High Court gives landmark ruling against puberty blockers

4 December 2020

Dr Carys Moseley comments on the recent judgment in the case of Keira Bell.

In a landmark ruling, the High Court in London ruled on Tuesday (1 December) that children under 16 cannot consent to puberty blocking drugs. It also recognised that clinicians may only want to refer 16 and 17-year olds for gender ‘treatment’ with the prior authorisation of the courts. The basis of this ruling was that judges determined that children must understand the nature of the treatment and its long-term effects first. The entire judgment can be read here.

The whistleblower, the concerned mother and the de-transitioner

The case had originally been brought by Susan Evans, a former psychotherapist at the Gender Identity and Development Service (GIDS), who blew the whistle on the tendency to rush children onto puberty blockers. She complained that they did not get enough psychotherapy. Evans had worked at the GIDS between 2004 and 2007 and became horrified at the fact that children as young as ten were being put on puberty blockers. She was joined as co-claimant by an anonymous mother of an autistic girl who was on the GIDS waiting list, known as Mrs A.

More recently they were joined by Keira Bell, a 23-year-old woman who had been given puberty blockers by the GIDS when she was 16, followed by testosterone and a double mastectomy to look like a man. Bell has now de-transitioned, anguished by the problems she experienced. Together they made the case that no child could truly give consent to puberty blockers as they could not truly understand the long-term implications, including the known great likelihood of being given cross-sex hormones and gender reassignment surgery. The effects of the latter are irreversible.

Long-term risks must be considered

The judges pulled no punches in making their decision. Working within the parameters of the law on children consenting to medical treatment, they said this:

“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.”

In a sign of the absolute seriousness pertaining to the case, the High Court refused the Tavistock and Portman NHS Foundation Trust’s application for permission to appeal the ruling. Now the Trust has until 22 December this year to apply directly to the Court of Appeal.

All referrals for puberty blockers stopped

As a result of the ruling, all referrals for puberty blockers in England and Wales are to be stopped. This includes private healthcare providers as well as NHS providers. Also included are referrals made from abroad where puberty blockers are administered in England and Wales. This is very important as it prevents people from contacting doctors and providers elsewhere in order to circumvent new restrictions.

The NHS made the following statement:

“We welcome the clarity which the court’s decision brings. The Tavistock have immediately suspended new referrals for puberty blockers and cross-sex hormones for the under-16s, which in future will only be permitted where a court specifically authorises it.”

Court surprise at lack of data analysis

No less than three times, the judges expressed their surprise at the lack of relevant data collection by the GIDS. First, the GIDS did not provide data on the age distribution of children treated with puberty blockers between 2011 and 2020. The data was available but had not been collated for each year. Some data was available for the year 2019-2020, but only because there had been a review of the work following a highly critical report by Dr David Bell.

Second, the GIDS did not provide the court with statistics it requested on the number or proportion of young people referred by GIDS for [puberty blockers] who had a diagnosis of Autistic Spectrum Disorder.” This is really rather extraordinary given that the GIDS admitted that this data would have been found on the records of individual patients. This information was required for legal reasons, namely, to determine how many patients found to be ‘Gillick competent’ (able to consent to puberty blockers) had Autistic Spectrum Disorders or mental health diagnoses.

Third, the court was very concerned that so many teenagers were known to progress from puberty blockers to cross-sex hormones. In other words, puberty blockers were not just being used to ‘pause puberty’, but more often than not, were a prelude to shutting it down altogether. Once again, the GIDS did not provide the relevant data to compare with figures from the Netherlands, where puberty blockers were first used.

“We find it surprising that GIDS did not obtain full data showing the figures and the proportion of those on puberty blockers who remain within GIDS and move on to cross-sex hormones. Although neither Dr Carmichael nor Professor Butler could give the equivalent figures in the United Kingdom to those from the Netherlands, the language used in their witness statements suggests that a similarly high proportion of children and young people in the United Kingdom move from PBs onto CSH.”

All this begs the question of why did the GIDS did not bother to collate the data when asked for it.

Tavistock disappointment shows bias

The Tavistock and Portman NHS Trust expressed its disappointment with the ruling on its website. However, its Q&A section on the implications claims its work is mainly ‘psycho-social’, which normally means treating gender through talking, not physical treatments.

“I am waiting to be seen / have just started an assessment at GIDS. If you can’t offer physical interventions, how can GIDS support patients?

The purpose of our service is, first and foremost, to support our patients and their families while gender identity is explored. It is important to remember that GIDS is largely a psycho-social service providing extensive support to children and young people facing issues pertaining to the development of their gender identity. This psycho-social support will remain of upmost importance and unchanged.”

If the Tavistock is mainly a psycho-social support service, why is it so disappointed with the ruling against puberty blockers? This raises serious questions about bias towards puberty blockers within the trust. It is an open secret that therapists working within the trust have disagreed amongst themselves for years on this topic.

Also telling is how on the same page the Tavistock recommends organisations to turn to for help at this time. This links to another GIDS page, which in turn links to a Tranzwiki page run by transgender charity GIRES. This includes a map of Britain divided into regions where you can find a list of local LGBT groups. There are no links to organisations critical of gender reassignment. GIRES has a long history of working alongside Mermaids. What this means is that nothing has changed at the GIDS. It is still favouring advice and support from transgender organisations.

Mermaids CEO says puberty is ‘torture’

In an interview on BBC Newsnight, Susie Green the CEO of transgender charity Mermaids described puberty as ‘torture’ (at 11: 54). On the one hand it would be reasonable to complain that the BBC gave so many more minutes of airtime to Susie Green than to Keira Bell. At the same time, letting Green talk for longer meant that she came up with the most outrageous statements possible – statements which show up transgender activism for the dangerous lunacy that it is.

Green was forced to admit on air that her claim that puberty blockers are ‘life-saving’ was based merely on anecdotal evidence. She pulled the stops out emotionally saying the ruling was ‘devastating’ and ‘catastrophic’. It is indeed – for Mermaids, Stonewall and the rest – and about time too. Having no solid scientific evidence for either puberty blockers being good for teenagers she had to resort to sheer hyperbole. In this respect she went even further than what the UN Independent Expert on Sexual Orientation and Gender Identity said in his report on ‘conversion therapy’ back in May. The UN expert only called psychotherapy for gender identity ‘torture’ – not puberty itself!

Implications of the judgment

The judgment has been hailed as a victory for those critical of puberty blockers as well as gender reassignment for minors. This is undoubtedly the case. The court was careful to restrict itself to asking questions that would enable it to decide whether children could offer valid consent to puberty blockers. It did not engage the question of whether puberty blockers should ever be used at all. That was deemed to be a question for clinicians. This opens up the question of alternative treatment for gender confusion.

As shown above, the GIDS appears biased towards puberty blockers, at least officially. This would be partly why so many therapists recently resigned in protest. Nevertheless, it is important and sobering to remember that these were only a minority from among the therapists. What has been shown up is the open secret, that therapists have never agreed amongst themselves about what is suitable treatment. Is it to be puberty blockers and cross-sex hormones, or talking therapy? And if the latter, what should its philosophical basis be?

Was GIDS talking therapy adequate?

Keira Bell was 16 when she went to the GIDS. She is now 23. This means she went there in 2014. This is relevant as we shall see below. She had an overwhelming sense as a teenager that she was meant to be a man. She said that she saw a psychiatrist at the GIDS. This psychiatrist allegedly tried to get her to see that gender ‘is a spectrum’. This was in order to challenge her belief in a purported male destiny. ‘Gender spectrum’ theory goes with the idea that people can be ‘non-binary’, neither male nor female socially and psychologically. This would hardly be an adequate solution to the problem as it denies reality. It is completely unsurprising that it failed to dissuade her. So why did the GIDS use it?

‘Gender spectrum’ theory was taught by Mermaids to teachers in a Church of England primary school recently, as a leaked audio recording shows. Susan Evans had complained that outside groups were influencing staff to give into teenage patients’ fantasies of being able to change gender. It is well-established that Mermaids always had a very close relationship with the GIDS, as acknowledged by its first head Dr Domenico Di Ceglie (see page 490 of his academic history of the GIDS, ‘Castaway’s Corner’). Did Mermaids influence the psychotherapy at the GIDS?

The effect of the ban on ‘conversion therapy’

The other problem that nobody is investigating is the timing in all this. Evans had raised concerns during the period 2004-2007. However the court was told that the number of GIDS referrals increased greatly after 2011. What the court was not told was that they coincided with the moves by the mental health professional bodies to ban ‘conversion therapy’ for same-sex attraction as well as normalising transgender identity in counselling. The UK Council for Psychotherapy issued a statement in 2010 on ‘reparative therapy of sexual minorities’. In 2012, the British Psychological Society published Guidelines on Working with Sexual and Gender Minority Clients. Note how gender identity confusion was put alongside same-sex attraction. This is relevant because it has been said that a number of the teenagers referred to the GIDS also had same-sex attraction.

In 2014 Health Minister Norman Lamb convened a round table on banning so-called ‘gay conversion therapy’ with representatives of professional bodies. Presentations were given by Professor Michael King, Dominic Davies, the CEO of Pink Therapy, and David Pink, the CEO of the UKCP. That meeting led to the drafting of the first version of the Memorandum of Understanding on Conversion Therapy in the UK. That prohibited therapists and counsellors from offering therapy that could diminish or change same-sex attraction. The same professional bodies that signed this Memorandum agreed to a second version in 2017, this time also prohibiting therapy that would prefer one gender identity over another. In other words, therapy that would truly address gender confusion. Marcus Evans, another GIDS whistleblower and former director, and husband to Susan Evans, recently criticised the Memorandum for the effect it has had on patient treatment. Now is a good time to revisit this ban on ‘conversion therapy’ and assess the damage it has done.

Good news for now

Overall, this ruling is very good news for vulnerable children and also for conscientious clinicians and parents, at least those who live in England and Wales. (Unfortunately the ruling will not affect the Sandyford Clinic in Glasgow, which prescribed puberty blockers to children in Scotland.) This is the end of a good year for conscientious objectors to transgender ideological capture of public policy. The government has acted to protect adults from easier gender change by refusing to reform the Gender Recognition Act in England and Wales. The Scottish Government has paused its own plans for similar reforms. Schools in England are now prohibited from telling children that they might be ‘born in the wrong body’, or from using organisations which promote this idea. However, activists working for the transgender cause are unabated in their zeal. For there to be real gains for children, families and conscientious professionals, all concerned must press on with the vision for ethical healthcare.

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