A decision today in the High Court could have serious implications for children struggling with gender dysphoria, but it may also represent a turning point in the wider trans conversation.
Keira Bell is now 23 and lives as a woman. She was born female, but as a teenager wanted to become a boy and was given puberty blockers at the age of 15 after being referred to the Tavistock clinic in London. At the age of 17 she received cross-sex hormones and at 20 had a double mastectomy. She has now de-transitioned.
Lawyers representing Ms Bell, and Mrs A, whose autistic child is currently on the waiting list for treatment at Tavistock, argued that children going through puberty were not capable of properly understanding the nature and effects of puberty blockers.
In a landmark ruling, the court concluded that there will be “enormous difficulties in a child under 16 understanding and weighing up this information and deciding whether to consent to the use of puberty blocking medication. 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 judgment noted that young persons aged 16 and over, were legally presumed to be able to consent to medical treatment. However, given the long-term consequences of the clinical interventions and given that the treatment is innovative and experimental, the court recognised that clinicians may well regard these as cases where the authorisation of the court should be sought before starting treatment with puberty blocking drugs.
The court also noted its surprise at the lack of data and analysis by the Gender Identity Development Service at Tavistock on whether patients had Autistic Spectrum Disorder or a mental health diagnosis and whether they progressed to cross sex hormones. The lack of evidence base for the treatment of children was striking.
There is little doubt that this ruling will have significant implications for the Tavistock clinic and its current treatment practices. In a submission to the court Bell said she had been left with “no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered”. She had to live with the fact that if she had children in the future, she would not be able to breastfeed. “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,” she said.
Prior to the ruling Professor Michael Biggs, a professor of sociology at Oxford, said: “If Keira won, this would have an effect all around the English speaking world. It would be a very significant ruling.” She has now won and we await the full implications.
Those who experience gender dysphoria will continue to need treatment. They will need help and support to navigate a medical condition in what has become an ideological battleground. Children must be treated as children, rather than pawns in a culture war. Medics, therapists and counsellors should be free to work in the best interests of the child - affirmation should not be the only treatment plan for gender dysphoria.
Engagement with these issues requires compassionate, nuanced and often complex conversations. However, as a society, we must reflect on how we reached the point where it required court action to stop children receiving ‘innovative and experimental’ treatments without proper scrutiny or assessment. Hopefully, this decision clears the ground for a deeper, more informed conversation on understanding transgender in our rapidly changing culture.
Peter Lynas is the UK director of the Evangelical Alliance, a former barrister, and the author of Transformed, which aims to cover many of the issues raised in this case from a biblical and pastoral perspective