Court of Appeal overturns puberty-blocking drugs ruling for children with gender dysphoria

Doctors can prescribe puberty-blocking drugs for patients under the age of 16 with gender dysphoria without parental consent, the Court of Appeal has ruled.

The landmark ruling reverses a High Court decision made in December 2020 that under-16s were unable to give informed consent to the treatment, which temporarily delays the onset of puberty.

Judges ruled it was "highly unlikely" under-13s would be able to consent, while it was “very doubtful” a child of 14 or 15 would understand the long-term consequences of the treatment.

The Tavistock and Portman NHS Foundation Trust, which runs the UK’s only gender identity development service for children, brought an appeal against the ruling in June.

In a judgment on Friday, the Court of Appeal said it was inappropriate for the High Court to give the guidance and ruled it is for doctors to exercise their judgment about whether their patients can properly consent.

In their ruling, the Lord Chief Justice Lord Burnett, with Sir Geoffrey Vos and Lady Justice King, said: “The court was not in a position to generalise about the capability of persons of different ages to understand what is necessary for them to be competent to consent to the administration of puberty blockers.”

“It placed patients, parents and clinicians in a very difficult position," they added.

The original case was brought by Keira Bell – a 24-year-old woman who began taking puberty blockers when she was 16 before later “detransitioning” – and the mother of a teenager who is on the waiting list for treatment.

During the two-day appeal earlier this year, the Tavistock’s lawyers argued the ruling was “inconsistent” with a long-standing concept that young people may be able to consent to their own medical treatment, following an appeal over access to the contraceptive pill for under 16s in the 1980s.

However, Jeremy Hyam QC, representing Ms Bell and Mrs A, argued policies and procedures at the Tavistock “as a whole failed to ensure, or were insufficient to ensure, proper consent was being given by children who commenced on puberty blockers”.

Human rights group Liberty, which intervened in the appeal, said the High Court had imposed a serious restriction on the rights of transgender children and young people to “essential treatment.”

The Court of Appeal heard the Tavistock does not provide puberty blockers itself but instead makes referrals to two other NHS trusts – University College London Hospitals and Leeds Teaching Hospitals – who then prescribe the treatments.

John McKendrick QC, for the other trusts, told the court the median age for consenting to puberty blockers is 14.6 for UCL and 15.9 for Leeds.