U.K.’s High Court Rules Children Under 16 Cannot Make Wise Decisions on Hormone Treatments to Alter Biological Sex

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Children under the age of 16 can not longer get puberty-blocking transgender hormones unless they can show an understanding of the risks and costs, says a High Court in the United Kingdom.

“The judgment today is a watershed moment,” a response to the ruling on Transgender Trend website says. “As a society we must ask ourselves how we allowed this to happen. The threats, bullying and the silencing of alternative views must stop here.”

Even for children under 18 doctors may need to consult the court for authorization for hormone or other treatment, three senior judges ruled in the suit brought against Tavistock and Portman NHS trust, which operates a “gender identity development service,” (GIDS) for children, according to the Guardian:

The 19-page judgment effectively introduces guidelines for the way in which the London clinic handles young patients who experience gender dysphoria – the condition where they are distressed because of a “mismatch between their perceived identity and … their sex at birth”.

The claim was brought by Keira Bell, a 23-year-old woman who began taking puberty blockers when she was 16 before detransitioning, and the unnamed mother of a 15-year-old autistic girl who is on the waiting list for treatment.

In their decision, Dame Victoria Sharp, president of the Queen’s bench division, Lord Justice Lewis and Mrs Justice Lieven, said a child under the age of 16 may only consent to the use of medication intended to suppress puberty “where he or she is competent to understand the nature of the treatment.” Such an understanding must include “the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life changing consequences for a child”.

“It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers,” the judges wrote. “It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”

The judges said they believed persons over 16 could be mature enough to consent to treatment, unless the end game is surgical sex reassignment.

“Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment,” the judges wrote.

“At a hearing in October, lawyers for the claimants argued that children going through puberty were “not capable of properly understanding the nature and effects of hormone blockers,’” the Guardian reported.

The Tavistock organization “treats” children who live in England and Wales. In the year 2019-2020, of 161 children referred to GIDS, three were aged 10 or 11 and 95 under the age of 16, the Guardian reported

A spokesman for the Tavistock and Portman NHS trust said the trust would seek permission to appeal.

“The trust is disappointed by today’s judgment and we understand that the outcome is likely to cause anxiety for patients and their families,” the spokesman said. “Our first duty is to our patients, particularly those currently receiving hormone blocking treatment, and we are working with our partners, University College London hospitals NHS foundation trust and Leeds teaching hospitals NHS trust, to provide support for patients concerned about the impact on their care.”

Bell said in the Guardian report that she is “delighted” with the outcome.

“This judgment is not political, it’s about protecting vulnerable children … I’m delighted to see that common sense has prevailed,” Bell said.

In her witness statement, Bell said, “I made a brash decision as a teenager, (as a lot of teenagers do) trying to find confidence and happiness, except now the rest of my life will be negatively affected.”

The Transgender Trend website, which took part in the lawsuit, also reported on the ruling:

Through her court action, Keira Bell has ensured that other troubled teenagers will now be protected from the harmful consequences she has had to face.

Transgender Trend intervened in this case particularly on the issue of the recent unprecedented rise in the referral rate of teenage girls and the specific cultural context within which the most vulnerable young people are now suddenly adopting a transgender identity. We are delighted that the judgment reflected some of the concerns we raised in our intervention about the failure of the Tavistock GIDS to ground medical intervention in evidence and objective science.

In our intervention, we submitted evidence that the GIDS operates within a core illogicality: a belief that biological sex is irrelevant to being a boy or being a girl, while providing a service that is predicated on the existence of, and ability to define, a ‘boy body’ and a ‘girl body’ that children might move between through medication and subsequent surgery.

“This is of course an impossibility, but it is an outcome that children are led to believe is possible,” Transgender Trend said.

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