It argued against the high court ruling, saying it interfered with the ability of children to make decisions for themselves. It said the expert evidence presented against its practices was “partisan.”
The other claimant in the case was the mother of an unnamed teenage autistic girl waiting for treatment.
“A child experiencing gender distress needs time and support – not to be set on a medical pathway they may later regret,” said the claimant, identified in news reports only as Mrs. A.
In the past five years, the number of people referred to the Gender Identity Development Service has almost doubled. According to the service's website, there were 1,408 referrals in 2015-16 and 2,728 in 2019-20.
Alison Holt, social affairs correspondent for BBC News, said that the ruling has effectively “removed the courts from the decision-making process in all but the most difficult cases.”
In the December high court decision, the judges said that children under the age of 16 could only consent to puberty blockers if they were “competent to understand the nature of the treatment.” This includes “an understanding of the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life-changing consequences for a child.”
“It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”
The December decision said the clinical interventions are still “innovative and experimental.”
Puberty-suppressing drugs had been prescribed to children as young as 10 on the basis of informed consent. This is a fundamental principle of modern medicine in which a doctor informs a patient of potential risks before they agree to undergo medical treatment.
In March 2021, the High Court’s family division allowed parental consent to puberty blockers for children under 16, so long as safeguarding measures were considered.
In September 2020, before the first High Court ruling, the National Health Service had commissioned Dr. Hilary Cass to review its gender identity services, an NHS spokesman said. This review aimed to “to ensure the best model of safe and effective care is delivered.” The review will set “wide-ranging recommendations,” including the use of puberty blockers and “the many contested clinical issues identified by the court.”
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The review is not yet finished.
In March 2021, Sweden’s Karolinska University Hospital, which treats minors with gender dysphoria, said it would cease providing “puberty blocking” drugs or cross-sex hormones to children under the age of 16. It cited concerns about long-term effects of the drugs and hormone procedures, as well as questions about the fully informed consent of patients under the age of 16. Its statement cited the December 2020 decision against Tavistock. Children with gender dysphoria would still be able to receive psychological and psychiatric care, it said.
In October 2019, a Swedish investigative television show reported that the hospital performed double mastectomies on children as young as 14 years old.
Other critics of transition procedures have come forward. In a June 25 essay for Newsweek, New York woman Grace Lidinsky-Smith said she regrets going through gender transition surgery. She believed other factors motivated her decision to seek a gender transition.
Lidinsky-Smith is president of the Gender Care Consumer Advocacy Network. The organization lobbies against efforts legally to prohibit “trans care,” arguing instead for best practices and accountability for medical providers. She backs the standards of WPATH, the World Professional Association for Transgender Health, but laments that there is no requirement that these standards be followed.
Paul McHugh, psychiatry professor at the Johns Hopkins University School of Medicine, has criticized WPATH standards and purported gender transition protocols that progress from social transition, to medical interventions and to surgery. He says they lack evidence.