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Healthcare provision for transgender and gender-diverse young people (TGDY) remains emotive, controversial and ethically challenging.1 The indefinite ban on the prescription of puberty blockers (PBs) implemented by NHS England2 in response to the Cass review3 poses ethical questions for those treating TGDY and the proposed clinical trials. The review’s recommendation to screen for ‘neurodevelopmental conditions including autism, or autistic spectrum disorder’ (ASD) as part of the assessment process raises further questions, as posed in this journal by Simona Giordano.4