Autonomy and transgender young people

The High Court is currently dealing with a potentially ground-breaking case relating to the administration of puberty blockers to transgender young people.

The applicants seek to judicially review the Tavistock and Portman NHS Foundation Trust which runs the UK’s only NHS Gender Identity Development Service (NIDS), and NHS England. The review has been brought through a crowdfunding effort organised by a former nurse at the clinic and could potentially result in any trans child having to seek judicial approval before puberty blockers are prescribed.

Currently when a young person presents at the clinic, following clinical assessment and obviously with their consent, they can be offered puberty blockers which delay the onset of puberty. Blockers are often prescribed to children under the age of 16. For many trans teenagers, it is the onset of puberty which heightens their distress and their vulnerability, often leading to self-harm and suicidal thoughts.

One of the arguments for the prescribing of hormone blockers is that it allows the young person time to reach a final decision whilst allowing them to live in their chosen gender. There are already considerable delays for young people accessing such services in the UK. It is interesting to note that in the US, where services are not state funded, puberty blockers are commonly prescribed to much younger children.

Many adults who have transitioned will testify that the earlier hormone blockers are taken, the easier the emotional and indeed physical transition into adulthood in their preferred gender.

Parents who have been down this path with their children might well argue that, when a child presents with huge distress as to their gender identity, the prescription of blockers is preferable to the mental health trauma that their child would suffer if they had to go through puberty. For many families, hormone blockers are lifesaving as well as life enhancing.

The claimants in the current case argue that children are too young to give informed consent when receiving puberty blockers and that there is insufficient information as to their long term effects.

The judicial review raises additional issues which go to the very heart of what it is to be a young person, trans or otherwise. There is an argument that the case is not, in fact, about trans rights, but is addressing the autonomy of any young person to make decisions as to their own body and what medication they wish to take, following counselling and professional advice.

Young people are not prescribed blockers as a matter of course but following consultation with a multi-disciplinary team, including endocrinologists. Children are also prescribed similar hormones during childhood for a variety of other reasons unrelated to their gender identity.

It will be interesting to see the outcome of this case, and a review of the current procedure, along with clarity and demystification of the process, has to be welcomed. I would hope that the outcome gives confidence that young people will be listened to and their decision making respected.