A British court will rule on Tuesday whether children aged 17 and under will need a judge’s approval to take puberty-blocking drugs in a landmark case that comes amid a global debate about the age at which a child can choose to transition gender.
Lawyers for Keira Bell, 23, who took puberty blockers at 16, argued that under-18s cannot understand the drugs’ consequences in the case against the Tavistock & Portman NHS Foundation Trust, which runs England’s only youth gender identity clinic.
Bell, who “destransitioned” in her early 20s and now lives as a woman, fears the treatment may have damaged her ability to have children.
The case comes as increasing numbers of adolescents globally seek to change gender, dividing those who fear doctors are too hasty in prescribing puberty blockers and cross-sex hormones and those worried about access to medication they deem life-saving.
Courts and lawmakers from Canada and the United States to Mexico and Brazil are having to answer questions about parental rights and the age at which someone can make medical decisions.
“It’s to make sure that these young people get a really good thorough assessment,” said Susan Evans, a psychiatric nurse who worked for the Tavistock for about three years at the gender clinic in the mid-2000s, and originally launched the case.
“It’s only out of care and concern and clinical experience that I followed this through,” Evans, who stepped down from the case when Bell joined, told the Thomson Reuters Foundation.
The case at the Royal Courts of Justice has become a lightning rod for concerns about a nearly 30-fold rise in child referrals to the clinic in the past decade, to 2,560 last year.
The loser is likely to take the issue to the Supreme Court.
Lui Asquith, legal director of Mermaids, an advocacy group supporting trans children, said the ramifications were “huge”.
“Puberty blockers have been saving lives for many transgender young people for a significant period of time,” Asquith said by email.
“Not all trans young people require medical intervention, but those who do should be able to access it, without discrimination.”
The World Professional Association for Transgender Health, a global body of doctors specialised in treating trans people, says puberty blockers may prevent the negative mental impact of gender dysphoria in puberty.
It described them as “fully reversible” but acknowledged concerns about possible impacts on bone development and height.
Currently in Britain under a 1985 court ruling, children under the age of 16 can consent to medical treatment if they are deemed to understand and fully appreciate the implications, in what is known at the Gillick competence test.
Opponents of puberty blockers said they wanted to make sure adolescents understood the drugs’ long-term consequences.
“Many of us do things as adolescents which we later regret, but not many have irreversible, lifelong consequences,” said Paul Conrathe, a lawyer for Bell.
“It’s not a culture war case. It’s a case about children.”
The age at which someone can choose to transition is fuelling a controversial debate globally.
In Canada a mother is fighting a legal battle to stop her 17-year-old child undergoing a double mastectomy, while a court in British Columbia in January ruled against a father who tried to stop his 15-year-old from treatment to transition to male.
A 2019 battle in Texas between two parents over the gender identity of their child led some state legislators to propose bans on prescribing puberty blockers and cross-sex hormones, with bills under consideration in Texas and Alabama.
In January, Brazil lowered the age requirement for hormone therapy from 18 to 16 – although under-18s must have the consent of a parent or guardian – while Mexico last year said children should be able to access puberty blockers.