The High Court says puberty blockers are ‘experimental’, but evidence proves they can save trans kids’ lives
Dr Helen Webberley of private trans healthcare clinic GenderGP reflects on the landmark High Court ruling on puberty blockers and the “abundance” of evidence they benefit trans youth.
If a patient feels that the treatment they received from a doctor or hospital fell short of expected standards, they have every right to challenge that care. That is the premise upon which the case brought against the Tavistock and Portman NHS Trust should have been based.
Instead, it has become a debate between two parties about whether an established, evidence-based medical intervention should be available to a particular patient group; a patient group whose treatment, in and of itself, elicits a considerable amount of discrimination and debate.
In drawing its conclusion the court began by saying “there is real uncertainty over the short and long-term consequences of the treatment [puberty blockers] with very limited evidence as to its efficacy, or indeed quite what it is seeking to achieve”.
The judge’s assertion that the treatment is therefore “innovative and experimental” echoes a narrative that seeks to block access to this treatment which has been proven to be life-saving.
All medical intervention carries with it risks, benefits and side effects, which is why all potential outcomes should be thoroughly discussed with the patient to allow them to make an informed choice about their care. The decision around whether or not to go ahead with a particular form of treatment is based on the balance of benefits versus risks.
There is an abundance of literature available to support the benefits of the treatment available to trans youth.
Many robust clinical guidelines, by leading experts in the field, are available outside of the UK. These experts have considered the evidence and drawn the relevant conclusions based on thoroughly reviewed research papers, clinical protocols, case reports and their findings.
In early 2020, the world’s leading experts made the following unanimous statement in support of the use of puberty-blocking medication in trans youth: “The American Association of Paediatrics, The Endocrine Society and the World Professional Association of Transgender Health support providing transgender adolescents with gender-affirming care. This includes gonadotropin-releasing hormone analogs that temporarily block puberty by stopping the production of testosterone and estrogen.”
Clear evidence also exists of the harm caused by failure to intervene, with studies showing that transgender adolescents have a higher incidence of suicidality than cisgender adolescents.
It is vital that we remember, we are talking about deaths in young people.
It is of vital importance that we remember, when looking at these statistics, that we are not talking about the incidence of smoking, or tattoos – we are talking about deaths in young people. Suicide is life-changing, it is drastic, it is irreversible and not only is it happening to trans youth, but the potential treatment is being actively withheld.
Having capacity to consent to treatment lies at the core of every medical intervention, whatever the condition being treated.
Throughout history, young people have had to make difficult decisions about their health and wellbeing, and the UK understands that young people should be involved in every decision as much as possible.
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Indeed, in the UK, the GMC (General Medical Council) has produced very clear guidance on assessing capacity in those under 18: “You can provide medical treatment to a child or young person with their consent if they are competent, or with the consent of a parent or the court.”
While the judges in this case understand that we must take every step possible to ensure that young people have the capacity to understand what intervention means, we must still make sure the voice of that young person is heard. If you listen to the community talking about access to care on the NHS, this does not currently appear to be the case.
The medical evidence – that these interventions are beneficial – is clear and it is vital to consider both the long-term effects of having treatment, as well as those of not having that treatment.
Today, there will be many young trans people and their loved ones who will be frightened for what the future holds. The Tavistock and Portman NHS Trust has already put out a statement saying that it will appeal the judgement.
At GenderGP we will continue to assess capacity to make decisions, as we always have done, based on all the information available to us.
If ever we need the court to assist us in that, then we will ask.