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In late 2025, campaigners brought legal action against the government and health bodies claiming the trial was unethical and that children could not give properly informed consent.
One of those taking legal action was Bayswater Support Group, which works with 800 parents who are wary of medical solutions for their gender-questioning children.
Others include the psychotherapist James Esses and Keira Bell, who began taking puberty blockers when she was 16 before detransitioning and speaking to the media about her experience.
"It's a tragedy that the court has refused permission for this challenge to proceed," she said.
"The medical profession and morality do not always walk hand-in-hand. If they did, this trial would be out of the question."
The Bayswater Group said the design and size of the study, and the lack of evidence about any possible benefits of puberty blockers, "raise fundamental questions about whether the protective framework for minors has been properly implemented".
The Pathways trial was originally due to start recruiting participants in January 2026 but was paused because of the legal action.
When details of the trial were first announced, there was no lower age limit for involvement, but in February 2026 the medicines regulator, the MHRA, raised safety concerns and suggested a minimum age of 14 should be set.
In June it announced that, after discussions with researchers, safeguards had been strengthened and girls would be able to take part from age 11 years old with boys participating from 12.
