Thread by @hannahsbee

Court has resumed after lunch. Barrister for endocrinologists explains:
For UCL, median age for blockers 14.6, for cross sex hormones 17.4, youngest 10
For Leeds, median age for blockers 16, cross sex hormones 17.2, youngest 12

Of 145 patients referred to Leeds, 38 experienced delays to treatment. On two occasions pressure was seen to be coming from parent and choice not freely made. Barrister says evident there is no immediate access to treatment after referral

Barrister for endocrinologists says the relevant information on risks/benefits is very different for stage 1 (blockers) and 2 (cross sex hormones). ‘It’s no answer to say the majority of patients do go from stage 1 to stage 2.’

Practice is consistent with the guidelines from Endocrine Society. Treating gender dysphoria with puberty blockers has been shown to improve psychological function

Puberty resumes upon stopping treatment with the blocker, it’s said. ‘It is a reversible treatment... there may be side effects, but that does not mean it’s not a reversible treatment’

Judge notes that one of the benefits also cited is that blockers can lead to better physical outcomes. Barrister replies ‘that maybe a side benefit.’ Explains that if young girl takes blockers then there would be less breast tissue to remove later in, should they want to

Another judge questions whether evidence base depends on Dutch study only

Barrister denies assertion that treatment with blockers can lead to inability to orgasm.

During the period of taking the. Blockers, there is an impact on sexual function, but no long term impact.

Same goes for stunted genitalia. While on blocker genitalia does not grow. Once blocker removed from the body, the genitalia continues to grow. There is an issue regarding timing of taking the blocker, my understanding is that in respect to natal makes it may be better...

Not to take the blocker until 14, to allow the penile tissue to grow IF they wants surgery later, says barrister

It is not the view of UCLH that Keira Bell lacked capacity to consent to treatment

Concern of endocrinologists if this claim were to succeed is impact on any other treatments and the involvement with the court. Would this impact on use of blockers in precocious puberty, he asks? ‘This could create a very unhelpful precedent.’

It would be damaging for a child to have to go to court - it’s argued - and that assessment to date is right and the correct way to gain consent.

Some clarifications on earlier points. Of 161 referrals to endocrinology for puberty blockers last year, break down by age is:
10/11 - 3
12 - 13
13 - 10
14 - 24
15 - 45
16 - 51
17/18 - 15

So in fact fewer than a quarter were under 14

Explaining why there has been a delay in publishing results of Early intervention study, Tavistock explains that one author is Russell Viner, president of Royal College of Paediatric and child health. Due to his commitments in the Covid pandemic...

...The team are awaiting his responses to the submissions of peers. Because of the controversy surrounding subject matter, it’s deemed inappropriate to put anything into the public domain until this process has been completed

Barrister for transgender trend now speaking. Concern over increase in the proportion of natal females being referred to GIDS, from around 50% in 2010 to 76% in 2018/19

Transgender trend argues that detrimental effects of cross sex hormones are greater for girls than boys.

It’s argued that defendant must go significantly further in challenging and probing patients, in a constructive way, than currently appears to be the case. Broader cultural factors must feed into the process.

Hyam QC for Bell and Mrs A bow replying

On competency and consent: put headline sign off is “autonomy without comprehension is no autonomy at all.”

Hyam argues that far from resolving the dysphoria, dysphoria persists for those who begin treatment with the blocker and they go onto take cross sex hormones. We have not got away from the v high percentages in the De Vries paper (high 90s).

Hyam says while Butler of UCLH gives a figure of 80% of those on blockers progressing to cross sex hormones, there is also an acknowledgement of loss to follow up.

There is room for the court to separate the exercise of competence from informed consent, Hyam argues. Regarding jurisdiction, it needn’t be court of protection, but rather ‘the court’

Responding to additional evidence from Polly Carmichael, Hyam argues that it is necessary to understand medium and long term consequences when going on the blocker, rather than not requiring a complete understanding.

Hyam says that at one point earlier today it was argued that these children are highly distressed and that there is a risk of Suicide. He argues that there is no evidence of reduced suicide risk with treatment with puberty blockers

Process of gaining of informed consent from these young children is a ‘fairy tale’ he alleges.

Responding to explanation of delay in publication of early intervention, Hyam says he understands point being made about Viner, but you might think it possible to come to court and say how many had gone on to take cross sex hormones. The answer in Dutch study was 100%, he adds

Hyam repeats that claimants position is that whether they be 11 or 17, the child does not have full understanding of puberty blocker treatment, nor understanding of failure to treat. “The suggestion that these very young children are giving informed consent is a fairy tale.”

Anticipated consequence of failure to treat being Desistance, he claims.

Hearing ENDS

Apologies for any typos. Have tried to be as clear as possible and just report what has been said in court