The travesty of Bell v. Tavistock

In the United Kingdom, transgender minors are treated by the Gender Identity Development Service, a part of the Tavistock and Portman NHS Trust. (GIDS is a part of NHS England, and its offices are all in England, but it treats trans minors from throughout the UK.) GIDS does not provide any surgical interventions, and patients under sixteen are only offered GnRH analogues, which prevent puberty. Until early this year, even this was only available to patients who were at least twelve years old, but that policy was changed to allow under-twelves who have begun puberty, and display Gillick competence (a longstanding standard for determining whether a person under the age of sixteen is able to consent to medical care), to stop it. (GIDS does not accept parental consent to prescribe GnRH analogues for patients who do not meet the Gillick standard.)

The use of GnRH analogues for puberty blocking is fairly well-studied. While the majority of research is on cis children experiencing precocious puberty, some studies have also been done on trans children (and trans adults who used GnRH analogues as children). Of course, as always, it is not totally risk-free — there is a chance of reduced bone density, as well as of episodes of physical discomfort — but this risk must be balanced against the harms of a gender-dysphoric puberty, both psychologically and in terms of later necessitating more invasive treatments to reverse its effects. Puberty blocking does not cause irreversible changes; the medication must be taken until starting hormone supplements, or puberty will simply continue as typical, though delayed.

Unfortunately, the High Court of Justice in England and Wales feels that three decades of helping trans children, and even longer helping cis children, simply isn’t enough evidence of the efficacy of puberty blocking. Bell v. Tavistock ([2020] EWHC 3274) was brought by Keira Bell, a GIDS patient who has since chosen to detransition, and by “Mrs A”, the mother of a fifteen-year-old trans boy. Ms Bell does not claim that GIDS in any way failed to inform her of the effects of puberty blockers; indeed, she specifically acknowledges that, before even being accepted as a GIDS patient, she was invited to consider whether such treatment was appropriate for her. Mrs A’s son is not on puberty blockers, is not a GIDS patient, and — because of the lack of parental support — would not be taken on as a GIDS patient. The Court also chose to allow a recognise hate group to join the case as an intervenor, accepting at face value their claim that they merely “provide information and resources”.

Of course, Ms Bell’s story is unfortunate. It is also rare. Even high estimates put transition regret rates at under 2%. Of those, most do not report that they were mistaken in their desire to transition, but instead that they could not continue facing problems like discrimination and community rejection, or even that they feel their transition was insufficient, leaving them feeling as though they were stuck in a limbo. (Ms Bell’s account to the court suggests that the latter may have been her own reason for detransitioning.)

The Court, regrettably, decided that children under the age of fourteen cannot be Gillick competent to understand the effects of puberty blocking, and that it is “very doubtful [but] there is a possibility” that a fourteen- or fifteen-year-old could. The Court did not, of course, consider that a person who is incapable of consenting to nothing happening must surely be incapable of consenting to something happening.

Such a decision can only come from a belief that being transgender is bad, and that any sort of protection for cis people — no matter how little — is worth any harm to trans people — no matter how much. GIDS helped hundreds of trans youth every year. Now, they are being forced to refuse treatment to needy patients, some of whom had already begun puberty blocking. While they do intend to appeal the ruling, even if the appeal is successful, untold harm will be caused while waiting for it to be heard and decided.

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