Doctor exploits NHS loophole to prescribe hormones for children

It is 7pm in Hove and through the mist come seven figures — one dressed as a large inflatable dinosaur. The figures are women, and they are protesting against Sam Hall, a GP who they say has been prescribing cross-sex hormones to 16-year-olds, sometimes without their parents’ knowledge or consent.

Last week the Cass report concluded the NHS has been failing thousands of children by prescribing puberty blockers and cross-sex hormones despite “remarkably weak evidence”. Dr Hilary Cass, the report’s author, called for a “fundamental change of direction” but nowhere is more emblematic of how hard that may be to realise than in Brighton & Hove.

Hall, a trans man, who has described his experience of hormones as “sublime” is something of a hero here, closely aligned to a network of charities and schools. He has been championed as a trailblazer on posters around the city.

Lesley Hammond, 69, who is holding up a banner bearing the words: “First do no harm?” has had enough. “We are aware that Sam Hall has been providing bridging prescriptions, sometimes to children as young as 16. We think this is very wrong,” she says.

Medical support for gender-dysphoric young people has ground to a halt since Cass published her interim report two years ago. The Gender Identity Development Service (Gids), an NHS clinic in London, closed last month. It was replaced by two regional hubs, but waiting lists for treatment have spiralled to four years. In this void, a series of private clinics have opened, prescribing puberty blockers and cross-sex hormones to desperate young people for a fee. But Hall, who works at the WellBN clinic, has been doing so within the NHS.

Hannah Barnes exposed this in the updated edition of her book about Gids, Time to Think, and spoke to parents to whose children Hall had prescribed cross-sex hormones after only one consultation.

One of them was Mary*. Her daughter has severe autism and ADHD and first started to express confusion about her gender in April 2022, when she was 15. She is very intelligent, but like many autistic young people she was prone to fixations, her mother says, and struggled to understand long-term consequences: “She’s got the emotional regulation of a seven-year-old and the impulse control of a three-year-old.”

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The family were seeking support from psychologists and counsellors, and had agreed with their daughter that she would not embark on medical treatment until she was 18. However, in February last year, they discovered that she had been prescribed testosterone by Hall after a blood test and a consultation with him lasting about ten minutes.

Mary was horrified: “She’s started taking a drug that has irreversible consequences at a time in life where her brain and her body are still developing.”

Hall appears to be using a loophole in NHS guidelines that allows GPs to prescribe “bridging prescriptions” to patients in acute distress while they await a specialist service, for example for pain relief to cancer patients, despite the fact that NHS guidance states such prescriptions should only be used for adults.

Cross-sex hormones, which begin the medical transition, have never been used in this way before. At the Gids clinic, 16-year-olds could only be prescribed the drugs after spending a minimum of a year on puberty blockers (for which they would have had a minimum of three assessments).

The Cass report states that the evidence for the indicated uses of puberty blockers and masculinising/feminising hormones in adolescents are unproven and the benefits and harms are unknown. As a result she advised “extreme caution” and a clear rationale for providing hormones at this stage, rather than waiting until patients reaches 18, and only after they have been seen by a specialist in gender dysphoria or from a multidisciplinary team. Mary’s daughter has never had a diagnosis.

Hall did not respond to request for comment, but a spokesman for the WellBN clinic said “We can’t discuss an individual patient’s care without consent, but if any parents of patients receiving care wish to contact the practice to discuss the care of their children, we would encourage them to do so.” He also highlighted a page on the WellBN website which states: “Since 2016 [we] have prescribed hormones to people as indicated by their presentation and using an informed consent model of care which underpins all of primary care. We have established robust pathways, a multidisciplinary team and built up expertise amongst our clinicians in the prescription of hormones to thousands of patients over the past eight years and have access to specialist advice when needed.”

The spokesman also highlighted guidance from NHS England which advises that hormones can be given to people “around the age of 16” so long as they have been seen by a specialist multidisciplinary team, have agreed on a care pathway and have “cognitive and emotional maturity to consent”. NHS England is reviewing these guidelines in line with recommendations in the Cass report.

Hall, who transitioned as an adult having been married and had three children, is a revered figure in Brighton. Posters celebrating him as a “trailblazer” were seen around Brighton during last year’s Pride parade. He works closely with the local trans youth charity Allsorts, dubbed “the Mermaids of the south coast” — the trans charity that lobbied doctors at Gids and supports the use of puberty blockers — and is a prolific blogger who has talked openly about how his practice is guided by his beliefs.

“My own experience of the dire state of trans-affirming healthcare in the UK helped point me in a new direction — general practice,” he wrote in a blog in 2022. “I had learned about the right treatment for gender incongruence through my own pain and I wanted to help other individuals.”

In 2020 he launched the Trans Health Hub at WellBN, the GP practice where he works. Since then the service has grown from 35 patients to over a thousand. It is believed to have a waiting list of 8-12 weeks. This success has been driven by a network of charities.

In October last year, Gendered Intelligence, another trans-led charity heavily involved with Gids, wrote to all the families on its mailing list to tell them about this “opportunity” for “trans affirming primary healthcare”. Parents and carers were informed that WellBN “is a Brighton-based NHS general practice” that will take “out-of-area patients” and that can “prescribe blockers/HRT under their informed consent model for anyone 16–18”.

The informed consent model of care for trans people is one that removes any type of mental health assessment from the process of obtaining hormones or the need to see a specialist.

Mary is in contact with at least ten other families whose 16-year-olds have been prescribed cross-sex hormones by Hall. Many were directed to him by Allsorts, which also works closely with local schools and was brought in by the council to provide training to social workers.

Some are grateful for his support. Keith* went with his daughter to see Hall shortly after her 16th birthday last year and describes him as “very helpful and fair”. Keith desperately did not want his child to take hormones but “had been promising for two and a half years ‘sit tight — you need to think — at the age of 16 things will change’,” he says. He does not think that Hall was pushing a medicalised approach. “What happens to children with gender dysphoria is that they get lost in the system, no one knows what to do with them.” He thinks Hall is doing the best he can in “a broken system”.

Barnes does not doubt that Hall has good intentions. “No doubt Hall truly cares for his patients. Waiting times for gender clinics — for both young people and adults — are many years, and he sees bridging prescriptions as a way to relieve distress and improve the lives of trans people,” she writes.

However, taking hormones as a mature adult having had children, is very different from giving them to a vulnerable teenager. NHS England has begun a review of its guidelines on the prescribing of cross-sex hormones, following the advice of the Cass report and is seeking advice from the health department on closing loopholes that allow private clinics to continue to prescribe puberty blockers and hormones. But Hall appears to be operating in a grey area.

Mary has raised her concerns with the Care Quality Commission, which did not respond. The General Medical Council said: “This does not appear to be something that falls within our legislative remit or with which the GMC can otherwise assist.” NHS England has passed the problem to the national medical director and director of primary care. Mary is awaiting a response.

Outside Hall’s clinic, there is a mood of cautious optimism. “The Cass report has thrown up a lot of things, people are saying it’s going to be a game changer but I think in Brighton it’s going to take a lot longer,” says Ali Hooper, 58. “It is all so entrenched here.”

Some fear the change will come too late. Like Mary’s daughter, Tom’s child is autistic and has been spending time with Allsorts since she was 11. She has socially transitioned against her father’s wishes, supported by the charity and her school. Today is her 16th birthday and she plans to start taking testosterone. She has told him she already has an appointment with a local GP.