Puberty blockers and consent to treatment: an analysis of the High Court’s ruling

The experimental nature and potential lifelong consequences of puberty-suppressing medication led judges to conclude that the courts must sanction its use for children with gender dysphoria, says Michelle Janas

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Michelle Janas (PhD) trained as an immunologist and worked in research and experimental medicine for 20 years. She recently embarked on a career change into social work. This article was updated on 19 January 2021. 

On 1 December, a landmark judgment was delivered in the case of Bell & Anor v The Tavistock And Portman NHS Foundation Trust [2020] EWHC 3274. The High Court was asked to determine whether children experiencing gender dysphoria could give informed consent to receive puberty-suppressing drugs, by achieving Gillick competence.

The court found that competence to consent to such treatment was “highly unlikely” for 13-year-olds and “very doubtful” for those aged 14 or 15. While consent can be presumed for young people aged 16 and 17, medical professionals may want to seek court approval before treatment if there are doubts as to whether it would be in the young person’s long-term best interests.

The Tavistock and the two NHS trusts who administer the treatment appeal have been granted leave to appeal by the Court of Appeal and so implementation will be deferred until the appeal is decided.

Referrals ceased for under-16s

However, on the day of the judgment, NHS England, which commissions the Tavistock’s Gender Identity Development Service (GIDS), ordered it to cease referring patients under 16 to paediatric endocrinology clinics for puberty blockers unless a ‘best interests’ order for the child in favour of the treatment has been made.

It also ordered GIDS to review all current patients under 16 it had referred for puberty blockers, with lead clinicians either making a best interests application to the courts to determine what should happen or safely withdrawing treatment.

Although NHS England has commissioned a full review of services for children and young people experiencing issues with their gender identity, for the foreseeable future such medical treatment via the GIDS clinic will not be an option for children under 16 without a court order.

This is an important judgment for social work. GIDS provides social work support and also liaises with social workers already working with the children referred to it, while many practitioners work with children with gender identity issues.

‘An experimental treatment with potentially lifelong consequences’

There were two factors that combined to play key roles in this decision: that the treatment is experimental in nature and, because of this, there are unknown and potentially profound lifelong consequences that a child will struggle to comprehend for their adult self.

In this article I will refer directly to the judgment throughout and attempt to outline why the treatment was determined to be experimental, and how the experimental classification impacted on the ruling of competence. I draw upon my 20 years of experience in working in research medicine and early-stage clinical trials, as well as my interest in the ethics of social science research, which I have written about previously.

Puberty blockers (PBs) are formally known as gonadotropin-releasing hormone agonists (GnRHas). This is important as this medication was originally developed for a different use to how it was being prescribed at GIDS. These drugs act by supressing the release of the sex hormones and are typically used to treat prostate cancer and breast cancer, and to assist in fertility treatments in women.  Controversially, GnRHas are sometimes used to chemically castrate male sex offenders in other countries.

In children, these drugs are used to treat a very rare condition called precocious puberty, in which puberty occurs early at around the age of six. GnRHas halt this premature puberty until the child has reached the appropriate developmental age of around 12 – hence the name ‘puberty blockers’.

The diagnosis of gender dysphoria in itself is somewhat contested, but one which the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines as a “difference between one’s experienced gender and assigned gender, and significant distress or problems functioning”.

GnRHas were being prescribed by GIDS as an ‘off-label’ treatment – meaning the medication is not being used for its licensed purpose – to treat gender dysphoria in adolescent children after the commencement of normally timed puberty. Off-label use of medication is relatively common, particularly for paediatric populations. The caveat, however, is that there should be justifiable scientific evidence that the treatment is safe and beneficial for the patient. The safety data here is paramount, as it helps prevent catastrophic unintended consequences of untested medications, as seen in the thalidomide scandal of the 1950s.

A lack of evidence

The court found that for PBs, the evidence for safety and efficacy was lacking. Indeed, the judges found the absence of data on the age distribution of patients (until 2019-20), the proportion of children referred to it for the treatment with an ASD diagnosis and the percentage who move on to take cross-sex hormones “surprising”.

Also, an interim report from a GIDS Early Intervention Study (which commenced in 2011) concluded that for 44 young people who received pubertal suppression, “there was no overall improvement in mood or psychological wellbeing using standardized psychological measures” (para 73).

The judges also noted an incongruence between the GIDS claim that puberty blockers were “fully reversible” and other evidence, including the NHS website’s section on the treatment of gender dysphoria, which states, “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria” (para 67).

Therefore, due to the lack of both safety and efficacy data on the use on GnHRas for gender dysphoria, the court has considered the treatment to be experimental in nature.

For experimental medicines to become licensed, they need to progress through a strictly defined series of clinical trials, starting from small-scale safety studies and then increasing in size and complexity as the efficacy of the treatment is tested. The design of the studies is agreed in advance, including all the data to be collected, and the patients are carefully monitored. It is an issue which is currently writ large in the public imagination, as we watch the Covid vaccine make its way through these hurdles. To date, GIDS has been unable to produce data from the types of clinical trials that would set puberty blockers along the road to licensing for gender dysphoria. But it has also not produced sufficient scientific evidence to justify their use as off-label medication.

Gillick competence

The court stated explicitly that it was not addressing whether the use of PBs for gender dysphoria was effective, but whether a child could consent to such experimental treatment. Two key issues were defined by the court: whether Gillick competence could be achieved and whether the information being given was adequate (to enable Gillick competence).

Gillick competence is the legal test, in which a minor can consent to surgical, medical or dental treatment in the absence of a parent or guardian. The child needs to show “sufficient maturity to understand what is involved “ (Lord Scarman, 1986). Whilst case law has made clear that the child does not need to comprehend “all the peripheral detail”, they do need to be “able to demonstrate sufficient understanding of the salient facts” (Cobb J, 2019).

It is important to note that the demonstration of Gillick competence is crucial for these children, as GIDS guidelines state that although the parents or guardian must also be in agreement, they cannot give consent on behalf of the child.

The judges considered both evidence presented and case law, and as it is not within my expertise to cover them all, (Marina Wheeler QC gives a neat summary). I will instead restrict myself to medical aspects. One of the pertinent pieces of medical information given in evidence was that practically all children (although, as stated above, GIDS could not give exact data) who started on puberty blockers progress to cross-sex hormone (CSH) treatment (testosterone for females and estrogen for males). Therefore, it was considered relevant by the court that a child was able to understand both the consequences of PBs and CSHs for Gillick competence.

The issues of “lifelong” and “life-changing” implications were raised throughout the judgment. These included the possibilities presented in evidence by GIDS regarding “uncertainty of apparent long-term physical consequences of puberty blocking on bone density, fertility, brain development and surgical options” (para 62).

Understanding future impact

The judgment cites several pieces of evidence regarding the court’s concerns on a child’s ability to understand the impact on future fertility and sexual relationships. This includes the GIDS testimony that for children these implications will always involve “some act of imagination” (para 122) and a witness statement from a 13-year-old trans boy who wrote, “I haven’t really thought about parenthood…I just have no idea what me in the future is going to think”. Also, Kiera Bell, who brought the legal challenge, stated in evidence, “It is only until recently that I have started to think about having children and if that is ever a possibility.”

In determining competence, the judgment states that a child must not only have sufficient understanding of the factors relevant to the present, but also be able to objectively weigh information relevant to the future (para 124). Thus, although a child might understand the concept of fertility loss, it is not the same as understanding how this might affect their adult life (para 139).

Induced sterility is a principal ethical dilemma in paediatric cancer medicine, as the treatments given for advanced or complex tumours can render a child infertile. However, as the treatment is usually a final life-saving option, sterility, although distressing, is perhaps considered acceptable. The court also refers to this to emphasise the gravity of these types of decisions by stating that “apart from life-saving treatment, there will be no more profound medical decisions for children than whether to start on this treatment pathway” (para 149), a statement which gives context to the court’s justification for the high bar it has set.

Therefore, although the court acknowledges that a lack of evidence in experimental medicine is not a barrier to competence per se, it is the combination of this with the potentially profound lifelong consequences that a child will struggle to comprehend that has led it to conclude that Gillick competence for a child under 16 is highly unlikely to be reached, no matter how much information and support is given.

This judgment also gives social work pause for thought. Social workers, by virtue of the profession, are interested in issues of social justice and welcome diversity and difference. However, just as for the medical profession, we do need to ensure that foremost, we do no harm.

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26 Responses to Puberty blockers and consent to treatment: an analysis of the High Court’s ruling

  1. Sal December 11, 2020 at 7:01 pm #

    As a social worker for 20 + years in child protection, I don’t think any child under the age of 18, should be given puberty blockers, nor be able to undergo gender re-assignment surgery. Children are still growing physically and emotionally, and puberty blockers have serious and lasting side affects. I fully support children being able to dress, identify, and play with whatever toy they want too, but let them be ‘children’, and allow them to come to their own conclusions naturally and over a long period of time, so they can make an informed and mature decision once they are an adult.

    • Jason M December 14, 2020 at 9:07 am #

      For a teenager with gender-dysphoria help may be needed to intervene with what happens ‘naturally’. That turn of phrase reminded me of debates over s28 back in the day.

      I have to say I am really not sure what a “mature decision” is! My son made decided at17 to take testosterone with a key part of his reasoning being ‘my future without any help to be who I feel is more uncertain’. Does that meet your test?

      Anyway, you have the issue in the wrong place, I think? Consent to treatment cannot be removed from the 16 year old, only the power of the NHS to offer it. If they change that due to lack of evidence of effectiveness, fair enough and I have no argument with the case made in Court in spite of my admiration for the GIDS professionals I have met. But ease off the moralising, please.

    • Anonymous December 14, 2020 at 5:11 pm #

      Agree with you Sal. I don’t think children under 18 yrs even older sometimes are able to make informed decisions that are in their beat interests..

  2. Andy December 12, 2020 at 8:16 pm #

    Some concerned professionals have faced extremely severe challenges to their employment status as a result of previously bringing up some of the issues highlighted in this judgement.
    Other commentators have stated this issue was ultimately destined for the courts and this judgement is likely to have some influence in other similar jurisdictions in Britain and beyond.
    It is disturbing to fully digest the fact that according to this court judgement, large numbers of professionals in this field have been implementing irreversible treatments on children without sound evidence. I cannot fathom the number times I have encountered the term “evidence based practice” over many years in social work.
    It is all the more disturbing that previous efforts to merely raise questions about this issue in any public forum have invariably and almost automatically been met with very harsh condemnatory attacks suggesting any number of deeply unacceptable social characteristics of the questionner.
    A knowledgeable observer will note that the inevitably protracted court process (which still remains open to any appropriate applicant and their parents/carers in this context) will be of such a significant duration that a young person is likely to have achieved maturity before its conclusion.
    It is important that additional support mechanisms are made available to children and their parents/carers who might otherwise have viewed this form of treatment as the best means of addressing their needs.

  3. Amrita Shar December 13, 2020 at 8:04 am #

    I would like to ask, then, for clarity, whether a social worker should be using a child’s preferred name and pronouns against the wishes of the parent(s). This could be perceived as an affirmative stance and as such nudging a child further down the path towards medical transition which may or may not be in that child’s best interests.

    • Jason M December 14, 2020 at 9:17 am #

      An ‘affirmative stance’? Surely any relationship starts with respect? When you have that, you can ask questions. Would you tell them ‘I will not be calling you X/Y because I should have no opinion on this matter that you probably feel in central to your identity”? How far would that get you? I have seen several of my trans son’s friends ‘experiment’ with this and make their own way back to their former gender, without anyone having to intervene, limit or control.

      And the decision about their ‘best interests’ is not yours to make. If anyone suggests the acceptance of identify really is harmful, which would be exceptional but not impossible, the approach to take would need discussion with all involved. No ‘stance’ needed, just good decisions.

  4. Bionic woman December 16, 2020 at 5:33 am #

    Kiera Bell said after the High Court tgat she did not receive the excellent standard of psychiatric care that she needed to really explore her gender dysphoria and identity issues prior to embarking on such a life changing course of action. The fact that she links the issues of her gender dysphoria with an underlying history of poor mental health cannot be ignored in terms of her ability to decide upon issues of gender, let alone making irreversible physical changes to her body. Doctors seem to be a law unto themselves and it has take a young person such as Kiera to bring them to task over it. This is disturbing; where were the checks and balances?

    We are facing a crisis in our mental health system with long waiting lists for CAMHS services. There is an explosion in the number of our children suffering from poor mental health reflected in the rising numbers of children presenting with depression, eating disorders, self-harm, suicide. Alongside this is the impact of social media, bullying, criminal and sexual exploitation which is out of control. The whole situation is going to spiral even further due to Covid.

    How many children, like Kiera, are in fact suffering with body dysphoria due to poor mental health that think that changing their gender could be a solution. When CAMHS and education and/or NHS counselling services cannot even offer basic help to children suffering with poor mental health, then how can children really grapple with such complex issues of gender identity? Without such help children cannot be left to decide upon such life changing issues?

    If you want to respect Children, perhaps you should start with making sure they are given the very best mental health services that they need, rather than the shambolic level of care that Kiera, and many other children receive. Perhaps for some children taking puberty blockers or undergoing physical surgery can at worst be a form of self harm. Without a thorough and very careful exploration of what is happening for the child, we fail to respect them.

  5. Suzanna December 16, 2020 at 11:36 am #

    I am confused, GIDS has social workers in its team and almost all young people referred to it have a social worker but the criticism is for the doctors only Bionic Woman? Social work is a mess precisely because it lacks self awareness let alone the ability to reflect on its its own failures.

    • Bionic woman December 16, 2020 at 9:23 pm #

      Psychiatric evaluation is essential prior to treatment and they are Doctors. S/Workers are not qualified to advise on or administer drugs & surgery. However, I’m not just criticising the doctors, as the inadequate mental health services is unacceptable and includes social workers.

  6. frasierfanclub1 December 16, 2020 at 2:18 pm #

    I know a 13 year old Looked After Child. From the age of around 4 he insisted that he was a girl. When he entered care and started at his new primary school he was allowed to socially transition, in that he wore girls clothes, wore his hair long and went by a girls name.

    He went to secondary school as a girl and his peers were unaware at the time.

    Then puberty hit. He resolved his dysphoria and now goes to school as a boy, terrified because the boys know that he identified as a girl. He plays the class clown for a sense of protection.

    This boy, like many that we work with experienced trauma, loss, rejection in early childhood. He is so angry at the moment that he was allowed to do what he wanted and feels let down by the adults in his life.

    What has not been spoken about much has been the sheer volume of girls identifying as trans during puberty, or the higher numbers of trans identified children and young people who have a diagnosis of ASD, underlying mental health difficulties, etc.

    • Amrita Shar December 18, 2020 at 11:20 pm #

      This story reinforces my belief that, post Keira Bell case, SWs and schools are the new front line – social transition being the first step. If you read the interview in Mail on Sunday with “Mrs A” co-claimant in this case she said that she knew that “…the Tavistock …. would have affirmed [my child’s] belief in being trans. I know that because by the third letter we had from the clinic, they were already referring to her by her chosen male pronouns, having never even met her.’ In her interview with Woman’s Hour the same parent said of CAHMS “their affirmation undermines my caution”. This new cohort of teenage girls have self-diagnosed via the internet, YouTube influencers and Reddit. If any of us took any one of the “Am I Trans?” Questionnaires available online then I guarantee you will also be trans. Would that be enough to convince you that you have in fact spent all your life so far in the wrong body? No, of course it would not. Why? Because you are not currently loathing the way your body is changing AND you have a fully developed pre-frontal cortex. Our guidelines tell us to show respect to these young people in order to gain trust. Surely we should do that by not lying to them – reinforcing their fantasy that they can change sex? Keira Bell said “Nobody questioned me enough. Nobody told me I could not be a boy”. She also acknowledged that if she had been challenged more she would have seen that as a test of her resolve and she would have fought even harder for what she wanted. Those of you who have read anything of cult psychology will recognise this behaviour. I have followed many stories of this new cohort of natal born females exhibiting Rapid Onset Gender Dysphoria. There are a number of common indicators – too many for it to be a mere coincidence. What stuns me is that with all the young people being referred to GIDS nobody there openly said anything about it. It seems most of the dissenters just voted with their feet.

      • Vicky December 24, 2020 at 2:01 pm #

        Rapid Onset Gender Dysphoria is a myth. There is no evidence of its existence and most of the academic responses have been highly sceptical.

        The Keira Bell case is highly atypical, and most of the key decisions were made after she turned 16 years old.

        The job of social workers and schools is to safeguard children and this requires prioritising the interests and the views of the child over the biases and prejudices of uninformed adults.

  7. Jayston December 21, 2020 at 2:34 pm #

    Actually dissenters did not choose to vote with their feet, they were bullied and slanderd as transpobes and hetrocentric practitioners and driven out. GIDS is a middle class dominated fad driven cult. That of course makes me an unfit social worker in the new groupthink.

  8. Vicky December 24, 2020 at 1:56 pm #

    The ignorance in this article and these replies makes me worry for the future of this profession. As well as considering the consequences for the small amount of children who experience regret after transition, we also need to consider the consequences for the vast majority of children who do not experience regret but have now been denied potentially life-saving treatment because of a judgement based on a highly atypical case.

    The tone of this article and the comments below underline the fact that widespread training in transgender issues is needed in the sector. To read screeds from professionals who have clearly bought into hysterical anti-trans media stories is very disturbing.

    Puberty blockers are not “experimental” and there is plenty of evidence about their effectiveness in relation to trans children. Gillick competency cannot simply be suspended in cases where adults don’t children being able to make their own decisions – that’s the whole point of Gillick competency. Sometimes adults don’t make the best decisions for children.

    I’m also pretty shocked to see people in comments implying that a diagnosis of ASD makes a child less able to identify their own gender, or the implication that there is a pro-trans orthodoxy which social workers have to resist. When a community is constantly being slated in the media, that should tell you that the job of an anti-oppressive professional is to listen carefully to that community and boost their voices over those of self-appointed experts.

    • R December 27, 2020 at 6:56 pm #

      Thank you for being a voice of reason here.
      The ignorance that is being expressed of what transgender children and young people experience here is disturbing for my profession. Medical treatment (as well as social transition) can be vital for the mental health and wellbeing of many trans children and young people who experience gender dysphoria and, unlike the court and the author seem to be aware of here, has a wide international evidence base (see WPATH statement on this). This evidence base shows that puberty blockers and, if needed later, cross sex hormones are effective in improving the child/young person’s mental health.
      GIDS defended their practice and their research project very poorly in court and the court refused to hear from trans supportive organisations and other young people who have been treated by GIDS. The UK has a transphobia problem that few are aware of and which this case has effectively made social work’s business. In what other area of anti-oppressive practice would you take the views of the Mail on Sunday as accurate? There was research by Nathan Hudson-Sharp in 2018 stating clearly that social work is under-informed, poorly educated and can be discriminatory when it comes to working with trans children and young people.
      Community Care needs to be more careful that they are not fanning the flames of ignorance and hatred of trans people here.

      • Michelle Janas December 30, 2020 at 2:08 pm #

        Thank you for reading this article. I am grateful to Community Care for publishing it and allowing a space for these discussions to occur. I would like to address two points you raise.
        The World Professional Association for Transgender Health’s statement on Bell v. Tavistock refers to their own Standards of Care, however these have not been adopted by other professional bodies and are rather considered as guidelines. The Endocrine Society is an example of one such organisation. Further, on Dec 2nd the Tavistock released the preprint of the long-term study that had been requested by the court in which the results showed “no changes in psychological function” and reduced growth for height and bone-mass density for the 44 pediatric participants who had been treated by GIDS.
        With reference your assertion that the court refused to hear evidence from young people who have been treated by GIDS, a witness statement was given from a 13yo trans boy who had been on the GIDS waiting list but was subsequently treated by GenderGP. I quote from his statement in the article. The court also heard evidence from J, a 20yo transgender man (para 85 in the judgement) and an 18yo trans women (para 88), both of whom had been treated with GnRAs.
        You mention that Community Care should be more careful that they are not ‘fanning the flames of ignorance’, however I believe that I have been diligent and thorough in my background research and in the reading of this judgement.

      • And December 31, 2020 at 12:42 pm #

        When we start talking about anti-oppressive practice we should note that gender itself is a mechanism for men (The patriarchy) to oppress women and other men.

        Rather than encouraging children to accept this oppressive system and be pathologized we should be encouraging them to understand how regressive gender stereotypes makes most of us ill at ease. Current gender structures are indicative of the sickness in our society Sadly the approach of some practitioners is just to affirm the oppressive patriarchal framework by encouraging children to be pathologized and transition within the framework.

    • Maggie Mellon December 31, 2020 at 5:30 pm #

      You have no evidence at all to assert that the majority have no regrets – there is no follow up of the children after they leave the children’s service, no data. Thanks to the evidence set out in the higher court ruling we do know that puberty blockers are not a pause, they are not reversible and that there is no evidence that they alrbuate children’s distress in anything but the short term. There is evidence that fear of homosexuality in their children worried lots of patents – such as Susie Green of Mermaids who openly disclosed her husbands rejection of her son as a non gender confirming child. Read the judgement

  9. Sarah Phillimore December 29, 2020 at 10:55 pm #

    I have a question for Vicky. Is it just this court judgment that you refuse to follow or does this arrogant disdain for court decisions influence all of your practice? A court has made a ruling after careful consideration of the evidence (or lack of it) presented to them. I could give you, sadly, many examples of cases where social workers were rightly criticised for their failure to obey the law – or even apparently to recognise it.

    You are not above the law and you do not get to pick and chose which court decisions you follow. To set yourself up as the arbiter in this or any other field, is a betrayal of your profession and what it should stand for.

    I hope you can read the judgment again, reflect and reconsider. Unless and until it is appealed, it is the law, it is setting a clear benchmark for child safeguarding and you, of all the professions, ought to respect that. That you apparently cannot makes me very worried about the standards of training and critical analysis for social workers.

    • Vicky Hall December 31, 2020 at 11:34 am #

      It is not a case of “refusing to follow” a court judgement. I am a social worker and it is not up to me whether health services prescribe puberty blockers or not. The fact you’re accusing me of flouting the law suggests you don’t really understand the context of this judgement. Policy on prescribing hormone blockers is determined by the government, who have adjusted their policy in response to this case. It is not something I can obey or disobey, it is completely out of my hands.

      However, I retain the right to be critical of a highly flawed court decision and to advocate for transgender young people against a backdrop of unrelenting bigotry that is highly reminiscent of the homophobia that preceded Section 28 in the 1980s.

      I am not obliged as a social worker to agree that every decision made by a court is a good one.

      • Sarah Phillimore January 4, 2021 at 4:29 pm #

        But you are obliged to follow court rulings. You explicitly stated that the treatment path of the Tavistock was not experimental. The High Court found it was. So I ask you again – do you pick and chose the court rulings by which you are bound?

        I do not care if you ‘agree’ with the law. I care that you follow it.

    • Robin Sen January 3, 2021 at 3:44 pm #

      The court arrived at a ruling but social workers, and others, can raise questions about it. Have you never voiced public criticisms of a court judgment? Have you never voiced public concerns about the operation of the law? Just because you strongly approve of this judgment, Sarah, does not mean others cannot legitimately dissent.

      I do not agree with all that Vicky writes, but she is well within her rights to criticise a ruling with which she strongly disagrees. I do not think equating criticism- even trenchant-of a court judgment with an unwillingness to abide by the law is at all helpful, not least on a topic where much greater discussion is needed.

      • Sarah Phillimore January 4, 2021 at 4:30 pm #

        So when Vicky enters a household where a child is transitioning, she will disregard what a court says about the experimental nature of the treatment proposed and substitute her own judgment instead?

        Social workers like this may put children at risk of harm but they at least liven up my job in cross examination, so thank you for that at least.

        • Robin Sen January 5, 2021 at 4:26 pm #

          Well Sarah, we would do well to remember that this here is not a cross-examination but a comments forum, the primary purpose of which is to allow those in the social work and social care sector to express opinions, and debate them. I saw on Twitter that you had welcomed social workers discussing and debating this issue in this very forum. That appears to have been before a few comments were made in it with which you do not agree. It seems then that you are encouraging of social workers expressing their views on this topic, but only if their views broadly accord with your own. Such an approach to ‘debate’ is not going to help move us forward.

          You are a well-informed and fierce advocate for the positions you hold and there is a time and a place for the kind of combative approach you typically adopt. However, I do not believe that time and place is here or indeed that you are well placed to moderate discussion of this sensitive, complex and charged issue in my profession more generally. Your past comments towards/about trans people have sometimes been inflammatory and pejorative. For instance, you have referred to gender reassignment surgery as ‘mutilation’, and you are closely associated with a group who vindictively Tweeted from their account with a hashtag ‘SayYesToHate’ on Trans Day of Remembrance last year. That kind of discourse is not positively productive or kind. It is not a discourse capable of allowing, far less encouraging, what my profession most needs on this issue at this time – a dialogue generating more light than heat.

          • Sarah Phillimore January 8, 2021 at 5:41 pm #

            There is no legal or moral obligation upon me to ‘be kind’ – particularly not when I see the rights of women and the safety of children trampled upon.

            You seem to miss a fundamental point here. Vicky is not merely ‘disagreeing’ with the judgment. She is stating that it is invalid. She is substituting her opinion about treatment, saying explicitly that puberty blockers are not ‘experimental’ for the ruling of the High Court that they are. I repeat: unless and until that ruling is appealed or varied, Vicky – and every other social worker – is bound by it.

            I can quite understand that my ‘combative’ position sits uneasily with the gentle world of polite discussion that you inhabit. I make no apology for that. Because the attitudes of social workers and their understanding and application of the law are hugely significant for parents and children who are at the sharp end of this highly imbalanced relationship of power. They do not want you to be ‘kind’. They want you to be fair. And to obey the law, just as they have to.

            You can debate all you wish about ‘heat’ and ‘light’ – but if I am instructed to represent the best interests of a parent in a case where the social worker is displaying this kind of disdain for the actual law – I am afraid they had better be ready and willing to face me at my most combative.

  10. Bionic woman January 1, 2021 at 10:22 am #

    The high court decision was based on scientific facts about the medical uses of hormone blockers. Clearly qualified social workers and doctors are struggling with the information, let alone children and young people.

    Vicky (& R) when you say Keira Bell’s case is atypical, I’d like to know what research you are using to support your opinions. An article in the Medical and Life Sciences News points to there being a lack of research. The article is about Charlie Evans who regrets becoming a trans man and says many other people have contacted her, as they regret transitioning. These are just a few cases in the media. One woman I know about, not reported, had hormone blockers and a double mastectomy, but later decided she was not a trans man and detransitioned to live as a lesbian. So how does transphobia take priority over homophobia? In her case the lack of adequate psych/sw evaluation led to her making a decision that had major consequences; how does that uphold her equality rights? Or was it poor medical decisions based on inadequate services? Or is it major decisions being left prematurely to young people who lack the maturity to decide, let alone have adequate medical knowledge and advice? Or a combination of these factors?

    Please see article in the medical and life sciences news on http://www.news-medical.net called, ‘Hundreds of trans people regret changing their gender, says trans activist”

    Presumably Keira Bell and Charlie Evans cannot be simplistically accused of being transphobic? Or is it convenient to call anyone who upholds their experiences and the high court decision a transphobe or do you simply dismiss the rights of one marginalised group in favour of another? And how do you get to decide?