Thread by @MatthewGreenf11

judiciary.uk/judgments/r-on… "for the year 2019/2020, 161 children were referred by GIDS for puberty blockers (a further 10 were referred for other reasons). Of those 161, the age profile is as follows:
3 were 10 or 11 yrs old at the time of referral;
13 were 12 yrs old..

...10 were 13 years old;
24 were 14 years old;
45 were 15 years old;
51 were 16 years old; 1
5 were 17 or 18 years old."

"We note here that we find it surprising that such data was not collated in previous years given the young age of the patient group,the experimental nature of the treatment and the profound impact that it has."

"The number of referrals to GIDS has increased very significantly in recent years. In 2009, 97 children and young people were referred. In 2018 that number was 2519."

"Further, in 2011 the gender split was roughly 50/50 between natal girls and boys. However, in 2019 the split had changed so that 76 per cent of referrals were natal females."

"It is recorded in the GIDS Service Specification and the wider literature that a significant proportion of those presenting with GD have a diagnosis of Autistic Spectrum Disorder (ASD)...

...The court asked for statistics on the number or proportion of young people referred by GIDS for PBs who had a diagnosis of ASD. Ms Morris said that such data was not available, although it would have been recorded on individual patient records."

"We therefore do not know the proportion of those who were found by GIDS to be Gillick competent who had ASD, or indeed a mental health diagnosis. Again, we have found this lack of data analysis – and the apparent lack of investigation of this issue - surprising."

"The court asked for statistical material on the number, if any, of young people who had been assessed to be suitable for PBs but who were not prescribed them because they oung person was considered not to be Gillick competent to make the decision...

...whether at GIDS or the Trusts. Ms Morris could not produce any statistics on whether this situation had ever arisen."

"The court gained the strong impression from the evidence and from those submissions that it was extremely unusual for either GIDS or the Trusts to refuse to give PBs on the ground that the young person was not competent to give consent...

...The approach adopted appears to be to continue giving the child more information and to have more discussions until s/he is considered Gillick competent or is discharged."

"Relevant to the evidence of consent is the evidence of Professor Scott (Director of University College London’s Institute of Cognitive Neuroscience). She “seeks to explain, from a neuroscientific point of view, why...

...I have significant doubts about the ability of young people under the age of 18 years old to adequately weigh and appreciate the significant consequences that will result from the decision to accept hormonal treatment for gender dysphoria.” "

"it is my view that even if the risks are well explained, that in the light of the scientific literature, that it is very possible for an adolescent to be unable to fully grasp the implications of puberty-blocking treatment...

... All the evidence we have suggests that the complex, emotionally charged decisions required to engage with this treatment are not yet acquired as a skill at this age, both in terms of brain maturation and in terms of behaviour.”

"There is some dispute as to the purpose of prescribing PBs. According to Dr Carmichael, the primary purpose of PBs is to give the young person time to think about their gender identity. This is a phrase which is repeated on a number of the GIDS and Trust..documents...

...As is clear from the literature and referred to by the HRA, the other purpose of giving PBs is stopping the development of the physical effects of puberty...

...because slowing or preventing the early development of secondary sex characteristics during puberty can make a later transition (both medical and social) to living as the opposite sex easier."

" it is said, it is possible for a young person to come off the PBs at any point and not proceed to taking CSH..However, the evidence that we have on this issue clearly shows that practically all children / young people who start PBs progress on to C[ross]S[ex]H[ormones]."

" the evidence of Dr de Vries...a founding board member of EPATH.. She says that of the adolescents who started puberty suppression, only 1.9 per cent stopped the treatment and did not proceed to CSH. "

"We find it surprising that GIDS did not obtain full data showing the figures and the proportion of those on puberty blockers who remain within GIDS and move on to cross-sex hormones."

"Both WPATH and the Endocrine Society in their documentation describe PBs as fully reversible. Professor Butler says that “we do not know everything about the blocker and as far as we know it is a safe reversible treatment with a well-established history.”...

....However, it is important to note that apart from the Amsterdam study, the history of the use of PBs relied upon in this context is from the treatment of precocious puberty which is a different condition from GD, and where PBs are used in a very different way."

De Vries; “Ethical dilemmas continue to exist around ... the uncertainty of apparent long-term physical consequences of puberty blocking on bone density, fertility, brain development and surgical options.”

GIDS Early Intervention Young Person Information Sheet; "We do not fully know how hormone blockers will affect bone strength, the development of your sexual organs, body shape or your final adult height...

...There could be other long-term effects of hormone blockers in early puberty that we don’t yet know about."

"Thus, the central point made by the claimants is that although most of the physical consequences of taking PBs may be reversible if such treatment is stopped, the child or young person...

...will have missed a period, however long, of normal biological, psychological and social experience through adolescence; and that missed developmentand experience, during adolescence, can never be truly be recovered or “reversed”. "

"A second key part of the argument about reversibility turns on the relationship between PBs and CSH and the degree to which commencing PBs in practice puts a young person on a virtually inexorable path to taking CSH. CSH are to a very significant degree not reversible."

"the lack of a firm evidence base for their use is evident from the very limited published material as to the effectiveness of the treatment, however it is measured. "

"the degree to which the treatment is experimental and has, as yet, an unknown impact, does go to the critical issue of whether a young person can have sufficient understanding of the risks and benefits to be able lawfully to consent to that treatment."

"it may be that the very fact of the diagnosis and the course of treatment which affirmed that diagnosis (that is, both gender affirmative psychotherapy and the use of PBs) solidified the feeling of cross-gender identification...

...and led the young people to commit to sex reassignment more strongly than they would have done if there had been a different diagnosis and treatment."

"the treatment may be supporting the persistence of GD in circumstances in which it is at least possible that without that treatment, the GD would resolve itself."

"the psychiatrist attempted to talk of the gender spectrum as a way of persuading me to not pursue medical transition. I took this as a challenge to how serious I was about my feelings and what I wanted to do and it made me want to transition more...

...Now I wish I had listened to her."

"I started to have my first serious doubts about transition. These doubts were brought on by for the first time really noticing how physically different I am to men as a biological female, despite having testosterone running through my body."

"Despite these doubts, when she was 20, she had a double mastectomy."

"I was being perceived as a man by society, but it was not enough. I started to just see a woman with a beard, which is what I was. I felt like a fraud and I began to feel more lost, isolated and confused than I did when I was pre-transition.”

"I still do not believe that I have fully processed the surgical procedure that I had to remove my breasts and how major it really was. I made a brash decision as a teenager..trying to find confidence and happiness, except now the rest of my life will be negatively affected."

"he felt a strong need to become a boy from an early age and how he was bullied at school for his behaviour. He found the onset of female puberty horrifying and unbearable. After a number of sessions at GIDS he was prescribed PBs from the age of 12."

"S is a 13 year old trans boy..He was told that he would have to wait for approximately 24 months to be seen and with his parents decided to see a private provider, GenderGP, where he has been prescribed PBs....

... We note at this point that the GP in question was removed from the professional register and now operates from outside the United Kingdom."

Lord Donaldson; " it is a feature of anorexia nervosa that it is capable of destroying the ability to make an informed choice. It creates a compulsion to refuse treatment or only to accept treatment which is likely to be ineffective...

...This attitude is part and parcel of the disease and the more advanced the illness, the more compelling it may become...

...Where the wishes of the minor are themselves something which the doctors reasonably consider need to be treated in the minor’s own best interests, those wishes clearly have a much reduced significance.”

Nolan: "if the child’s welfare is threatened by a serious or imminent risk that the child will suffer grave and irreversible mental or physical harm, then once again the court when called upon has a duty to intervene...

... It makes no difference whether the risk arises from the action or inaction of others, or from the action or inaction of the child. Due weight must be given to the child’s wishes, but the court is not bound by them."

"there is real uncertainty over the short and long-term consequences of the treatment with very limited evidence as to its efficacy, or indeed quite what it is seeking to achieve. This means it is, in our view, properly described as experimental treatment. "

"there is a lack of clarity over the purpose of the treatment: in particular, whether it provides a “pause to think” in a “hormone neutral” state or is a treatment to limit the effects of puberty, and thus the need for greater surgical and chemical intervention later"

"the consequences of the treatment are highly complex and potentially lifelong and life changing in the most fundamental way imaginable. The treatment goes to the heart of an individual’s identity, and is thus, quite possibly, unique as a medical treatment."

"The condition being treated, GD, has no direct physical manifestation. In contrast, the treatment provided for that condition has direct physical consequences, as themedication is intended to and does prevent the physical changes that would otherwise occur within the body"

"the clinical intervention we are concerned with here is different in kind to other treatments or clinical interventions. In other cases, medical treatment is used to remedy, or alleviate the symptoms of, a diagnosed physical or mental condition, and...

...the effects of that treatment are direct and usually apparent. The position in relation to puberty blockers would not seem to reflect that description."

"It is said therefore the child needs only to understand the implications of taking PBs alone to be Gillick competent. In our view this does not reflect the reality...

...The evidence shows that the vast majority of children who take PBs move on to take cross-sex hormones, that Stages 1 and 2 are two stages of one clinical pathway and once on that pathway it is extremely rare for a child to get off it."

"the use of puberty blockers is not itself a neutral process by which time stands still for the child on PBs, whether physically or psychologically. PBs prevent the child going through puberty in the normal biological process."

"That adolescents find it difficult to contemplate or comprehend what their life will be like as adults and that they do not always consider the longer-term consequences of their actions is perhaps a statement of the obvious."

"the combination here of lifelong and life changing treatment being given to children, with very limited knowledge of the degree to which it will or will not benefit them, is one that gives significant grounds for concern."

"The issue in our view is that in many cases, however much information the child is given as to long-term consequences, s/he will not be able to weigh up the implications of the treatment to a sufficient degree...

...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."

"The conclusion we have reached is that it is highly unlikely that a child aged 13 or under would ever be Gillick competent to give consent to being treated with PBs...

...In respect of children aged 14 and 15, we are also very doubtful that a child of this age could understand the long-term risks and consequences of treatment in such a way as to have sufficient understanding to give consent."

"We consider that it would be appropriate for clinicians to involve the court in any case where there may be any doubt as to whether the long-term best interests of a 16 or 17 year old would be served by the clinical interventions at issue in this case."

"The approach of the defendant appears to have been to work on the assumption that if hey give enough information and discuss it sufficiently often with the children, they will be able to achieve Gillick competency..we do not think that this assumption is correct."

judiciary.uk/judgments/r-on… The full judgment again, for those who came late to the (incredibly long) thread 😉