A High Court has ruled that Trans children under the age of 16 can only consent to puberty blockers if they understand the nature of the treatment.
The ruling was given during a landmark case, in which Keira Bell, 23, brought legal action against Tavistock and Portman NHS Trust, which runs the UK’s only gender identity development service for children.
Keira Bell, who has since transitioned, started taking puberty blockers at 16 and went on to take cross-sex hormones and underwent a double mastectomy.
A second legal challenge was also put forward by Mrs A, the mother of a trans autistic girl, 16, on the waiting list for treatment.
Both Ms Bell and Mrs A asked the High Court to rule it unlawful for trans children to be prescribed hormone blockers without a ruling from the court that such treatment was in their best interests.
In reply, the Tavistock and Portman NHS Trust said the claimants were attempting to impose a blanket exclusion on children under the age of 18 being able to consent to medical treatment, which they described as a radical proposition.
In a judgement, Dame Victoria Sharp, sitting with Lord Justice Lewis and Mrs Justice Lieven, said that children under 16 needed to comprehend the immediate and long term effects of puberty blockers before they receive them.
She described a child’s capacity to give valid consent as being able to understand, retain and weigh many factors involved in the treatment.
She noted these would include understanding the immediate consequences of the treatment in physical and psychological terms, and the reality that the vast preponderance of patients taking puberty-blocking drugs proceed to take cross-sex hormones, meaning they were a pathway to much greater medical intervention.
Dame Victoria also said children would need to comprehend the impact of the treatment pathway on future and life long relationships, and be mindful of the unknown physical consequences of taking puberty-blocking drugs and the fact that the evidence-based for this treatment is as yet highly uncertain.
She added that the court was only ruling on the informed consent of a child to take puberty blockers and not the benefits or disbenefits of the treatment and the judges noted that it was highly doubtful that a child of 13 or under would be competent to give consent and doubtful that a child or 14 or 15 could comprehend the long term risks and consequences of puberty blockers.
However, puberty blockers can be reversed by stopping the medication if the child later decides not to transition to another gender and puberty blockers can give transgender children a smoother transition into their chosen gender identity as an adult.
Of course, children and people make poor decisions all the time. People have breast implants and then regret them. People get married and then regret it. People have children and then regret them but you can’t stop someone doing something they’ve wanted for several years just because they might regret it, but what is important is that all trans teenagers must have access to a range of therapies to help them make the best decisions for themselves.
Puberty blockers are designed to prevent early transitions because they prevent puberty occurring until they’re old enough to decide on their own if they choose to transition as adults, which then makes the transition easier.
If they’re one of the very few who choose not to then transition they can simply quit taking the drug and allow puberty to occur.
This isn’t giving children the choice to transition early, it’s quite literally allowing them to become adults first before they make a life decision.