today
a major decision that will affect the
care of thousands of young people
questioning their gender identity the
high court ruled that children
under 16 are unlikely to be able to give
informed consent
to undergo treatment with puberty
blocking drugs
the case was brought by kiera bell who'd
been prescribed the drugs age 16
against london's tavistock and portman
trust
over the past 18 months newsnight has
reported on a series of concerns
raised about the trust's use of puberty
blockers
we've also reported on the challenges
some clinicians said they had
in raising questions about the care some
young people received at the trust's
gender identity development service
england's only nhs service for young
people questioning their gender identity
at the heart of today's ruling is the
role puberty blockers play
in a young person's treatment the court
found
there is real uncertainty over the short
and long term consequences of the
treatment
with very limited evidence as to its
efficacy
this means it is in our view properly
described as experimental treatment
but what is the purpose of the drugs the
tavistock and others
have long argued that puberty blockers
allow a young person
time to think about their gender
identity without the added distress of
going through puberty
but the judges questioned whether it was
that straightforward
the court also went further rejecting
the tavistock trust's argument
that the decision to take puberty
blockers was entirely
separate from the next stage of
transitioning the use of cross-sex
hormones
testosterone for girls or estrogen for
boys
the court said the evidence that we have
on this issue clearly shows that
practically all children and young
people who start puberty blockers
progress on to cross-sex hormones
so what does all this mean for informed
consent the available evidence suggests
that
starting puberty blockers would likely
mean a young person
would then go on to take cross-sex
hormones would a child
under the age of 16 fully understand the
implications of this on their bodies
in the long term in effect the court
said no
it said it was doubtful informed consent
was possible for under-16s
and even for those who were 16 or 17 it
would be appropriate to involve the
court
where there is any doubt treatment was
in their long-term best interests
there is no age-appropriate way to
explain to many of these children
what losing their fertility or full
sexual function may mean to them in
later years
in this ruling there are no winners as
of today there will be no new referrals
for puberty blockers for under-16s
from the gender identity development
service and
tonight news 9 has learned that jids
will have to review
all current cases of children under 16
who are on blockers and get a court
order
if they wish to continue treatment but
for the thousands of children
waiting to be seen by the clinic it's
unclear what help there will be for them
deb cohen with that report we asked the
tavistock trust to join us tonight
nobody there was available in a
statement
they said the trust is disappointed by
today's judgment and we understand the
outcome is likely to cause anxiety for
patients and their families
our first duty is to our patients
particularly those currently receiving
hormone blocking treatment
and we're working with our partners to
provide support for patients concerned
about the impact on their care it added
the trust seeking permission to appeal
the judgment will not be making new
referrals to endocrinology until we have
more clarity
joining me now is one of the claimants
in that case kyra bell
um who won the case today keira for
those who don't know you just outline
your own story for us briefly uh yes so
uh i was referred to the clinic at age
15
and i was seen from age 16 and i was put
on puberty blockers that same year
and onto testosterone the next year and
then i
went on to surgery through the adult
clinic just explain to us you suffered
gender dysphoria as a as a girl
yes and you felt that you you wanted to
transition to become a
man yeah yeah and then what happened
um so yeah when i when i first arrived
at the clinic you know
my belief you know that i was a boy or
you know that i should become a boy was
affirmed
um you know there was no investigation
into why i had those feelings
you know it was pretty much accepted
from the get-go and you know
yeah medical interventions were spoken
of quite quickly
so you went ahead you had you had the
blockers you had surgery
and then you decided that that wasn't
the right course for you
yeah yeah i'm just realizing i think
that a lot of it isn't based
in you know it doesn't have scientific
evidence behind it um you know and and
just realizing that
um you know it's not a healthy route to
go if you know i can
uh you know if i don't need to continue
on with it so i mean
it's it's incredibly personal it's very
sort of you specific but in your case
you felt that what they they had let you
have
access to the drugs too quickly
is that right and that you should have
been denied that because you you weren't
making
a sound judgment yeah yeah that's right
i was dealing with a lot of other
mental health issues also and you know a
lot of
past issues that hadn't been brought up
or again it wasn't investigated so um
yeah there's always a lot of issues
going on behind the scenes uh you know
definitely in my experience and i think
um you know with the
current kind of um you know trend that
we're seeing of young girls
being referred to the clinic i guess
this judgment
would stop them handing out the the
treatment
straight away or after a short amount of
counselling but if you
you know as an articulate young woman
went to the court and said i really mean
this and i'm serious about it
there's every chance that the court
would still have allowed you to do
something which you would
later regret isn't there um i i wouldn't
say so
um because you know they they would have
actually looked into
the reasons you know why i wanted to uh
proceed with the treatment and you know
i'm sure that the mental health issues
and everything that should have been
discovered at the tavistock would have
been
brought out in the courts there will be
thousands of young people tonight who
will be terrified
by this judgment as you know terrified
that this will stop them
living the life that they need to be
incredibly distressed because something
that didn't work for you
may still work and be very important to
them
yeah i mean i think when we're dealing
with the topic of mental health you know
obviously emotions will be running high
and i understand that you know
um i would have been in the same
position perhaps as you know
you know someone uh you know age 16 for
example
um you know listening to you know what
happened today
um but you know again the high court you
know they
they came to their decision you know
their their high tier judges
and you know they're looking you don't
worry about the kids now who i mean some
of them might
even have their current drug treatment
yeah
stopped do do you want them
yeah of course yeah i'm definitely
concerned about them and i completely
empathize with them um you know i think
that better mental health services
um need to be put in place uh to help
that that person through
you know the period that they're going
through um you know i think that's
that's the vital you know that's what
needs to happen because for every kiera
bell
there could be somebody who isn't
allowed
and wants to be allowed yeah yeah
absolutely but you know again
the high court you know they came to the
conclusion that it isn't possible for
you know
particularly under 16s to consent to
that treatment
uh you know and those protections are
put in place for a reason
cara bell thank you thank you very much
for coming in let's speak now to susie
green the ceo of mermaids a charity
which supports
transgender children and teenagers and
their parents
susie green nhs england have said
tonight that they welcome the clarity
that this judgment brings
and they have amended their service
specifications
even including those who are actually on
blockers
and they'll be reviewed starting
immediately
your response i think it's a disaster
quite frankly i think this is um
ushering a new era of discrimination
against trans people
nobody else has got this kind of
measures in terms of young people and
their autonomy over their own bodies it
is only young people who are trans who
are being subjected to this
and then i can't go into individual
instances because obviously that
would violate people's privacy but we've
seen today
the devastating impact that this
judgment is already having
and will continue to have over the next
few months and years to come
our helpline in our forums being swamped
by families and young people who are
personally impacted
and the inevitable rising self-harm of
suicide suicidality we are seeing is
worrying if you don't mind let's deal
with those
separately this is not as you'll know
it's not
denial all it does is put it back to the
courts to make the final decision
so they're not saying no one can have
this treatment they're just saying
we need to get this right we need an
extra level of
checking so we don't end up with a kind
of regret that you just heard a moment
ago from kira
yeah but you've got to appreciate that
that kira's experience
although obviously valid is not
representative of the vast majority of
people who go through this
process there's less than a one percent
regret
after transition are we saying that it's
so much better
not to be trans that will sacrifice the
happiness of those 99 trans young people
who need this treatment
i guess what we're saying is that the
court weighed up thousands of pages of
evidence they took
those views into account they heard from
young people
three kids patients who were submitted
by the tavistock
they've done their homework on this and
they think more protection
and more guidance for young people is
used with these highly unusual
innovative drugs that they know very
little about
these have been used for over three
decades this is not experimental
treatment not not not in this specific
way to start the transitioning process
which as you know it does
the dutch the dutch instigated this kind
of treatment
in the 1980s late 1980s this has been
used routinely
to treat gender dysphoria and to halt
puberty
for many many years this is not
experimental and there are
so many studies out there that show how
efficient this is
how much it helps young people how much
it um
helps them to live their lives this is
literally life-saving treatment that is
now
right well i'm not sure that you can say
it's life-saving
because we know that
any suicide is way too many but there
is no strong evidence to support that
this is either life-saving
or that this increases the risk of
suicide kid's own website
says thankfully suicide is extremely
rare so to say it is life-saving
is dangerous it's different territory i
don't think so not when this is
anecdotal this is what parents are
saying to us this is what families and
young people are saying to us that this
is literally something that they
desperately needed that their children
desperately needed that this is
something that literally saved their
lives so this is anecdotally from
parents
i've been working in this field for like
over 21 years because
um and i've seen literally thousands of
families and i have seen a difference
the positive difference that
access to puberty blockers gives to
young people that allows them to get on
and live their lives without the torture
that is puberty and having to and we
like without bear
is horrendous and this now is
is basically going to force potentially
thousands of young people to experience
that
i think it's different i wouldn't i
wouldn't for a moment contradict your
own experience or what you've heard from
young people because as we said a moment
ago
this is intensely personal and every
single person is different
but what the judges have said is that
the evidence base for the treatment is
highly
uncertain it's an experimental treatment
and even when i was speaking to the
tavistock
a year ago elizabeth van horn says the
evidence is not gold standard
they do not have the evidence to try and
draw conclusions
about the benefits of this and surely an
extra layer of protection can only be a
good thing
is there any other treatment pathway
whether it is
new or established or well-versed
that has ever had to go through a court
for a young person to be able to access
i don't think so and i think whether it
is deemed as being
experimental or not whether they're
going to ignore the breadth of
international evidence that shows how
good
this treatment works for young people
and the positive outcomes even if they
ignore
all of that even if they ignore all of
that are they going to
listen to young people susie green thank
you very much for joining us thank you
thank you