NHS child gender clinic argues ban on puberty blockers 'undermines' young ...

NHS child gender clinic argues ban on puberty blockers 'undermines' young ...
NHS child gender clinic argues ban on puberty blockers 'undermines' young ...

A landmark ruling on the use of puberty-blocking drugs for children 'undermined' their rights dating back decades, the NHS's child gender clinic argued at the Court of Appeal today.

In December, the High Court ruled that children under 16 with gender dysphoria can only consent to the use of hormone blocking treatments if they are able to understand the 'immediate and long-term consequences'.

The court also said it was 'highly unlikely' that a child 13 or under would be able to consent to the treatment, and that it was 'doubtful' a child aged 14 or 15 would understand the consequences.

The case was brought by Keira Bell - a 24-year-old woman who began taking puberty blockers when she was 16 before later 'detransitioning' - against the Tavistock and Portman NHS Trust, which runs the UK's only gender identity development service for children.

A mother of an autistic teenager who was on the waiting list for treatment, only known as Mrs A, supported Ms Bell in their successful legal challenge.

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Tavistock began its appeal against the ruling on Wednesday and Fenella Morris QC, for the trust, said the decision 'reset almost half a century of established law' and caused 'serious distress to many young people and their families'.

The Tavistock and Portman NHS Trust (file picture) runs the UK's first gender clinic in London

The Tavistock and Portman NHS Trust (file picture) runs the UK's first gender clinic in London

Keira Bell outside the Royal Courts of Justice in central London after December's ruling. The 23-year-old, who began taking puberty blockers when she was 16 before 'detransitioning', brought legal action against the Tavistock and Portman NHS Trust

Keira Bell outside the Royal Courts of Justice in central London after December's ruling. The 23-year-old, who began taking puberty blockers when she was 16 before 'detransitioning', brought legal action against the Tavistock and Portman NHS Trust

In written arguments, she said: 'The effect of the court's judgment is to deny trans children and young people access to treatment which they desperately want and need. It is unclear what 'benefit' there is to be gained from this.'

She continued: 'It undermined the entitlement of children under the age of 16 to make decisions for themselves when they have been assessed individually as competent to do so by their treating clinicians. 

'It intruded into the realm of decisions agreed upon by doctors, patients and their parents where the court had not previously gone.' 

In the wake of December's judgment, the Tavistock paused new referrals to endocrinology services.

The barrister told the Court of Appeal that the ruling challenged the established rights of children and young people to make informed decisions regarding their medical treatment.

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What are puberty blockers and how can children transition gender? 

If a child is under 18 and may have gender dysphoria, they'll usually be referred to the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust.

GIDS has 2 main clinics in London and Leeds.

The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.

Young people with lasting signs of gender dysphoria may be referred to a hormone specialist (consultant endocrinologist) to see if they can take hormone blockers as they reach puberty. 

These hormone, or 'puberty' blockers (gonadotrophin-releasing hormone analogues) pause the physical changes of puberty, such as breast development or facial hair.

Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.

Although the Gender Identity Development Service (GIDS) advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.

It's also not known whether hormone blockers affect the development of the teenage brain or children's bones. Side effects may also include hot flushes, fatigue and mood alterations.

From the age of 16, teenagers who've been on hormone blockers for at least 12 months may be given cross-sex hormones, also known as gender-affirming hormones.

These hormones cause some irreversible changes, such as breast development and breaking or deepening of the voice.

Long-term cross-sex hormone treatment may cause temporary or even permanent infertility.

Source: NHS 

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She said: 'The courts have recognised since the 1950s that a child who is capable of appreciating fully the nature and consequences of a particular operation or of particular treatment can give an effective consent.' 

LGBT campaigners raised concerns about all young people's access to other forms of healthcare, including contraception, after the judgment.

The Tavistock's lawyers said the ruling was 'inconsistent' with a long-standing concept that young people may be able to consent to their own medical treatment, following an appeal over access to the contraceptive pill for under 16s in the 1980s.

Ms Morris said: 'It will be appreciated that there were in 1986 both known and unknown risks inherent in the use of the contraceptive pill, far greater than any physical risks that are known to be inherent in the prescription of puberty blockers which have been in use for a far longer period of time.'

The three High Court judges also said in December that children and young people wishing to start puberty blockers would also have to understand the implications of taking cross-sex hormones.

Ms Bell's lawyers previously argued there is 'a very high likelihood' that children who start taking hormone blockers will later begin taking cross-sex hormones, which they say cause 'irreversible changes'.

However, the Court of Appeal heard that it was not inevitable that a young person would move from puberty blockers to cross-sex hormones - which will only be prescribed to those over 16 - with even fewer going on to have surgery.

Ms Morris argued the judgment 'saw fit to prescribe a one-size-fits-all checklist of relevant information that the child or young person would have to understand. This was wrong'.

She continued that there is no clinical evidence that puberty blockers have irreversible effects on fertility or sexual functioning.

In the previous judgment, the High Court said the use of hormone blockers was 'innovative and experimental'.

This was rejected by Ms Morris, who said the treatment had been in 'mainstream usage for decades', including to treat early puberty.

She added: 'The use of puberty blockers in precocious puberty and in the treatment of gender dysphoria is the same. The conditions which the drugs are used to treat are different, but the way in which the drugs are used and their purpose is identical.'  

She also told the court that puberty blockers were prescribed 'to reduce distress' for children with gender dysphoria, allowing them to make decisions in the future.

She continued: 'Then, having reduced that distress, it creates the possibility to take time to consider options ... it allows the child to make the choice.'

She added: 'Not providing treatment means that the child remains in a position of distress and difficulties in making choices about what to do next.'

Ms Morris said that puberty blockers are deemed fully reversible in international guidelines.

She later told the Court of Appeal that children or young people who may go onto puberty blockers are told about the potential implications

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