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UK Court of Appeal rules that trans, gender diverse teens can give consent to delay puberty treatment

The UK ruling preserves access to medical treatment for transgender and gender diverse teenagers; and protects the ability of physicians, not the courts, to determine the capacity of a person under 16 to consent to medical treatment.

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The UK Court of Appeal ruled that transgender and gender diverse teenagers are competent to give consent to treatment to delay puberty.

This decision – which overturns the court’s December 2020 ruling in Bell v Tavistock and Portman NHS Health Foundation – preserves access to medical treatment for transgender and gender diverse teenagers; and protects the ability of physicians, not the courts, to determine the capacity of a person under 16 to consent to medical treatment.

The Endocrine Society and a coalition of LGBTQ+ youth and reproductive health organizations argued in a joint submission to the Court of Appeal of England and Wales that transgender teenagers should be able to give informed consent to treatment the same way teenagers with other medical conditions can.

“We are pleased the court agreed that the rules governing consent must be applied the same way to transgender and gender diverse adolescents as they are to other adolescents who are making decisions about medical care,” said Sabine Hannema, M.D., Ph.D., a paediatric endocrinologist at Amsterdam UMC in the Netherlands, a co-author of the Society’s Clinical Practice Guideline on Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons and a co-author of the World Professional Association for Transgender Health statement responding to the Bell v Tavistock ruling.

“We hope this ruling will set a precedent protecting access to care for transgender teenagers in the United Kingdom and in other countries,” Hannema said.

The interveners in the case included Gendered Intelligence, a community interest group for trans youth, and youth sexual health organization Brook, as well as the Endocrine Society. The intervention was supported by the Good Law Project’s Legal Defence Fund for Transgender Lives.

International medical organizations — including the Endocrine Society, the World Professional Association for Transgender Health, the European Society of Endocrinology, the European Society for Pediatric Endocrinology, and the Pediatric Endocrine Society — agree on the appropriate care for transgender people. Scientific studies support the concept that biological factors, in addition to environmental ones, contribute to the development of gender identity. The Court referred to the Endocrine Society’s clinical practice guidelines on gender dysphoria/gender incongruence as the relevant national and international guidelines on which Tavistock relied.

Gender-affirming care, as part of a multidisciplinary approach, is widely accepted as standard practice for transgender and gender diverse teenagers. Prior to puberty, transgender children are encouraged to explore their gender identity. A mental health professional can provide support in this process. After transgender and gender diverse minors start puberty, prescribing hormones to delay puberty is the recommended strategy after careful screening, if it is desired by the patient and if diagnostic and treatment criteria are met.

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Scientific research shows that delaying puberty and providing teens with access to gender-affirming hormone therapy, when administered by a trained professional following a thorough assessment, improves psychological functioning and is potentially lifesaving. A June 2020 study published in the Journal of Adolescent Health found that transgender and gender diverse youth who had started treatment to delay puberty had lower suicidality and improved psychological functioning, comparable to the general population, while those who had not yet begun treatment were found to have higher psychological problem scores and increased rates of suicidality.

The treatment to delay puberty in a reversible manner gives adolescents more time to explore their options.


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