The NHS is to launch its first ever service for trans patients wanting to return to the gender in which they were born.

It comes in the wake of the Cass Review, an independent report into transgender services, which found children were being hurried down “affirmative” pathways involving powerful drugs and medical interventions.

The report made a series of recommendations to the NHS, including to provide care for trans patients who had changed their mind after transitioning, and warned health leaders not to use the same medics who were previously involved in their care.

NHS England published its plans to “transform” care for gender-questioning children on Wednesday and accepted the recommendations of the Dr Hilary Cass report in full.

This includes developing the first NHS service to treat transgender patients who want to return to their birth sex.

NHS officials said the next step was to “define an NHS pathway for those individuals who choose to detransition” because currently no guidance on how to care for them exists.

The health service said: “There is no defined clinical pathway in the NHS for individuals who are considering detransition. NHS England will establish a programme of work to explore the issues around a detransition pathway by October 2024.”

It said this would include examining the rate at which patients detransition and their reasons for doing so, as these are currently unknown, and would recognise “that individuals who choose to detransition may not wish to re-engage with the services they were previously under” as per the recommendations.

Dr Cass said a lack of long-term data made it impossible to know how frequently people detransitioned, although anecdotally it was “increasing”.

The lack of long-term evidence was also why the review said puberty blockers should not be prescribed outside of a clinical trial.

That trial is now set to begin from early 2025, the NHS confirmed, with the first patients enrolled from April next year.

This will be the only way to legally access puberty blockers in the UK after the High Court upheld a ban that extended to private prescriptions after it was introduced in May.

Prof Sir Stephen Powis, NHS medical director, hailed Dr Cass’ “invaluable” work and said the plans outlined by the health service would ensure a “fundamentally different and safer model of care for children”.

He said: “The plan published today now fully maps out this new service for children and young people and their families, which will be led by evidence and ongoing research to ensure their needs are fully met.”

In its update, the health service also confirmed it would publish a review into adult services by the end of the year after Dr Cass heard concerns from staff and patients that extended beyond the remit of her review into children’s services.

That review will be led by Dr David Levy, the medical director for Lancashire and South Cumbria integrated care board, and look to improve care.

Prof James Palmer, NHS medical director for specialised commissioning, said it was “clear that our services for adults need focus too” and that the review would “address poor experience but also learn from good experiences of care”.

The NHS will also look at setting up an early adulthood service for trans patients aged 17-25, who had until now been sent straight to adult clinics where gender assessments are less holistic.

Dr Cass found that children were being given powerful cross sex hormones at adult clinics from the age of 17, while there was also evidence people changed their mind up until about the age of 25, as she advocated an “unhurried” model of care.

The NHS will also continue with its plans to open eight specialist hubs by 2026 for children with gender dysphoria or incongruence, replacing the defunct Tavistock clinic.

The first two opened in April, and are run by Great Ormond Street Hospital in London and Alder Hey Children’s Hospital in Liverpool.

The next regional hub is set to open in Bristol this November, with a further site operated by Cambridge University Hospitals NHS Foundation Trust opening next spring. By 2026 there will be one in every region, offering a suite of paediatric and mental health support for children and families.

Dr Cass said “the next important step will be the most challenging – turning it into a reality”.

She said: “The vision of the review – reflected in the implementation plan – is to increase available services for gender-questioning young people which take a holistic approach to care addressing the needs of each individual, and which put in place a full package of care which can be delivered as close to home as possible.”