Puberty-blockers ruling will NOT be challenged at Supreme Court

Landmark puberty-blockers ruling will NOT be challenged at Supreme Court: Children under 16 who have gender dysphoria can continue to be given life-changing drugs with GP’s consent

  • The Tavistock and Portman NHS Foundation Trust won a bid to overturn a ruling 
  • It was ruled it was ‘unlikely’ 13-year-old could consent to puberty-blocking drugs 
  • But NHS Trust brought an appeal against 2020 High Court ruling in June 2021 
  • Court of Appeal agreed it was inappropriate for High Court to give guidance 
  • Supreme Court has now rejected application to make a final ruling on the matter 
  • A landmark ruling allowing children to take puberty blockers without their parents’ consent as long as their doctor agrees will not reach Britain’s highest court after judges stepped in to kill a final appeal, it was revealed today.

    The original High Court case was won by Keira Bell against the Tavistock and Portman NHS Foundation Trust, which runs the UK’s only gender identity development service for children. 

    Hormone blockers pause the physical changes of puberty, such as breast development or growth of facial hair. Critics argue they could leave youngsters infertile and have longer-term effects on sexual function and bone density.

    Ms Bell – a woman who began taking puberty blockers when she was 16 before later ‘detransitioning’ calling the treatment a pathway to sterilisation – then lost when the Court of Appeal overturned the 2020 landmark ruling against the NHS gender clinic. 

    Today it was announced that the Court of Appeal’s decision would not be challenged at the Supreme Court as it did not ‘raise an arguable point of law’. 

    Following the Court of Appeal’s decision in September 2021, Ms Bell said she intended to appeal the ruling at the UK’s highest court. But Supreme Court Justices Lord Reed, Lord Sales and Lord Stephens denied Ms Bell permission to bring the case.

    A spokesman for the Tavistock and Portman NHS Foundation Trust said: ‘We welcome the Supreme Court’s decision. We are proud of our hardworking, caring and thoughtful colleagues in GIDS (gender identity development service). They and the patients they support will be relieved by the end of this period of uncertainty.’

    The case was brought by Keira Bell (pictured), a woman who began taking puberty blockers when she was 16 before 'de-transitioning', and a mother of a teenager who is on the waiting list for treatment. Their legal fight appears to be at an end

    The case was brought by Keira Bell (pictured), a woman who began taking puberty blockers when she was 16 before ‘de-transitioning’, and a mother of a teenager who is on the waiting list for treatment. Their legal fight appears to be at an end

    The High Court had ruled it was 'unlikely' a child aged 13 or under could consent to puberty-blocking treatment. But the Tavistock and Portman NHS Foundation Trust (pictured) brought an appeal and won. The Supreme Court has backed them again

    The High Court had ruled it was ‘unlikely’ a child aged 13 or under could consent to puberty-blocking treatment. But the Tavistock and Portman NHS Foundation Trust (pictured) brought an appeal and won. The Supreme Court has backed them again

    After the Supreme Court’s decision was made public on Thursday, Ms Bell said she was disappointed in the decision but ‘delighted at what has been achieved as a result of this case’.

    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 continued: ‘We have shone a light on the murky practices of one of the greatest medical scandals of the modern era.

    ‘Practice and policy has changed as a result.’

    Ms Bell added she felt ‘privileged to have played my part in the development of a more cautious approach to treating children with gender dysphoria’.

    LGBT campaigners had expressed concern after the High Court’s original ruling, with the charity Stonewall arguing it was a ‘green light to those who want to use this as an opportunity to roll back not just the healthcare rights of trans young people, but the rights of all young people’.

    The saga began around 16 months ago with an historic ruling in December 2020.

    The High Court ruled that children under 16 with gender dysphoria could only consent to the use of hormone-blocking treatments if they understood the ‘immediate and long-term consequences’. 

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

    But the Tavistock and Portman NHS Foundation Trust, which runs the UK’s only gender identity development service for children, brought an appeal against the ruling in June 2021.

    In a judgment in September last year, the Court of Appeal said it was ‘inappropriate’ for the High Court to give the guidance, finding doctors should instead exercise judgment about whether their patients can properly consent

    Ms Bell said at the time she was ‘obviously disappointed’ with the ruling, and said the case had ‘shone a light into the dark corners of a medical scandal that is harming children.’

    She added: ‘I am surprised and disappointed that the court was not concerned that children as young as 10 have been put on a pathway to sterilisation.’

    During the two-day appeal last year year, Tavistock’s lawyers argued 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.

    But Jeremy Hyam QC, representing Ms Bell and Mrs A, argued procedures at the Tavistock ‘as a whole failed to ensure, or were insufficient to ensure, proper consent was being given by children who commenced on puberty blockers’.

    Human rights group Liberty, which intervened in the appeal, said the High Court had imposed a serious restriction on the rights of transgender children and young people to ‘essential treatment’. 

    IT engineer Miss Bell is pictured outside the Royal Courts of Justice in London in January 2020

    IT engineer Miss Bell is pictured outside the Royal Courts of Justice in London in January 2020

    Miss Bell (pictured as a five-year-old) had treatment which began at the Tavistock in London. She would later detransition

    Miss Bell (pictured as a five-year-old) had treatment which began at the Tavistock in London. She would later detransition

    The Court of Appeal heard the Tavistock does not provide puberty blockers itself but instead makes referrals to two other NHS trusts – University College London Hospitals and Leeds Teaching Hospitals – who then prescribe the treatments. 

    John McKendrick QC, for the other trusts, told the court the median age for consenting to puberty blockers is 14.6 for UCL and 15.9 for Leeds. 

    What is gender dysphoria? 

    Gender dysphoria is a condition in which someone becomes distressed because they don’t feel that their biological sex matches the gender they identify as.

    For example, someone may feel like a woman and want to live as a woman, but have been born with the anatomy of a man.

    Gender dysphoria is a ‘recognised medical condition, for which treatment is sometimes appropriate’ and is ‘not a mental illness’, according to the NHS.

    People who live as a gender which is not the same as their biological sex are called transgender.

    Some people may choose to have hormone therapy – for example, to make them grow hair or develop breasts – or to have reassignment surgery to give them the genitals of a person of the sex they identify as.

    People diagnosed with gender dysphoria are allowed to legally change their gender.

    According to the charity Stonewall, as many as 1 per cent of the population may be trans – although accurate numbers are not known.

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    The chief executive of LGBT charity Stonewall welcomed the Court of Appeal’s ruling.

    But Keira Bell said she was ‘surprised and disappointed’ in the decision but said she had no regrets in bringing the case.

    She said: ‘A global conversation has begun and has been shaped by this case. There is more to be done. 

    ‘It is a fantasy and deeply concerning that any doctor could believe a 10-year-old could consent to the loss of their fertility.’ 

    Human rights group Liberty, which intervened in the appeal, said the High Court had imposed a serious restriction on the rights of transgender children and young people to ‘essential treatment’.

    Liberty director Gracie Bradley said: ‘This ruling is a positive step forwards for trans rights in the UK and around the world.

    ‘As the court has recognised, trans children should be able to choose and receive the healthcare they need on the same basis as all other children. 

    ‘Access to treatment is life-affirming for trans children and young people – without it the risk of serious, long-term harm dramatically increases. 

    ‘This case has implications for trans children not just in the UK, but also all over the world. Other countries had already started using the UK ruling to restrict trans rights – now they must take note of this judgment, too. 

    ‘Liberty has a long and proud history of standing up for trans rights and we will keep working with others to build a society where trans rights are recognised as human rights.’

    According to the World Professional Association for Transgender Health (WPATH) guidelines, very few people regret treatment of their gender dysphoria, the court heard. 

    ‘They refer to satisfaction rates across studies ranging from 87% in male to female patients and 97% of female to male patients and regrets were extremely rare,’ Fenella Morris QC, for the trust previously said in court.

    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’.