Giving puberty blockers to transgender teenagers with gender dysphoria “reduces suicidal ideation”, London’s High Court heard today.
On the second day of a landmark legal fight over trans teens access to healthcare, the court was told about the benefits of puberty blockers to trans youth “distressed” by gender dysphoria.
John McKendrick QC, barrister for University College London Hospitals (UCLH) NHS Trust, which prescribes the medication to trans teens referred by the Tavistock’s gender clinic for young trans people, told the High Court today that puberty blockers are a successful treatment.
“The whole purpose of NHS England commissioning this service is to reduce the suicidal ideation and distress caused by gender dysphoria in young people,” McKendrick said. “And that has been achieved. We are treating distressed and vulnerable young people.”
He added that UCLH have been prescribing puberty blockers for trans teens since 2006, while the Leeds Teaching Hospitals NHS Trust has been doing so since 2013.
“They have treated hundreds of distressed children and adolescents,” McKendrick continued. “And they’ve gone through the process, and it is their view that the intervention may, and often does, alleviate the distress of the dysphoria.”
“Experienced endocrinologists see the benefits to the cohort of people that they treat. They are not providing puberty blockers to children and adolescents for no good reason.”
The judicial review into the prescribing of puberty blockers by the Tavistock and Portman NHS Trust, which provides specialised healthcare to trans people under the age of 18, has been brought by Keira Bell, 23, who took the medication at 16 but no longer identifies as trans, and Mrs A, who is trying to prevent her 16-year-old child taking puberty blockers.
Grilled by judges over whether trans teens can truly understand the effects of puberty blockers, Fenella Morris QC, barrister for the Tavistock, said that a young person with gender dysphoria “has particular insights into their experiences that a person not experiencing gender dysphoria won’t have”.
“There is an additional layer of scrutiny for patients under the age of 15,” she added. “While somebody is on puberty blockers what that does is alleviate immediate distress, which shouldn’t be belittled.”
“As the WPATH [World Professional Association of Transgender Healthcare] guidelines say: ‘Not providing puberty blockers is not a neutral act.’
“A decision not to give them is effectively a decision to continue distress when it might be alleviated. Puberty blockers allow more time for counselling and reflecting and life experience and time for decision making.”
She emphasised that the purpose of the puberty blockers, for the Tavistock, was to “alleviate distress” in gender dysphoric young trans people, and to give them time to think about future trans healthcare without the added burden of their body changing during puberty.
The waiting lists for treatment at the Tavistock’s gender clinic for young trans people, GIDS, is considerably longer than the recommended time of four months, Morris said.
Younger patients will have an average of 10 or 11 appointments at GIDS before they can be referred to an endocrinology service for hormone blockers, the court heard. Only young people with gender dysphoria are seen by GIDS, and only those capable of giving informed consent are referred for puberty blockers.
However, Jeremy Hyam QC, barrister for Bell and Mrs A, said that “the suggestion that these very young children can give informed consent is a fairytale”.
He said that trans youth who are prescribed puberty blockers by the Tavistock gender clinic are giving informed consent to “a basket of risks they can’t compute” and that they should be made to obtain a judge’s approval before being able to be prescribed the medication.
Claiming that they are not trying to prevent the medication being prescribed to trans youth, Hyam said that it would “protect the autonomy of these young children” for “the court to be the arbiter of whether appropriate care is given”.
“It should not be left to the doctors,” he said.
The judges have reserved their decision, which will be made in the coming months.