater Support Group against the Secretary of State for Health and Social Care. NHS England was named as an interested party but the court ordered that it be removed from the proceedings.
The judgment, dated 17 July 2026 and published by the Courts and Tribunals Judiciary on 7 August, also granted anonymity to the first claimant and the chair of the Bayswater Support Group. The court ordered that their identities, as well as information capable of identifying them, must not be published in connection with the proceedings.
The claim concerned the time taken by the Secretary of State to decide whether to ban private prescribing of masculine and feminising hormones, described in the judgment as “cross sex hormones”, for the treatment of gender incongruence in children.
The claimants argued that the delay had become unreasonable and therefore unlawful. They relied on what they described as the consequences of the delay, the vulnerability of children exposed to the alleged risks and concerns about private providers. The court rejected that argument at the permission stage.
Mr Justice Sheldon found that the decision under consideration was complex and required the Government to evaluate evidence and risks, consider possible unintended consequences of legislation and assess different measures that could potentially restrict access.
The judgment also distinguished the issue from the Government’s approach to puberty blockers. The court noted that the April 2024 review by Dr Hilary Cass, now Baroness Cass, had recommended that the Secretary of State identify statutory solutions to prevent inappropriate private prescribing of both puberty blockers and cross-sex hormones.
Following the Cass review, the then Secretary of State introduced an emergency temporary ban on private prescribing of puberty blockers to children in May 2024. The judgment records that the restriction became permanent in December 2024. The court also referred to earlier judicial review proceedings. On 21 May 2025, the Divisional Court refused permission for a challenge concerning the Government’s decision not to prohibit the supply of cross-sex hormones to children.
At that stage, the Secretary of State had said that no final decision had been made and that officials were assessing the appropriate approach. A working group had also been established to gather data and expert evidence and provide advice. Mr Justice Sheldon found that the Government had continued working on the issue after the May 2025 ruling rather than simply leaving the matter unresolved.
The judgment records work on possible policy options, including consideration of whether to end recognition of prescriptions issued in the European Economic Area and Switzerland. Officials also sought evidence and held meetings with regulators, devolved administrations and affected professions. The Government also engaged with the Northern Ireland Executive because of issues surrounding prescriptions from the Republic of Ireland across the border.
Advice was submitted to ministers on 31 March 2026, followed by further consultation with Baroness Cass and additional advice concerning recognition of EEA and Swiss prescriptions. The court noted that a new Secretary of State, who had taken office on 14 May 2026, would need to consider the advice and evidence before making a decision. James Murray held the health and social care portfolio from 14 May until 20 July 2026. Yvette Cooper was subsequently appointed to the role on 20 July 2026.
Although the court accepted that the decision had taken longer than the claimants wanted, Mr Justice Sheldon concluded that the delay was not arguably irrational in the legal sense required for judicial review. The judge stressed, however, that the decision should not be understood as allowing the Secretary of State to keep the matter under consideration indefinitely. He concluded that the point had not yet been reached where the delay could be said to amount to justice being delayed or denied.
The court therefore refused permission to apply for judicial review. It also ordered the claimants to pay the defendant’s costs of preparing the Acknowledgement of Service and Summary Grounds of Defence, assessed at £7,026.60. The claimants may seek reconsideration of the refusal of permission. The order sets out directions governing any renewed application, including preparation of a permission hearing bundle and, if required, a hearing estimated to take two hours.
The court separately ordered anonymity for RDS and the chair of the Bayswater Support Group, identified as RDA in the proceedings. Mr Justice Sheldon said the order was intended, among other things, to protect the identity of RDS’s vulnerable daughter and address concerns about potential abuse directed towards the claimants if their identities and addresses became public. The judgment states that the press and others affected by the anonymity orders remain entitled to apply to set them aside or vary them.