THE HORRIFIC INJUSTICE OF THE HIGH COURT HORMONE BLOCKER RULING

THE HIGH COURT HORMONE BLOCKER RULING – DECEMBER 2020.

Please give the countless voices of justice a chance to speak.

The recent High Court ruling against hormone blockers for under 16’s has been an absolutely devastating blow for transgender young people and their families across the country. A blow of epic, unchallenged and historic proportions that I cannot even begin to comprehend. We’re entering a new era of discrimination and we are already seeing the impact of this on the mental health of young trans people and the families tirelessly trying to support them. Families like mine. Thousands of us have been ignored, disregarded and left in a state of terror, panic and misery by this ruling and in the name of democracy and justice it is imperative that our voices are heard.

For the tiny % of Keira Bells out there, there are thousands of other genuine young trans people whose very existence depends on medical intervention. Hormone blockers can and do save lives and allow many young people to finally be free; to be able to accept themselves, go outside, engage in society, go to school, and feel authentic for the first time in their lives. We are now on the wrong side of history and embarking on a dangerous period of child experimentation alongside the violation of their rights to critical healthcare.  

Our family has been under the care of specialists and then the Tavistock for nearly 8 years. EIGHT YEARS. They say the interventions are too fast and ‘experimental’? My child has gone through years of psychological assessment and meticulous tests of competency and safeguarding. In the vast majority of cases this process is RIDICULOUSLY SLOW. The waiting lists for the GIC are over 3 years, how can they possibly pass a ruling that has little basis in the lived experience of the majority and is causing immense damage? Isn’t the key tenet of the medical profession’s Hippocratic Oath to “do no harm”?

 Campaigners have apparently celebrated a victory for 'common sense'. Common sense? How many of these campaigners actually have trans children? How many of them have spent 8 years going through rigorous assessments with gender specialists, endocrinologists, consultants and psychiatrists to reach considered conclusions? How many of them have spent even an hour with a family like mine, of which there are thousands? How many have actually spoken to the children! Do they really believe it is in any way ethical to ignore and completely overrule the patient, the parents & carers who know their child better than anyone and the specialists who observe and guide them? 

Do they not think that the medical experts in this field should be able to make decisions based on their assessments and professional judgements on a case by case basis without the spectre of a court judgement to question or overrule their expertise? Do they not think that when a family like ours goes to extraordinary lengths to preserve their child’s fertility, that they are not doing everything in their power to mitigate against any potential long-term effects of the medication they take? On balance, which is better - a very small number of adolescents who change their mind or hundreds of permanently scarred or worse, dead ones, who simply can’t cope with a life destroyed by crippling gender dysphoria? Of course, the outcomes of getting it wrong are potentially catastrophic, and a few do go on to de-transition, but the numbers are overwhelmingly higher for those who transition into happier trans adults. Should they be all have their medical care immediately stopped at the mercy of the court system in favour of 2 claimants? Are you kidding me? In what other aspect of law would the needs of 99% of vulnerable children and their families be overruled because of the anomalous experience of a few individuals? The international Standards of Care outlined in The World Professional Association for Transgender Health (WPATH) state that not intervening to interrupt an unwanted puberty ‘is not a neutral option’; in other words, it would cause entirely-foreseeable and, therefore, inexcusable harm to the mental health of the young person.

It is not only the terrible suicide ideation and self-harm rates that characterize the lives of many trans young people that makes this ruling so terrifying. Below this ‘obvious’ indicator of psychological pain is a raging subtext of other devastating manifestations of suffering. For a huge number of trans youth, the onset of puberty equals self-loathing, self-isolation, the refusal to engage in any meaningful kind of life, the refusal to attend school, the refusal to wash or even touch their bodies, and the refusal to eat. My own child was hospitalized with anorexia at the onset of 2^nd stage pubertal development as many do; tragically it is a disturbingly common way for trans teenagers to force pubertal developments to stop via starvation. Just because she was not visibly attempting suicide did not mean that the agony of witnessing the wrong puberty on her body was not manifesting itself elsewhere in equally deadly ways. She missed a YEAR of secondary school. She wouldn’t speak. She wouldn’t leave her room. Yet within months of being told she could have the blocker she started to improve and by her next academic term she received a clear run of A’s and A* for effort – the first of her entire school life.

 These judges see none of this, they know nothing of the hidden horrors that arise as a result of not being allowed to fit into your own sense of self. Blockers are the only thing that can stop this physical torture for these kids, and yet they have ruled to stop this with immediate effect and put the final decision into a lengthy ‘best interest’ court assessment system. What the hell are we supposed to do in the meantime? Don’t you think the parents have already gone through years of struggle with their child’s ‘best interests’ dictating everything they do and every decision they make? How can a court know the child’s best interests more than the parents who have advocated for their safety and wellbeing their entire life? Do you know how degrading and insulting this is to the families of trans children? Many of these kids will have fully developed by the time their cases get to court, by which time the irreparable damage is done. The average age for girls to start puberty is 11, while for boys the average age is 12. But it's perfectly normal for puberty to begin at any point between the ages of 8 and 13 in girls and 9 and 14 in boys. So, the High Court is pulling the emergency cord during the most critical point in a trans adolescent’s life and delaying or even stopping their help until puberty is either well underway or actually over?! What on earth do they do then? I’ll tell you what they’ll do – they’ll be forced into the torture of going through their natal puberty and then spend much of their adult lives seeking and risking even more invasive, dangerous and complicated surgeries as they desperately try to undo the permanent changes nature has forced up them. Changes that wreck their happiness and self-worth. Changes that wreck lives. Changes that could have been avoided and paused by blockers. And the High Court call this PROTECTION for vulnerable sufferers of gender dysphoria? The injustice and cruelty of this decision is breath-taking.

They speak of blockers as highly unusual, innovative and even ‘experimental’ drugs. Have they even consulted general medical opinion on this? Puberty blockers have been used for decades with great benefit. They are used routinely under license in cases of precocious puberty in younger children and they are NOT new. They are also used to treat prostate cancer in men and to treat endometriosis and fibroids in women. Does anyone call them unusual and experimental in this context? Or are they lifesaving? Why the harmful and inflammatory rhetoric? Oh yes, because it’s trans-related of course! In the vast majority of cases, hormone blockers are life-enhancing interventions that prevent excruciating emotional and psychological harm to vulnerable and sometimes suicidal teenagers. The use of puberty blockers is not the long-term experiment here; the long-term experiment is actually what happens to trans young people who need hormone blockers and denied them. If we speak to trans adults who suffered full blown natal puberty we can predict only too well how that pans out. Not much point having a conversation about how ‘immoral’ the hormone treatment is if the child is dead is there?

Research published in the Journal of the American Academy of Child & Adolescent Psychiatry reveals that when children are allowed to transition, including the use of puberty blockers, it significantly improves their mental health. Furthermore The American Academy of Paediatrics, which with 64,000 professional members is the most respected paediatric organisation in the world, recommends taking a “gender affirming” non-judgemental approach so that: “children feel safe in a society that too often marginalizes and stigmatizes those seen as different”. With this wealth of knowledge available at our fingertips, it is unfathomable that we should have arrived at a position where a judge’s determination results in the sudden withdrawal of a proven treatment.  

 Critics say, “It's also not known whether hormone blockers affect the development of children's bones, and side effects may also include hot flushes, fatigue and mood alterations”. Yes, of course all drugs sometimes have side effects. That’s why when you take the blocker you take vitamin D supplements to retain bone strength and have regular bone density scans. If you get a hot flush it is often mild and it passes. In our case there were 3 mild ones over a period of 2 weeks and then they went. There are many perfectly natural pubertal developments that affect mood and energy, and they are all a ‘normal’ part of growing up. Mood alterations are synonymous with teenage life, trans or not.

 They also say that “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” Really? At no age? So, the statutory RSE education that adolescents receive at secondary school is not age appropriate? And who says they will lose their fertility? GIDS encouraged us relentlessly to pursue fertility preservation and we successfully did so. The lengthy and in-depth explanations about protecting and preserving fertility that our independent fertility clinic explained in lucid terms were well understood by us and our almost 15 year old. Information that she researched further and took so seriously that she confidently agreed to preserve her fertility because she understood and articulated that even though she didn’t think she ever wanted children, if she took this step it would enable her to potentially become a parent one day. To say this cannot be explained to them at any age is so patronizing it’s insulting to all sentient, intelligent adolescents wanting to make decisions about their own futures alongside their informed, engaged and supportive parents.  Also, many trans teenagers despise their bodies so much they do not even want to engage in sex – many can’t even look at themselves naked, never mind let anybody else, so to use the ‘future sexual function’ argument is not only premature but totally misguided. How can individuals crippled by body dysmorphia enjoy a healthy sex life if they despise the body they are in? Wouldn’t their future sexual and emotional relationships have far more chance of success if they were comfortable with their bodies and happier human beings?

 The court employ the terminology of fear with the argument that “Long-term cross-sex hormone treatment may cause temporary or even permanent infertility”. Yes, many (but certainly not all) young people on blockers do go on to take cross-sex hormones and infertility is a possible outcome, but this was discussed in great detail with us and with our teenager. That’s why you do everything you can to get your child to a fertility clinic and preserve their eggs or sperm. Just in case. Just to be sure. Like we did. On the advice and persistence of the very people you tell us are harming our vulnerable children.

                                                                 

This draconian judgment will have a profound effect on young trans people's ability to access timely medical support. And what do people do when they are desperate? They turn to the internet and to any source they can to get treatments that are unregulated, dangerous and life-threatening. We had to work with meticulously timed intervention on the advice of GIDS; to ensure enough pubertal development had happened to provide robust physical outcomes later in life, but also to ensure our child was protected from the terrifying ordeal of full irreversible puberty.  Every possible angle was covered, every potential future outcome was discussed; not one single stone was unturned. The protocol to wait until Tanner Stage 2 before prescribing blockers ensures the most accurate level of timely intervention and that is exactly what we got. We have received nothing but thorough and painstaking levels of service and scrutiny from GIDS. It has been horrendously slow. Why? Because they do not set young children on this pathway without rigorous assessments, counselling and observation.

 What a dark, dark judgement this is for trans rights. HUMAN rights. Every trans adult out there was once a terrified trans child. These adults will overwhelmingly tell you how they could only have dreamt of blockers being available to them when they were young and how much misery it would have saved them to avoid or delay puberty. Why aren’t the High Court talking to these people? They are literally everywhere. These are the very people that would tell you over and over again that their only regret in transitioning is that blockers were not available to them when they were younger: at the very age when they could have prevented immense struggle and suffering as their bodies changed beyond their control. Many of these people will tell you how much pain they were in and how they couldn’t see a way out or how they often considered ending their lives. 

 The failings in this case are devastating. In addition to Bell’s legal team, they had the support of the infamous transphobic lobby group Transgender Trend.  Yes, you heard me correctly, Trend. Because it is of course ‘trendy’ to be an outcast, to be bullied and ridiculed, to have vitriol and discrimination poured on you from much of humanity, to hate your body and to want to die because you will ‘never fit in’. This pernicious myth, inflamed by TERFS and the political right is retrograde and wildly inaccurate. As a society we used to ask the same archaic questions about homosexuality – “when did you ‘decide’ to be gay?” , “Here let’s give you some ‘conversion therapy’ to correct your aberrant sexuality” or “Isn’t it trendy to be gay?”.   This disturbing and discriminatory lobby group are profoundly transphobic yet were astonishingly given a voice in this court case. This is the same group that proposed that “the government needs to take action to remove all transgender guidance and resources from schools and social services departments to safeguard children and prevent any further teaching of this ideology to children as ‘fact’. The Health Secretary must take steps to curb the influence of these lobby groups and eliminate ideology from medical theory and practice. Government departments, health bodies and schools must cancel their membership of the Stonewall Diversity Champions scheme”. It’s like stepping back in time. Ideology?! My 4-year old child asking me a decade ago ‘why god made them wrong’ and being persistent and consistent about their gender identity during their entire childhood is not the product of ideology – she had never read a newspaper, social media didn’t exist, and she wasn’t ‘groomed’ by some mythical ideological agenda – she was and is just inherently and inarguably trans. Yet who was there to argue against this terrifying violation of trans children’s rights alongside the GIDS staff? In defence of the Tavistock, where were the NHS commissioners? Where was their legal representation? Where were their allies and supporters in court? Why weren’t they talking to Gires (Gender Identity Research & Education Society) or Gender GP, or Stonewall or Mermaids, the incredible UK charity who have worked 24/7 since 1995 to support trans kids and their families. They all have a huge amount of both factual and anecdotal evidence in support of puberty suppressants. Where was the High Court’s consultation period with these critically important organisations? Why is the UK system so shamefully inept at providing the proof that we know is out there?

 We all knew the backlash would keep punching us in the face. It feels like section 28 all over again, like Stonewall all over again, like throwing yourself under a bus all over again. Apparently “Even for 16 and 17-year old’s, it may be appropriate to involve the courts in the decision”. So, treat trans kids differently to all other kids then, right? Kids that at 16 can have sex, drive, drink and undergo invasive cosmetic surgery with parental consent, whilst my trans child and her parents STILL can’t decide what they do with their body and mind? So, with parental consent, cisgender under 18’s can routinely have breast implants, butt lifts, nose jobs, liposuction and vaginal surgery to ‘neaten the labia’ but a trans person of the same age cannot consent to change their body too? ALL aesthetically driven cosmetic surgery is the removal of healthy tissue but this is routine, endemic and perfectly socially acceptable. So, if it’s in the name of vanity it’s OK, but if it’s life-changing for somebody with gender dysphoria it is suddenly some kind of shocking, irreversible self-mutilation? Do they not see the blatant discrimination in this?

Currently, before accessing medical intervention, the competency of patients under 16 years of age must be established. In the UK, competency is assumed from age 16, and young people under that age are required to be ‘Gillick competent’. This is achieved by following the ‘Fraser’ guidelines, by which clinicians must ensure that young people can give ‘informed consent’ for their treatment, that is, they understand the positive effects of treatment, but also the potential side-effects. If a court can determine that a young person cannot give informed consent, how do they propose to prove it? What are the implications of this assumption if you were to use the example of abortion rights in its place – if a young woman decided to undergo an abortion and then deeply regretted this irreversible decision later in life, would this mean that all young women should need a court order to terminate a pregnancy and have to defer their own agency and self-determination to a judge? Where would this frightening body-policing stop? The ‘best interest’ determination is currently decided by the patient and her doctor, not the judicial system. Gillick is there to mitigate against error and provide a sound, evidence-based risk assessment – so why do supporters of this ruling want to stretch Gillick’s logical and rational principles to breaking point? They want to break it to uphold a broader and more sinister agenda that undermines and erases fundamental trans rights.

Keira Bell, who began de-transitioning last year, said: "It was heart-breaking to realise I'd gone down the wrong path." Yes Keira, I’m sure it was, but it’s also heart-breaking to see your child try to cut off their genitals or tell you they want to die if they can’t be who they truly are. Don’t talk to parents of trans kids about heartbreak. Many of us live it daily. And we’ve just received a whole load more.

 

As such, I call upon those in positions of power and influence to help open a consultation specifically for trans youth and their parents, and the organisations that support them, to allow their voices to be heard in the High Court and add gravitas to the Tavistock & Portman NHS Foundation Trust’s stated intention to appeal this ruling. The NHS cannot fail to provide care for its young patients and just stop prescribing. It is imperative that they uphold their duty of care and provide data that aligns their knowledge with those of transgender centres of excellence around the world such as The Children’s Hospital in Melbourne, The Paediatric Association of America ,The Centre for Transgender Care in San Francisco and the inspirational Johanna Olson MD -The Adolescent Medicine physician and Assistant Professor at Children’s Hospital Los Angeles, whose highly specialised work with transgender children has established her as a global expert in this field. They have all practiced for many years using evidence-based International guidelines that clearly state blockers are safe, well-evaluated and reversible. They know the longer-term and positive outcomes of treatment on youth. So do the families they work with. This ruling is tantamount to gagging us all.

 

We need to open this up and not atomise the UK’s trans healthcare system or allow GIDS to suffer the ignominy of being the overstretched, overwhelmed and under-resourced service that can no longer do its job. To be on the right side of both history and democracy we need to make sure that the UK comes into line with more forward-thinking countries. We are at great risk of being left behind with a tragic legacy of transphobic-led policy provision and a generation of young trans people catastrophically failed by the systems that are supposed to protect them.

I implore you to act on behalf of us, the young people of the UK and their desperate families, so that the thousands of unheard voices can have their rightful say and overturn this profoundly harmful judgment.

Petition · Transgender Healthcare Services In The UK Are Broken - URGENT Improvements Are Needed · Change.org

 Nicky C

6th December 2020