Katie Roche's Blog

The Court of Appeal Must Uphold Bell Vs Tavistock and Portman

Thursday was the last day of Keira Bell’s hearing at the Court of Appeal. If you are unfamiliar with the case, here’s the background. When Bell was 16 years old, she wanted to transition to male. Bell received treatment from Tavistock and Portman’s Gender Identity Clinic. This is the only NHS clinic that treats transgender children. She took puberty blockers against her father’s wishes. At age 17, the clinic prescribed testosterone. She then underwent “top” surgery (a double mastectomy) at age 20. But at age 23, she realized she didn’t want to live as a man anymore and detransitioned. Sadly, the transition has left Bell with physical and emotional scars. Because of the testosterone, she still has a deep voice and facial hair. She’ll never get her natural breasts back either. Hoping to prevent this from happening to other people, Bell took Tavistock and Portman NHS Trust to a judicial review over the use of puberty blockers. This case was heard in December 2020. The court agreed that under 16s couldn’t consent to taking puberty blockers (you can read the full judgement here). However, that ruling was appealed by Tavistock and Portman. It is unclear when the judgement for this appeal will be released. The case could end up in the Supreme Court whichever way it goes.

Sadly, it’s not looking good for Bell. At one point, when her counsel said that puberty blockers were experimental, one judge replied that aspirin could also be described as experimental. Although that judge has inadvertently raised an interesting point about treatment risks. Children under 16 shouldn’t take aspirin because of Reye’s syndrome, a rare disorder that causes brain swelling and is often fatal. In 1983-1984, the incidence of Reye syndrome was 0.63 per 100,000 children in the UK. That’s about 1 in 160,000. This declined to 0.11 in 100,000 (about 1 in a million) in 1990-1991, after aspirin labels warned parents not to give the medication to children. To put this into context, over 10 in 100,000 people died in traffic accidents in 1980. A child who took aspirin was more likely to die in a car crash than to get Reye Syndrome. Yet, this tiny risk was enough to warrant stopping all children from taking aspirin. It illustrates that with children, doctors take great caution for even the most minimal risks. The same principle should apply to puberty blockers.

Puberty blockers carry many serious risks. They cause lifelong side effects, including reduced bone density, weak teeth, and potential infertility. In addition, as the original judgement pointed out, we don’t know the exact effects of puberty blockers when used for transgender children. Puberty blockers are normally used in children with precocious puberty (puberty that begins much sooner than normal, usually due to an underlying hormonal or neurological disorder). A child experiencing precocious puberty only takes the blockers until they reach an appropriate age for puberty to begin. However, transgender children take puberty blockers throughout their teens. Then they start cross-sex hormones in early adulthood. They never experience typical puberty.

The risks aren’t the only issue. There is little evidence that puberty blockers help transgender children. To determine their impact, there would need to be a study where one group of transgender children used puberty blockers. And another group of children who didn’t take them. Then, their mental health and other health outcomes in adulthood would be compared. This is the standard way of testing the effectiveness of medicines. For puberty blockers, that research has never been done. Although, a recent study published in the British Medical Journal found that puberty blockers do not reduce distress in transgender children. Furthermore, look at actual transgender people who took puberty blockers. Jazz Jennings for instance. Jazz was born male and began her transition at five years old. Now an adult, she looks like a natal female. But she’s had severe mental health issues, including Depression and Binge Eating Disorder. Did puberty blockers really help her mental health? Also, the blockers complicated her physical transition. When puberty blockers are used from a young age, the penis stays at prepubescent size, so there is not much material to create a neo-vagina with. Her surgeons used part of her bowel for the procedure. She also needed four surgeries, when normally only one is required. In Jazz’s case, she hasn’t had a good outcome from the “affirming” approach. Now that the “gender affirming approach” is the norm, there might be many more Jazz’s to come.

Alarmingly, the original hearing couldn’t establish why puberty blockers are prescribed at all. According to Tavistock and Portman, the aim of puberty blockers is to give children “time to think” about their gender identity. Also, some LGBT groups say that transgender children have a high suicide rate, and so prescribing puberty blockers help reduce suicides. Although Tavistock and Portman themselves say that transgender children are no more likely to attempt or die of suicide than other children. Others argue that puberty is upsetting for transgender children. Thus, puberty blockers reduce that distress. Although the BMJ’s study refutes that claim. Perhaps the main reason is because puberty blockers make future transition easier. Secondary sexual characteristics never develop. Meaning “top surgery” isn’t necessary for trans-identified females. They prevent facial hair growth in trans-identified males too.

However, there are also fears that puberty blockers stop brain development associated with puberty. This hasn’t been confirmed. Although the judgement implied it is an issue. In the first hearing, many witnesses who had been on puberty blockers testified. Several said they had no interest in sexual relationships. Some even said that the idea of sex repulsed them. Interest in sex develops during puberty. Had the puberty blockers prevented this from happening? Now, some people have a low sex drive. But for so many people who’d received blockers to say the same thing sounds like this caused the problem. This is concerning as children who’ve never experienced sexual desires can’t know what they’ll miss. They don’t understand what they’re consenting to.

Another major controversy is that the case may impact on Gillick competence. Gillick, (read this case here) looked at birth control pills prescribed to girls under 16 without their parent’s knowledge. (In the UK, children over 16 can give consent to most medical procedures). The court said that children could make medical decisions if they understood the risks and benefits of the treatment. A doctor must decide if a child has Gillick competence, based on their age, cognitive abilities, mental health and other factors. Gillick competence should be determined on an individual basis. The court seems to have intended for children to make simple decisions about their medical treatment. Also, the first Bell judgement noted that many patients at the Tavistock and Portman clinic live with developmental disorders such as Autism and ADHD. These children may be less mature than typically developing children. Therefore, they might not have the capacity to make decisions about their medical treatment.

There’s a big difference between a girl consenting to take the pill and a child consenting to take puberty blockers. Unlike puberty blockers, there are clear benefits to taking the pill. The pill prevents pregnancy. Teen pregnancy can ruin a girl’s life. It disrupts her education and carries extra health risks compared to pregnancy in adults. Many teenagers struggle with parenting, which leads to bad outcomes for the children born to teen mothers. Everyone wants to prevent this. The pill is safe and effective. There are some side effects, but most aren’t life-threatening. With very few exceptions, all the effects of the pill go away as soon as a woman stops taking it. Therefore, if a girl is in a sexual relationship, it’s in her best interests to take the pill. Although, many parents won’t be aware that their daughter is in a sexual relationship. So presumably they wouldn’t give consent for their daughter to take the pill. Which is why Gillick competence came about- to prevent girls from getting pregnant because their parents didn’t know they needed contraception.

Some campaigners have wrongly compared Gillick with Roe Vs Wade in the USA. It is not the same. Abortion in England, Scotland and Wales (but not Northern Ireland) is permitted by the Abortion Act 1967. Also, the UK legal system differs from the US system. British courts have much less power than US courts. Plus, Gillick only covers children under 16, whereas Roe Vs Wade was about all cases of abortion. Whatever the impact of the Bell case, it will have no impact on the legal right to an abortion. If Bell results in changes to Gillick competence that stop children making decisions they aren’t mature enough to make, then so be it. Indeed, the Gillick judgement said that children can consent to some treatments and not others. It was never intended to give children carte blanche over their medical care.

Let’s hope the court upholds the original judgement. We can’t risk even one more child being harmed. As I’ve said before, activists use transgender children to support the notion that people are born transgender. It’s important to them to dismiss other causes of Gender Dysphoria, such as autogynephilia. This bolsters their case that Gender Dysphoria can only be treated by changing their body. As opposed to psychotherapy or other treatments. Children should never be used as ideological pawns. Bell shows the real human cost of using children to make a point about adult issues. Puberty blockers also promote the idea that nothing can stop a child from being transgender. And that future sex change treatment is inevitable. They are a one-way ticket to transition and the permanent health and social effects associated with it. Adults can do as they please. Including undergoing sex reassignment if they wish. As long as they know the risks- like with anything else that permanently changes the body. But children can’t make informed decisions on these matters. They have neither the life experience nor the neurological development to make such choices. Let’s hope that nobody else goes through what Keira Bell went through.

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