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Tavistock and Portman NHS Foundation Trust wins bid to overturn landmark ruling on puberty-blocking drugs

It is up to doctors to decide if someone aged under 16 can be prescribed puberty blockers without parental consent, the Court of Appeal has ruled.

The court said last year that people aged under 16 would have "enormous difficulties" understanding what the treatment's long term effects would be - and therefore could not consent to the treatment.

Puberty blockers can be used for treating gender dysphoria - when someone feels their biological sex and gender identity are mismatched.

The ruling was appealed by the Tavistock and Portman NHS Foundation Trust, which operates the only clinic for treating young people with gender dysphoria.

This initial case was brought by Keira Bell, who transitioned from female to male aged 16, before reverting her gender later in life.

The 24-year-old was prescribed hormone blockers and had her breasts surgically removed, but now says there was not enough investigation or therapy before the decision was made that she should transition.

Gender reassignment surgery is not available for children.

On Friday, the Court of Appeal deemed it was inappropriate for the High Court to give the guidance, saying it is up to doctors to make a judgement about whether their patients are able to properly consent.

Lord Chief Justice Lord Burnett, with Sir Geoffrey Vos and Lady Justice King, said: "The court was not in a position to generalise about the capability of persons of different ages to understand what is necessary for them to be competent to consent to the administration of puberty blockers."

They added that the court's decision placed patients, parents and clinicians in a "very difficult position".

During the case, the Tavistock's lawyers argued the previous case was "inconsistent" with the idea that young people may be able to consent to their own treatment.

This was established in 1985, when the Law Lords - the precursor to the Supreme Court - ruled that consent could be granted by a young person as soon as they "understood fully what is proposed" in a case about the prescription of contraception.

Ms Bell brought the initial case alongside the mother of a teenager who is on the waiting list for treatment.

Keira Bell said the care she received for gender dysphoria, a condition where a person experiences distress due to a mismatch between their biological sex and their gender identity, steered her towards medical treatment.

She is seeking permission to appeal the latest ruling to the Supreme Court.

In a statement after the ruling, Ms Bell said she was "disappointed" with the court's decision an it did not "grappled with the significant risk of harm that children are exposed to by being given powerful experimental drugs".

She added: "I am surprised and disappointed that the court was not concerned that children as young as 10 have been put on a pathway to sterilisation.

"I have no regrets in bringing this case along with Mrs A and Sue Evans. It has shone a light into the dark corners of a medical scandal that is harming children and harmed me.

"The case has acted as a catalyst for change."

She went on to explain during the course of the case, the NHS changed its advice to explain that puberty blockers are not fully reversible and it added an "extra layer of protection for children receiving treatment at the Tavistock".

"A global conversation has begun and has been shaped by this case", Ms Bell said.

"There is more to be done. It is a fantasy and deeply concerning that any doctor could believe a 10-year-old could consent to the loss of their fertility."

A Tavistock and Portman spokesperson said: "We welcome the Court of Appeal's judgment on behalf of the young people who require the Gender Identity Development Service (GIDS) and our dedicated staff.

"The judgment upholds established legal principles which respect the ability of our clinicians to engage actively and thoughtfully with our patients in decisions about their care and futures. It affirms that it is for doctors, not judges, to decide on the capacity of under-16s to consent to medical treatment.

"We recognise the work we do is complex and, working with our partners, we are committed to continue to improve the quality of care and decision making for our patients and to strengthen the evidence base in this developing area of care."