Citing Dutch team again, “concerns have been raised that blocking treatment itself may increase the persistence of gender dysphoria”, but adds that we don’t know this yet.
Medium and long terms consequences of starting blocker treatment, it’s argued, include:
Inability to orgasm, compromised cognitive function, lifelong need for medication, repeated surgical intervention.
Inability to orgasm, compromised cognitive function, lifelong need for medication, repeated surgical intervention.
Case being made by Bell is that the blocker is not fully physically reversible, as claimed.
Tavistock reported in April 2020, 161 referrals to Endocronology. Ave age 15.4 years. Youngest 10 years old, 26 were 13 or under
Barrister arguing that the claimants do not believe these young people are “sufficiently mature enough to understand the effects of these drugs.”
Claimants do not question existence of GD, nor do they question that those who suffer from it experience sever distress
Nor do claimants believe that no young person should have access to blockers.
Involving the court in the decision for puberty blockers, they argue, does not undermine the autonomy of young people
While young people who want them should have access to blockers, it’s argued, it’s right that the court should be able to intervene if it is in their best interests.
Talking about Keira Bell and referring to her statement: “I was not able to weigh the loss of experiences” I had because of this treatment
Claimants argue that a child has no concept of sexual function, irrespective of any age appropriate language used. It’s argued, therefore, that requirements of informed consent cannot be met.
Barrister claims that the focus of the GIDS service specification is to ‘treat early’ with blockers. This can prevent the development of certain physical characteristic and will make any future surgery less invasive.
Referring to Early Intervention information sheet. benefits: “as far as we’re aware the puberty blockers will not harm your physical or psychological development.” possible disadvantages: bone strength, side effects, “there could be other l/term effects that we don’t yet know.”
There is a mention of the blockers possibly effecting the way YP think about their gender identity. Claimants argue that if this is a reference to persistence, it is “ambiguous and vague.”
Claimants accept that it’s true, as GIDS say, that when seeking consent “no question is off limits”
GIDS documents explicitly say that YP under 16 should be assessed for ability to make informed decisions
The Service underlines how important informed consent is
GIDS standard operating procedure: states that if child not deemed to have capacity to consent, “we do not proceed with medical treatment for under 16s.”
SOP says that YP only deemed competent to consent if been given all GIDS standard information on puberty suppression and this has been discussed in balanced way, as well as possible long term Unknowns, including future fertility. They must be assessed by GIDS as Gillick competent
Claimants say it’s just not possible for YP, esp 13 and under to fully understand long term consequences.
On GIDS’ Early Intervention study, which Newsnight reported on last summer, barrister cites Dutch study we mentioned that showed no adolescent withdrew from treatement with blockers. All went on to cross sex hormones.
This high number (100% or v late 90s) don’t match wording of GIDS service specification, it’s claimed, which says, “for some individuals, blockers are followed by cross sex hormones.”
GIDS director Dr Carmichael’s evidence says “it’s factually and conceptually wrong” to suggest all patients who start treatment with blockers progress to cross sex hormones.
Dr Carmichael argues in her evidence that claimant doesn’t mention the psychological benefits of treatment with blockers.
Prof Michael Biggs, for claimants, says that while full results of early intervention study not published, interim findings did not show psychological improvement. Biggs:”no proper evidence from GIDS that the puberty blockers they administer improve psychosocial functioning.”
Claimant’s barrister argues it’s appropriate to call treatment with puberty blockers ‘experimental.’ He cites RCGP statement which says “little is known about the safety” of the treatment and Prof Carl Heneghan, who looked at the evidence base last year. “Safety concerns remain.”
Defence argues that the treatment itself has been used for 30 years, though not always in context of transgender care.
Endocronologist Butler’s work cited. In first 2 years after Early Intervention Study, all continued with blocker. No overall improvement in mood or psychological well being observed (some YP improved, some didn’t). This does not say how many went to cross sex hormones, however
Claimants refer to HRA study, prompted by Newsnight report, which suggests that using the phrase ‘space to think’ has caused confusion to some.
Claimants allege that nowhere in GIDS documentation is risk of persistence (onto cross sex hormones) or the risk of loss of sexual function, mentioned. They “just cannot accept that there can be an age appropriate discussion” on these matters.
Tavistock say claimants case is misguided as they respond to all issues raised in accurate and neutral terms
Evidence from endocronologist Butler says it’s an absolute requirement that YP fully understand impact on fertility and sexual function, claimants describe. But claimants ask ‘where are these discussions?’ and allege they’re absent.
Evidence from Tavistock of some of the young people they have helped. Case J, 20 year old trans male, who was referred for puberty blockers in 2012 when they were 12. J says they discussed sex and sexuality, but it was not something that they’d thought about at that stage...
Their gender identity was Uninfluenced by attraction. Once they knew about hormone blockers, knew it was what they needed. It was a difficult decision to make because didn’t know if they wanted children in future, but having biological children was less imp than blocking puberty
J says they’d wished they had begun blockers earlier because they lost a large amount of childhood and adolescence
Another case, N, who received blockers at 17 in 2019 says she thought the blocker was helpful. Her voice had already started to break. Removing autonomy for this treatment, she says, would “terrible” on a personal level and ‘speak to the stigma of being trans.’
Claimants argue again their intention is not to remove access to puberty blockers for those who seek the treatment.
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