I hope the courts make the right decision on puberty blockers

Eufemia Didonato

The landmark judgment due in the case of Keira Bell vs the Tavistock and Portman NHS Foundation Trust should come down to the meaning of two words: “Informed consent”. Did 23-year-old Bell “agree to the health intervention”, made by the NHS’s Gender Identity Development Service (GIDS), when they prescribed puberty […]

The landmark judgment due in the case of Keira Bell vs the Tavistock and Portman NHS Foundation Trust should come down to the meaning of two words: “Informed consent”.

Did 23-year-old Bell “agree to the health intervention”, made by the NHS’s Gender Identity Development Service (GIDS), when they prescribed puberty blockers to aid her transition to a male “based on an understanding of the benefits and risks involved”?

To answer that question, you need only know one fact: at the time of her “consent”, Bell was 16.

Six years after this gender non-conforming child thought she had found the answer after years of “hatred for my female body” and “low self-esteem”, Bell’s problems are far from over. And although the clinic has insisted that all their patients undergo a thorough assessment process, which was ongoing, Bell claims it took only three one-hour appointments for the self-described “tomboy” to be given puberty blockers; these delay the development of the signs of puberty such as breasts, periods or facial hair. Cross-sex hormones were administered next and, at 20, Bell had a double mastectomy.

Today, Bell has been left with “no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered”. She will have to live with the fact that, if she is able to have children in the future, she will not be able to breastfeed them. And all because of “a brash decision” she told the court she made as a teenager “trying to find confidence and happiness”.

Again, GIDS have defended their approach, maintaining they work closely with children and their families to reach the right decisions for them, with fewer than half of those seen going on to take puberty blockers or cross-sex hormones, and that comprehensive information is provided to all throughout the process. Only the issue isn’t that the Tavistock didn’t explain the risks – the possible bone density loss, compromised fertility, poorer cognitive function and reduced height, alongside the enduring psychological and emotional implications – but that a child is not able to understand those risks.

The absorption and processing of information, after all, comes not from a list of words reeled off a disclaimer or indeed from the cautionary advice put forward by adults, but from the life experience that Bell didn’t have – a life experience no 16-year-old can possibly possess.

“I feel I could say anything to my 16-year-old self and I might not necessarily listen at that time,” Bell has explained. “And that’s the point of this case: when you are that young you don’t really want to listen.” In other words, a child cannot give informed consent.

Fenella Morris QC, representing the trust, said in a written submission that young people were made fully aware of the impact of hormone blockers prior to treatment and were “given all the necessary and appropriate information – and very considerable support to assist them in their thought processes”.

So how did we get here? How did we get to a place where children as young as three are being encouraged to question their gender and – back in 2018 – a third of the children referred to the NHS’s only gender clinic for children since 2011 were revealed to be autistic? How can it be that, in the US, activists have been trying to ban Abigail Shrier’s new book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, simply because the Wall Street Journal writer is questioning why there has been a sudden surge in those presenting themselves as trans, and raising concerns about the mental health of teenage girls? Indeed, it’s considered “brave” of her publisher, Swift, to be going ahead with its UK publication next month.

The answer is fear. Too scared to question the knee-jerk reactions of a health system bent on intervention and terrified of being branded “transphobic”, we have let down children like Bell and the autistic 16-year-old daughter of another woman, “Mrs A” – who has joined her in her High Court challenge this week – with our silence.

Focussing on “detransitioners”  – those who wish they hadn’t had gender reassignment surgery – when trans people are still struggling for rightful acceptance and often face stigma, anger, disbelief and trolling online is problematic in itself. And yet Bell is not alone in her experience.

Over the past five years, an increasing number of women and men have shared similar stories only to be met by the same stigma, anger, disbelief and trolling; and if the High Court rules in Bell’s favour, it seems likely that more will come forward. Their experiences are as valid and important as the experiences of many who have found gender reassignment not just a deliverance but life-saving, and have never regretted their decision.

Which is why, if I were Bell’s lawyers, I would make this my closing statement. Take the word “trans” – with all the emotion and controversy attached to it – out of the equation for a moment. Set aside your ethical, political and religious beliefs and simply ask yourself this: when the Ministry of Health recommends that both body piercing studios and tattoo parlours should get parental consent before working on anyone under the age of 18 and when it is illegal for anyone under the age of 18 to gamble, buy cigarettes, alcohol, fireworks or pornography, should any child be encouraged and enabled to make a life-changing decision before reaching adulthood?

Read Celia Walden every Monday at 7pm on Telegraph.co.uk 

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