UK High Court bans transgender puberty blockers for under-16s


Keira Bell, a 23-year-old activist, has won a stunning victory in the English courts over the conventional wisdom on gender dysphoria.

Keira had a very bad start in life. Her father walked out when she was four, leaving her and her sister in the care of her alcoholic mother. At 14 she was a miserable tomboy who didn’t fit in with the girls or the guys.

“I just stayed at home, locked in my room, playing video games,” she told the London Times. “And on the internet I read lesbian bloggers, but felt something else was wrong with me because I was so uncomfortable with my body and puberty and becoming a woman.” Then she discovered American trans activists on YouTube. “I thought, ‘That’s me. I need to do this, to medically transition to make myself better and live my life as I’m supposed to.’”

At 16 she sought help from the only gender-identity development service (GIDS) in the United Kingdom, the government-funded Tavistock Centre.

She says that after just three 60-minute appointments she was given puberty blockers. A year later she was prescribed testosterone and developed male facial hair and a deep voice. A couple of years after that she had a double mastectomy to remove both of her breasts. She changed her name to “Quincy” and had her birth certificate altered to make her legally a man.

It was a typical trajectory for teenage girls with gender dysphoria.

But Keira’s initial satisfaction quickly turned sour and she realised that she had made a big mistake. Or, rather, the Tavistock clinic had made a big mistake. “I should have been challenged on the proposals or the claims that I was making for myself,” she said. “And I think that would have made a big difference as well. If I was just challenged on the things I was saying.”

She sued Tavistock.

And this week she won her case in Britain’s High Court. It was a stunning victory which will cause ripples around the world. Over the past ten years, as in most other Western countries, the number of teenage girls referred to Tavistock rose by more than 5,000 percent.

Since many of these girls will endure infertility, surgical mutilation, psychological distress, and lifetime dependence upon medication, this is a very big deal.

The court ruled that it was highly unlikely that children under 16 could understand and give consent to puberty blockers.

Advocates of the transition process claim that the puberty blockers give children time to overcome the emotional turmoil of puberty and to give them time to make a considered decision. If this were the case, surely some patients would decide that they were better off in their birth sex. But in fact, the court observed, there is “a very high likelihood” that children who start on puberty blockers will move on to the next step of taking cross-sex hormones, which cause “irreversible changes”, especially loss of fertility. 

Although a child may understand the concept of the loss of fertility for example, this is not the same as understanding how this will affect their adult life. A child’s attitude to having biological children and their understanding of what this really means, is likely to change between childhood and adulthood. For many children, certainly younger children, and some as young as 10 and just entering puberty, it will not be possible to conceptualise what not being able to give birth to children (or conceive children with their own sperm) would mean in adult life. Similarly, the meaning of sexual fulfilment, and what the implications of treatment may be for this in the future, will be impossible for many children to comprehend.

One aspect of the ruling which escaped comment in the media was the number of times that the justices used the word “surprising” in their judgement.

Tavistock made assertions about its transgender treatment for which they had failed to collect data. “We find it surprising that such data was not collated in previous years given the young age of the patient group, the experimental nature of the treatment and the profound impact that it has … we have found this lack of data analysis – and the apparent lack of investigation of this issue – surprising … We find it surprising that GIDS did not obtain full data showing the figures and the proportion of those on puberty blockers who remain within GIDS and move on to cross- sex hormones.”

Originally, Tavistock only provided puberty blockers for children over 16. But in 2011 it began treating children as young as 12 with puberty blockers in an approved research study. Nine years later, Tavistock still has not published the results of the study.

The court understated sarcasm makes it appear likely that doctors were basing their treatment more on ideology than on science.

The result of the High Court’s decision – which is sure to be appealed – is modest. It does not ban transgender treatment. It simply declares that it is highly doubtful that children under 16 should be given puberty blockers because they cannot give informed consent. In the UK, children over 16 are deemed to be competent to consent to treatment. However, given that the treatment is innovative and experimental, the Court suggested that doctors should seek court approval first.

Mermaids, a group which lobbies for transgender children, was furious. The ruling “nods towards a future where the right to abortion and pro-choice decisions are restricted for all, destroying freedoms long fought for by women’s rights activists.”

Michael Cook is editor of BioEdge




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