Friday, January 21

The Observer’s opinion on the high court ruling on children’s drugs that block puberty | Transgender

Can a child consent to irreversible and life-altering medical treatment as part of their gender transition? This was the sensitive question at the heart of the case Keira Bell took against the Tavistock and Portman NHS Trust, which runs the Gender Identity Development Service (GIDS) for children with gender dysphoria. The superior court historical failure It clearly states that by referring children as young as 10 years to receive drugs that block puberty, GIDS has been misinterpreting the law on child consent. It will ensure that children now receive the protection to which they are legally entitled.

Bell’s story is harrowing. From the age of four or five, he began to prefer clothes and games associated with children. As a teenager, she was disgusted by her body and depressed; Then at 14, she began questioning her gender identity and investigated the transition online. At age 15, she was referred to GIDS. He started taking puberty blockers when he was 16 and testosterone at 17, then had a double mastectomy when he was 20, three years ago. She has since decided to stop taking testosterone and has become a woman again. “I made a shameless decision as a teenager … trying to find confidence and happiness, except now the rest of my life will be adversely affected,” he said in his court appearance.

There are undoubtedly transgender adults who began taking puberty blockers as children who, unlike Bell and other young people who have questioned his deal, feel that this was the right decision. But this was not the question in court: it was whether children can consent in a meaningful way.

The law says that children under the age of 16 can only consent for your own treatment if they are believed to have the intelligence, competence and understanding to fully appreciate what it entails. The higher court set out why it was highly unlikely that a child under 13 would be competent to consent to taking puberty blockers and doubtful in the case of a 14- or 15-year-old.

First, puberty blockers are an experimental treatment for gender dysphoria, the long-term health impacts of which are potentially serious, but unknown. Second, virtually all boys who start out with puberty blockers progress to cross-sex hormones, which have profound lifelong consequences, including on fertility and sexual function. Third, gender dysphoria may resolve on its own in some adolescents, and the higher court finds that puberty blockers may support the persistence of gender dysphoria. The court ruled that the highly experimental nature of the treatment and its complex and lifelong consequences make it unlikely that children will be able to consent.

There are serious doubts about how GIDS has fulfilled its duty of care. It was unable to provide the most basic data the court requested, including the age profile of the children referred to puberty blockers, how many had a mental health diagnosis, and data on their treatment pathway. And the ruling casts doubt on the gender-affirming treatment model for children with gender dysphoria. The idea that a child as young as 10 can come to a fixed vision of their gender identity that sets them on the path to irreversible medical treatment is alarming, but it has been incorporated into clinical practice. As we have reported, the long-standing concerns raised by the doctors at Tavistock have been closed, with a whistleblower facing disciplinary action.

Any questioning of the gender assertion model, and the role that trauma, internalized hostility towards same-sex attraction, or misleading online material can play in adolescent gender dysphoria, is dismissed as transphobic. This is a chilling state of affairs that is detrimental to child safety. There are children who will find last week’s trial distressing and it is imperative that they receive the professional support they need. Children are not pawns to be used in adult debates about identity. Bell’s bravery has paved the way for a child-centered trial that provides them with the protection they deserve.

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