NICE
The National Institute for Health and Care Excellence (NICE) is the British institute that develops guidelines and recommendations for healthcare and social care in England. It assesses treatments for their effectiveness and cost-effectiveness.
The main article on this subject is Gender Care in the United Kingdom.
What you can find
The website contains guidelines, quality standards, assessments of medicines, and information about how the institute operates.
Why it is included on this list
In 2020, NICE produced two evidence reviews commissioned by NHS England: one on puberty blockers and one on gender-affirming hormones for children and young people with gender dysphoria. Both concluded that the quality of the available evidence was very low. The reviews were used by the Cass Review. They are not NICE guidelines; they therefore do not appear among the regular guidelines on the website, but were published alongside the Cass Review documents.
History and methodology
NICE was established in April 1999 as the National Institute for Clinical Excellence. Its current name dates from 2013, when the institute also took on responsibilities for social care. It is an executive non-departmental public body under the UK Department of Health and Social Care. NICE’s authority applies directly to England; Wales and Northern Ireland use its recommendations in their own decision-making. The institute issues four types of recommendations: evaluations of medical technologies and medicines, clinical guidelines, public health recommendations, and social care recommendations. When weighing costs, NICE calculates the number of life-years gained in good health. Since 1999, this had involved a range of £20,000 to £30,000 per year gained. Since April 2026, the range has been £25,000 to £35,000.
The reviews’ place in the debate
The two evidence reviews on gender care were a first step. The Cass Review subsequently commissioned seven systematic reviews from the University of York, which were published in the journal Archives of Disease in Childhood; see the profile of the University of York. Together, they formed the evidence base for NHS England’s decision to stop routinely prescribing puberty blockers. The Cass Review documents have been deposited with the UK National Archives; see UK National Archives.
How to weigh this source
NICE is regarded as authoritative. In gender care, it is important to understand what an evidence review does and does not say. A conclusion that the evidence is of very low quality means that the studies provide little certainty about the effect. How evidence is weighed is explained in the evidence pyramid in gender care. It does not mean that a treatment has been shown to be ineffective or harmful.