The UK High Court has ruled that puberty blockers are experimental, are not "fully reversible", and lack evidence of benefit. The ruling confirms Professor Heneghan's view of puberty suppression as an “unregulated live experiment on children”.
Updated 05-04-2021: In another case the UK High Court has ruled that parents can consent to puberty blockers in the absence of the child's consent. However, the Bell judgement still stands and GIDS have stated in court  that they “[could not] conceive of any situation where it would be appropriate to administer blockers on a patient without their consent”. Its unclear how this judgement will affect GIDs policy on puberty blockers. The text on this page has been modified to reflect the lack of clarity.
Following the ruling, the UK’s Gender Identity Development Service (GIDS) will no longer prescribe blockers to children aged 10-15 without a court order. Clinicians must also obtain a court order for children currently on blockers or halt treatment. For children aged 16-17, the High Court advises clinicians to consider a court order if there is any doubt about the child's understanding of long-term consequences of blockers and cross-sex hormones. GIDS will now provide psychosocial support.
The High Court heard testimony from former patients of GIDS, including claimant Keira Bell. Bell believes that clinicians did not offer her the appropriate psychological help and pathologised her gender nonconformity. Bell now lives with the consequences of blockers, testosterone, and a double mastectomy. Bell made a media statement outside the court that began as follows:
“I am delighted at the judgment of the court today. It was a judgment that will protect vulnerable young people. I wish that it had been made for me before I embarked on the devastating experiment of puberty blockers. My life would be very different today.”
“This time last year I joined this case with no hesitation, knowing what I knew about what had and has been going on at the gender identity clinic. My hope was that outside of the noise of the culture wars, the court would shine a light on this harmful experiment on vulnerable children and young people. These drugs seriously harmed me in more ways than one and they have harmed many more, particularly young girls and women.”
“This judgment is not political, it is about the protection of vulnerable children. Please read it carefully. It exposes a complacent and dangerous culture at the heart of the national centre responsible for treating children and young people with gender dysphoria.”
The full judgement is available online here.
The court also heard evidence for and against puberty suppression. Michael Biggs, one of the expert witnesses, has summarised the High Court's conclusions in this regard:
- Puberty blockers are not ‘fully reversible’.
- Puberty blockers do not ‘buy time’, they are the first stage of a medical pathway very few children come off.
- There is no evidence that puberty blockers alleviate distress.
- The pathway of blockers and cross-sex hormones has serious physical consequences, including the loss of fertility and full sexual function, with profound long-term risks and consequences.
- The treatment is experimental.
The ruling upheld the legal concept of "Gillick competence". Children aged under 16 lack the capacity to understand the consequences and are unlikely to be able to provide valid informed consent. The claimants also argued that clinicians failed to fully inform patients. The court ruled that the child's capacity to understand consequences precedes the question of adequate information.
The ruling follows the pattern from independent reviews. When authorities without conflicts of interest examine the evidence, they conclude that it has inadequate support. Reviews by Swedish and Finish health authorities found that inadequate evidence for blockers and cross-sex hormones. Other reviews have found low or very low evidence (Hembree et al., 2017), and that the medical literature had a high or medium risk of bias (Chew et al. 2018).
These findings and the High Court's ruling are in stark contrast with the liberalised puberty suppression recommendations in guidelines published by the University of Waikato (the “Waikato Guidelines”). The Waikato Guideline’s lead author, Dr Jeannie Oliphant has described puberty blockers as "the gold standard for young people." and claims that "we are using puberty blockers very freely up until about till about 20". The Waikato Guidelines cite a single study (Vries et al., 2014), the Waikato Guidelines state that "good evidence" supports puberty blockers. The lead author of that study now believes that clinicians may be prescribing puberty suppression to a population of young people who would not have met the original inclusion criteria. She believes psychosocial support may be more appropriate for this population (Vries, 2020).
Clinicians in New Zealand cannot claim to be following any kind of "gold standard" or clinical consensus.
Finland has restricted blockers to cases where it can be deemed medically necessary. Finland will instead offer psychosocial support. In Sweden, the number of children referred to gender clinics has declined markedly. The decline follows the broadcast of a documentary on the experiences of detransitioners,
Parents in the UK and Australia have had their child removed from their care because the parents did not consent to puberty blockers or cross-sex hormones. These parents now have a clear legal recourse. The presumption was that the child's removal from parental custody was in their best interest. In truth, parents' concerns were wholly justified. We expect further legal challenges and increased scrutiny.
New Zealand children have the right to not be subject to medical experimentation. Parents will become aware of the experimental nature of puberty blockers and look for non-medicalised alternatives. Health authorities must uphold the right to informed consent and provide psychosocial support. If you are the parent of a child undergoing or considering puberty suppression we recommend reading the ruling in full and contacting your child's doctor to discuss the implications.