- London judges have ruled that children under 16 can consent to having puberty blockers if they can understand the treatment.
- Britain's only gender identity development service for children has been criticised for being too quick to prescribed treatment to children who wish to undergo gender reassignment.
- Clinicians said pausing puberty may have some long term effect on fertility, sexual function and bone density.
Three judges in London on Tuesday ruled that children under 16 who wish to undergo gender reassignment can only consent to having puberty blockers if they can understand the treatment.
The ruling came in a case brought against Britain's only gender identity development service for children, which has long faced criticism it is too quick to prescribe the treatment.
Lawyers for a woman who took hormone blockers aged 16 before detransitioning and the mother of a 15-year-old girl argued children could not properly understand the nature and effects of the drugs.
They also said once on them, children were "highly likely" to go on take cross-sex hormones, causing "irreversible changes".
In response, the Tavistock and Portman NHS Trust said taking puberty blockers, which prevent the development of breasts, periods, facial hair or a deeper voice, and cross-sex hormones were separate stages of treatment.
Proponents argue that artificially pausing puberty gives a young person time to consider their options, without the stress of unwanted changes to their body.
But clinicians say there may be some longer-term effect on fertility, sexual function and bone density, although evidence is limited.
The High Court judges said puberty blockers were "a stepping stone to cross-sex hormones". "Once on that pathway it is extremely rare for a child to get off it," they said.
"It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers," they added.
"It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers."
- 'Historic' ruling -
The judges stressed they were only making a ruling on informed consent, not on whether puberty blockers were appropriate for treating children with gender dysphoria.
Keira Bell, 23, who brought the case, said afterwards the judgment was "about protecting vulnerable children". "I'm delighted to see that common sense has prevailed," she added.
Paul Conrathe, representing the mother of the teenager who is awaiting treatment, called it an "historic judgment".
He said there was a "culture of unreality" at the Tavistock clinic, which has seen referrals jump from 1 408 in 2015-16 to 2 728 in 2019-20.
"This may have led to hundreds of children receiving this experimental treatment without their properly informed consent," he added.
The Tavistock and Portman NHS Trust said it was disappointed and the ruling would likely cause anxiety for patients and their families, and would seek permission to appeal.
Trans children's charity Mermaids called the judgment potentially discriminatory and an "absolutely devastating blow" for young people who had benefited positively from hormone blockers.
"We believe very strongly that every young person has the right to make their own decisions about their body and that should not differ because somebody is trans," said Mermaids head of legal, policy and operations Lui Asquith.
"The court today has decided to treat trans young people differently to every other child in the country."