The NHS has issued new guidance to GPs ordering them to refuse prescribing puberty blockers to under-18s, stating it is a criminal offence.
Health leaders have told doctors they "must refuse" requests to prescribe puberty blockers and "should refuse" cross-sex hormone requests to children unless carefully considered.
The clarification comes after concerns that GPs were being caught in a battle over a condition they are not trained to treat.
The guidance empowers doctors to turn away requests to prescribe these powerful drugs to under-18s.
Trans activists and unregulated clinics have sought to pressure GPs into illegally prescribing puberty blockers, according to the NHS
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Previously, GPs would continue prescriptions for children after they had initially received them from transgender clinics.
Trans activists and unregulated clinics have sought to pressure GPs into illegally prescribing puberty blockers, according to the NHS.
It is understood a number of GPs have felt pressured into prescribing the drugs to children or entering agreements to supply them on behalf of transgender clinics.
The NHS guidance specifically singles out two unregulated clinics to be avoided: GenderGP and Anne Transgender Healthcare Ltd.
Both organisations have "published statements that oppose the restrictions that have been put in place" by the NHS and the Government.
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It is understood a number of GPs have felt pressured into prescribing the drugs to children or entering agreements to supply them on behalf of transgender clinics
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There is no suggestion either organisation has broken any laws.
Last month, the Royal College of GPs updated its position to argue that the profession should not prescribe gender-affirming hormones to anyone under 18.
Wes Streeting announced last year that a UK-wide ban on puberty blockers would be made indefinite, outside of a clinical trial.
Cross-sex hormones, however, are still available to 16 and 17-year-olds.
The NHS guidance tells doctors they "must refuse" to prescribe puberty blockers to under-18s to treat gender dysphoria under any circumstances.
It states: "It is a criminal offence for a healthcare professional to privately prescribe or dispense this drug to patients under the age of 18."
Dr Louise Irvine, a GP and co-chairman of Clinical Advisory Network on Sex and Gender, said: "GPs can come under considerable pressure from patients to prescribe on the advice of unregistered gender clinics and this advice will give GPs much needed support to refuse in the interests of patient safety."
The NHS guidance tells doctors they 'must refuse' to prescribe puberty blockers to under-18s to treat gender dysphoria under any circumstances
PABut she said it did "not go far enough" because it was "not mandatory" and some GPs are "operating outside NHS prescribing protocols".
Paul Conrathe, a solicitor representing families taking action over clinics prescribing cross-sex hormones, welcomed the changes but said "tougher action is long overdue".
He added that "only a ban on prescribing cross sex hormones outside of the NHS will provide the necessary measures to protect vulnerable children".
The guidance comes amid various legal challenges attempting to ban cross-sex drugs in children, including one led by Kiera Bell, a de-transitioner who regretted trans surgery.
A GP clinic in Brighton, WellBN, faces legal action over prescribing cross-sex drugs to teenagers without parental knowledge.
The Cass Review said cross-sex hormones should not be given to under-16s and only with "extreme caution" to 16 and 17-year-olds.
An NHS spokesman said: "Unregulated healthcare services pose a risk to patient safety as they are not subject to the same level of scrutiny as registered services."
The NHS advised GPs not to cooperate with unregulated providers arranging medications for children "contrary to NHS policy".
