Credit: Sharon McCutcheon / Unsplash

Landmark case finds children “highly unlikely” to be able to consent to puberty blockers, sex changes.

The decision stresses the “experimental nature of the treatments”, that the evidence for their usage in young children was “non-existent”, and that they could cause “irreversible” changes to a child in the most “fundamental way possible.”

The High Court in London has today ruled in favour of British women Keira Bell in her case against the Tavistock Clinic. The Tavistock Clinic runs the only Gender Identity Development Service (GIDS) for children in Britain.

Bell claimed that the Tavistock Clinic provided inadequate information to children about the harms associated with puberty blockers and sex change hormones and that this lack of information, combined with an absence of procedural safeguards within the clinic, breached the rights of children as laid out in Article 8 of the European Convention for the Protection of Human Rights and Fundamental Freedoms.

Bell had previously been a patient of the Tavistock Clinic, going onto puberty blockers at age 16, testosterone at 17, and undergoing a double mastectomy at 20.  Bell later “detransitioned” after noticing that, even after her surgeries and hormonal treatments, there remained large differences between herself and biological males. She says “I was being perceived as a man by society, but it was not enough.” She says she began to feel she was “a woman with a beard, which is what I was.”

The case had focused on the question of if children under 18 could meaningfully consent to taking puberty blockers, and then sex change hormones, given the nature of the treatments and the potentially irreversible consequences of trying to change one’s gender.

In a judgement that could have wide-ranging impacts the court ruled that it was “highly unlikely” that those who 16 would be able to do so given that the treatments were “experimental”, the actual purpose of the treatments was unclear, and that the treatments can lead to “a loss of fertility” and “sexual function.”

The court argued that “whilst children may understand the concept of the loss of fertility”, this was not the same as being able to understand how that loss would affect their adult life. The court said that, with the Tavistock Clinic treating children as young as 10, it would simply not be possible for a child of that age to “conceptualise what not being able to give birth to children (or conceive children with their own sperm) would mean in adult life.”

The consequences of the judgement remain to be seen but an initial reading of the judgement indicates that it will now be legally difficult for those under 16 to be given puberty blockers or sex change hormones.

Until 2011 the Tavistock Clinic proscribed puberty blockers to children aged 16 and over, but in 2011 their policy changed and they began to offer puberty blockers to children as young as 12. In court the Clinic was unable to provide collated data on the age distribution of those it currently treated with puberty blockers – a situation which the court described as “surprising” given “the young age of the patient group, the experimental nature of the treatment and the profound impact that it has.”

Despite the lack of collated data the Clinic did reveal that in 2019/20 they had given puberty blockers to children as young as 10, and that most of the children given puberty blockers were 15 years old or younger.

The usage of puberty blockers in young children had been claimed to be safe and “fully reversible” but there have been growing concerns that puberty blockers “can have significant side effects” and that children, once they begin using puberty blockers, are almost certain to progress to using sex change hormones which will cause “irreversible changes to the child’s body with lifelong medical, psychological and emotional implications for the child.”

The court itself noted that, whilst puberty blockers and sex change hormones are usually presented as being entirely separate medical options, ”the evidence that we have on this issue clearly shows that practically all children / young people who start puberty blockers progress on to sex change hormones.” The Tavistock clinic was unable to provide the court with information as to how many children who took puberty blockers would move on to taking sex change hormones – a situation which the court described, again, as “surprising.”

In the judgement, after noting that these treatments go “to the heart of an individual’s identity” in a manner which is “quite possibly unique as a medical treatment”, the court said that “the use of puberty blockers is not itself a neutral process by which time stands still for the child on PBs, whether physically or psychologically. PBs prevent the child going through puberty in the normal biological process. As a minimum it seems to us that this means that the child is not undergoing the physical and consequential psychological changes which would contribute to the understanding of a person’s identity.”

Due to all of the above the court rules that “it is highly unlikely that a child aged 13 or under would ever be competent to give consent to being treated with puberty blockers.” Similarly, they said that, as regards children aged 14 and 15, “we are also very doubtful that a child of this age could understand the long-term risks and consequences of treatment in such a way as to have sufficient understanding to give consent.” The court did say that children of 16 years had a “presumption of capacity” and, as such, barring a dispute with the parents and the child being of good mind, the court would not intercede to stop treatment.

The number of children being seen in the Tavistock Clinic has grown at an incredible pace over the last number of years. In 2009 97 children were referred to the Clinic for puberty blockers. In 2018 that number was 2,519 – a 2,500% increase in less than a decade. It was noted by the court that 75% of all those now attending the Tavistock Clinic were female, and that a significant number of those presenting have a diagnosis of an Autistic Spectrum Disorder (ASD).  The Clinic said that they did not have exact numbers on how many children who had attended the Tavistock Clinic has a diagnosis of an ASD. A situation, which again, the court described as “surprising.”

It is expected that the Clinic will appeal the judgement. The full judgement can be read HERE.

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