- The UK's High Court ruled that trans children under the age of 16 are unable to give informed consent to receive medical care such as hormone blockers and hormone replacement therapy.
- The decision comes after Keira Bell, a woman who de-transitioned after she was prescribed hormone replacement therapy, sued the National Health Service (NHS), saying she was not given sufficient guidance.
- Medical professionals told Insider the decision could lead transgender youth to go through the wrong puberty. They cite studies that find putting puberty on "pause" can be life-saving for trans youth.
- "The [High Court's] decision will force some transgender youth to go through a puberty that does not match their gender identity when that could have been avoided," Dr. Joshua D. Safer told Insider.
- Visit Insider's homepage for more stories.
The UK High Court ruled transgender children under the age of 16 are "unlikely to be able to give informed consent" to receive gender-affirming treatments such as puberty blockers and hormone replacement therapy (HRT) on December 1.
Following the verdict, the Tavistock and Portman NHS trust, the UK's only gender identity clinic for youth, has stopped any new referrals of hormone blockers or HRT for children under 16 years of age.
Doctors and lawyers told Insider that this verdict that this won't simply impact transgender youth in the UK. It's likely to set a precedent worldwide as the issue of transgender rights — including access to gender-affirming care — becomes an increasingly mainstream conversation globally, including in the US.
Their concern, they said, is that in the UK and beyond, children questioning their gender identity will have no choice but to go through a puberty they don't want, which can be a traumatic experience.
Doctors from the Endocrine Society and Pediatric Endocrine Society drafted a paper listing the possible dangers of preventing trans youth from obtaining gender-affirming care, warning that this care can be life-saving.
"Barring gender-affirming medical and surgical care for transgender and gender diverse individuals would force many to go through distressing and even traumatic experiences in life related to misgendering," Dr. Sean J. Iwamoto, senior author and Co-Chair of the Endocrine Society's Transgender Research and Medicine Special Interest Group, wrote in the paper.
The ruling came after a woman who 'de-transitioned' sued the NHS for prescribing her hormone blockers without guidance
The verdict came after Keira Bell, a 23-year-old woman who de-transitioned after receiving gender-affirming care, sued the Tavistock and Portman NHS trust for allowing her to take hormone blockers at 16 years old, and later testosterone.
Bell came to regret receiving gender-affirming procedures to treat the gender dysphoria she felt in her youth.
In a witness statement, Bell said the treatments left her with "no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered." She says she was not given proper guidance from her doctors and counselors at Tavistock.
"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," Bell said.
Puberty blockers do not cause permanent changes and are often prescribed the trans youth under 16 rather than HRT
Puberty blockers are a kind of gender-affirming treatment used to pause puberty for adolescents questioning their gender by blocking secondary sex characteristics like breasts and body hair from developing.
Hormone replacement therapy (HRT) can lead to permanent changes such as a deeper voice and facial hair for those who take testosterone and breast development for those who take estrogen.
According to the Endocrine Society and Pediatric Endocrine Society's Clinical Practice Guideline on transgender medicine, puberty blockers should be prescribed to adolescents questioning their gender because their effects are not permanent.
HRT is only prescribed once a child has proven they can give informed consent to treatments with permanent changes like HRT or surgical intervention.
"The reason that most adolescents who take puberty blockers go on to hormone therapy is that most of the adolescents who are treated with puberty blockers in careful, conservative systems including the UK transgender clinic are correctly identified and are genuinely interested in more gender-affirming care as they age," Dr. Joshua D. Safer, coauthor of the guidelines, told Insider.
Advocates of similar bans on gender-affirming care for trans youth argue they are 'too young' to understand their gender
Bell's attorney Jeremy Hyam QC argued "nobody could sensibly think that a child of 13 or under who cannot in law give valid consent to sexual acts could possibly give informed consent to treatment of dubious benefits and lifelong consequences."
Similar arguments have been made in the US as various state legislators have attempted to pass similar bans on hormone blockers and HRT for trans youth on the basis that they are too young to understand their gender.
The largest study of trans youth to date found otherwise. The November 2019 study published in PNAS found trans youth develop their gender identity around the ages of three to four, similarly to their cisgender peers when they are in trans supportive environments.
A wealth of studies link gender-affirming care to saving lives
Numerous studies have shown gender-affirming care can reduce depression, anxiety, and suicidal thoughts in trans youth. According to a September study published in Pediatrics, transgender youth are less likely to suffer depression and suicidal ideations the earlier they have access to gender-affirming care like puberty blockers and HRT.
This is because going through puberty of a gender a child does not identify as can lead to increased gender dysphoria, the distress that comes with one's body not matching their gender. Experts argue growing hips, breasts, body hair, a deeper voice, and developing a mental cycle can be traumatic for trans youth.
"The [High Court's] decision will force some transgender youth to go through a puberty that does not match their gender identity when that could have been avoided," Safer said. "In addition to the unnecessary psychological harm, the puberty will include permanent changes which will then have to be reversed with surgery."
When trans people are unable to receive gender-affirming care, they are often driven to seek it out in less safe spaces. A November study published in the Annals of Family Medicine found one in 10 trans Americans get HRT from the "grey market."
Parents and trans advocates worry what the verdict will mean for trans youth everywhere
As the NHS appeals the ruling, trans youth in the UK are not sure what this means for their care. A clinician at GIDS told iNews treatment of young trans people has effectively stopped since the ruling.
Parents of trans children like Emma Williams are worried their children will enter puberty before the decision is lifted.
Williams' daughter, Emily, is 13 years old and transgender. She was meant to start hormones in December but was barred from doing so after the High Court's decision.
"Her body is changing, a body she already struggles to live in, so her now not getting to access blockers is a terrible blow," Williams wrote in a GoFundMe. "Without access to blockers I don't think she will make it through the next few years."
Safer told Insider the UK ruling could impact trans children in the US, whether it be through policy or attitudes towards trans youth.
"If other jurisdictions followed the UK court precedent, youth elsewhere would suffer the same harms as youth in the UK," Safer told Insider.
Even if that does not happen, the lobbying efforts to limit care for trans youth are fueling transphobic sentiments globally. "Discrimination against transgender people and attempts to disrupt healthcare will still be a source of much stress," Safer said.
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