PATHWAYS is a programme of research aiming to find out how the NHS can best support children and young people with gender incongruence.
The research was informed by the Independent Review of Gender Identity Services for Children and Young People in the UK, led by Dr Hilary Cass (the Cass Review). There has been significant media and social media interest in PATHWAYS and we've received a number of questions and requests under the Freedom of Information Act about the studies, and about our role as one of the organisations which reviews health and social care research before it can start.
Because of this exceptional level of public interest, we have published a wider range of documents about the study than are usually available on our website, in the format in which they would usually be shared with someone making a request under the Freedom of Information Act.
They are available for anyone to view, though we understand that the format might mean they are not accessible for people who use assistive technology. If you would like to access a document on this page but would require it in another format, please email the communications team.
The documents on this page
When an applicant submits a study to the Health Research Authority for regulatory approval, they need to include copies of all of the documentation which will be used in the study if it gets permission to start.
As part of the review process, the independent Research Ethics Committee, which includes a legally constituted balance of experts in medicine or research as well as lay people, may request changes and updates to these documents, based on their feedback.
We have published the final versions of all the approved documents relating to the PATHWAYS TRIAL, along with the minutes of the meetings where the study was discussed, and decision correspondence between the HRA and the study team. This includes:
- Application documentation and supporting cover letters
- Study protocol and investigator information
- Participant information and consent or assent materials
- Questionnaires
- Financial and insurance documents
- Minutes and decision correspondence
Application documentation and supporting cover letters
- Initial application submission cover letter 20 August 2025
- REC application form
- Ionising Radiation for Combined Review Form
- PATHWAYS Response to Grounds for Non-Acceptance 9 October 2025
- Further Information Response document 31 October 2025
Study protocol and investigator information
- PATHWAYS TRIAL protocol 29 September 2025
- Ferring Pharmaceuticals Gonapeptyl Depot summary of product characteristics 12 June 2023
- Takeda UK Prostap summary of product characteristics 10 July 2024
- Ipsen Decapep summary of product characteristics 14 November 2024
- Ipsen Decapeptyl SR 11.25mg (triptorelin pamoate) summary of product characteristics 14 November 2024
- AstraZeneca UK Zoladex LA summary of product characteristics 10 May 2023
- PATHWAYS CONNECT template GP letter confirming trial participation
- PATHWAYS HORIZON INTENSIVE template GP letter confirming trial participation
- PATHWAYS TRIAL template GP letter confirming trial participation
Participant information and consent or assent materials
- PATHWAYS TRIAL Consent form for parents and legal guardians
- PATHWAYS TRIAL Assent form for children and young people under 16
- PATHWAYS TRIAL Consent form for young people 16 years and older
- PATHWAYS TRIAL Participant information sheet for parents and legal guardians
- PATHWAYS TRIAL Participant information sheet for children and young people
- PATHWAYS HORIZON Intensive consent form for parents and legal guardians
- PATHWAYS HORIZON Intensive assent form for children and young people under 16
- PATHWAYS HORIZON Intensive consent form for young people 16 years and older
- PATHWAYS HORIZON Intensive participant information sheet for parents and legal guardians
- PATHWAYS HORIZON Intensive: Participant information sheet for children and young people
- PATHWAYS CONNECT consent form for parents of children and young People under 16
- PATHWAYS CONNECT Assent form for children and young people under 16
- PATHWAYS CONNECT Consent form for young people 16 years and older
- PATHWAYS CONNECT (Trial): Participant information sheet for parents and legal Guardians
- PATHWAYS CONNECT (Trial): Participant information sheet for children and young people
- PATHWAYS CONNECT (HORIZON Intensive): Participant information sheet for parents and legal guardians
- PATHWAYS CONNECT (HORIZON Intensive): Participant information sheet for children and young people
Questionnaires
- Body Image Scale- Gender Spectrum
- The Delis-Kaplan Executive Function System - a review
- The Wechslet Intelligence Scale for Children - 5th UK edition
- Child and Adolescent Memory Profile - rationale, development and guidelines for use
- Behaviour rating inventory of executive function (BRIEF 2)
- Using the memory validity profile - research paper
- Child behaviour checklist for ages 6-18
- Kidscreen health questionnaire for children and young people
- KIDSCREEN-52 (Parent) (Adapted)
- RCADS-25 questionnaire for children and young people
- RCADS-P-25 for parents and caregivers (Adapted)
- Utrecht gender dysphoria scale
- DERS-18 questionnaire for children and young people
- Parental attitudes of gender expansiveness scale for parents and caregivers
- Parental attitudes of gender expansiveness scale for children and young people (PAGES-Y) (Adapted)
- ASQ- Child report (adapted) (baseline)
- ASQ – Child report (adapted) (follow up)
- SNAP-IV teacher and parent 18 item rating scale
- Adolescent primary care traumatic stress screen questionnaire for parents and caregivers
- Adolescent primary care traumatic stress screen questionnaire for children and young people
- Social transition questionnaire
- Sexual attraction questionnaire
- Gender identity questionnaire
- Intensive about yourself questions
- SCOFF Questionnaire for parents and caregivers (adapted)
- SCOFF Questionnaire for children and young people
- Intensive Youth Self Report for Ages 11-18 (adapted)
- Intensive Social Communication Questionnaire
- Intensive questions about romantic relationships ALSPAC
- Difficulties in emotion regulation scale – Parent version (DERS-P) (Adapted)
- Body Image Screen- gender spectrum (BIS-GS) (Adapted)
- ASQ- Parent or caregiver report (adapted) (follow up)
- ASQ- Parent or caregiver report (adapted) (baseline)
Financial and insurance documents
- No fault compensation for human clinical trials insurance
- Legal liability for human clinical trials
- Letter to Chief Investigator confirming proposal recommended for funding 23 January 2025
Minutes and decision correspondence
- London (City and East) Research Ethics Committee meeting minutes – 4 September 2025
- Expert comments
- HRA and HCRW Approval status update – provisional outcome – 11 September 2025
- London (City and East) Research Ethics Committee sub-committee meeting minutes – 28 October 2025
- HRA and HCRW Approval status update – request for further information – 29 October 2025
- London (City and East) Research Ethics Committee sub-committee meeting minutes – 6 November 2025
- Written comments provided by members (summary extract)
- London (City and East) Research Ethics Committee further information favourable opinion – 6 November 2025
These documents have been redacted in line with our policies and procedures. These are the same if the documents are shared following a request made under the Freedom of Information Act, or if they are published on our website.
Please contact the communications team if you need any of the above documentation in an alternative format.
The research summaries for PATHWAYS HORIZON and PATHWAYS TRIAL have also been published on our website.