PATHSA response to the Bell vs. Tavistock judgement

PATHSA with professional conviction disagrees with the recent judgement of the London High Court in the strongest possible terms.  

The judgement concludes that:

1. Children under 16 are highly unlikely to be able to give consent to taking hormone blockers.
2. It will force them to be assessed by the law courts, as to whether they are able to consent.
3. They conclude that hormone blockers set children on an irreversible path of taking cross-sex hormones later and have surgeries, that they might otherwise not have chosen to have.
4. It also concludes that there is “no proven benefit to this treatment physically or psychologically” for children under 16 years old and that
5. The practice is ‘experimental’.

Each point will be discussed below.

1. Transgender youth are invariably significantly/profoundly advanced in understanding gender identity as compared to their cisgender peers, as they are faced with prejudice and their gender dysphoria on a daily basis and usually constantly think and reflect critically and deeply about all the potential issues, including taking hormones and outcomes, on a daily basis.
2. Putting essentially bureaucratic and legalistic obstacles in place and slowing down the process by getting courts to assess and decide, is not only unnecessary, but unethical. Appropriately trained gender specialists, with the appropriate clinical knowledge, skills and expertise, should assess transgender youth, not courts. Slowing down the interventions can produce permanent damage, as bodies go through puberty and develop irreversible changes before 16, worsening outcomes permanently. The Tavistock waiting list is unethically long (22 to 26 months as of November 2019) for youth urgently needing to get onto hormone blockers to stop their bodies changing. Further lengthening this period by getting courts to give their consent seriously worsens this situation. Parents and children should be presented with the known facts relating to the child’s situation and make their own informed decisions accordingly. They make the best decisions they can, and neither health professionals nor the courts should be making these decisions for them. This judgement has demonstrated how bad the courts could be at understanding transgender youth and how paternalistic they are towards them and their families. They are likely to be very poor at helping them make appropriate decisions. Where there is uncertainty, we should be letting young people and their families make the decisions and not making decisions for them.
3. Youth are given hormone blockers only at Tanner stage 2 at a stage where research had already shown over 90% of them will not change their gender identity. Deducing that hormone blockers cause more children to sustain a transgender gender identity is simply false.
4. It is alarming that the court has deduced there is no proven benefit of the hormone blockers. The judgement fails to recognize how essential ‘passing’ as their identified gender is for the future happiness and wellbeing of trans and gender diverse children.  The judgement fails to appreciate the permanent poor outcomes of transgender youth having to go through the psychological trauma of going through a puberty that they do not want and which result in permanent physical changes (e.g. voices dropping and growing breasts) that cause them to face a life time of discrimination and gender dysphoria. Their chances of having a good mental health outcome are seriously reduced. Any health professional working with transgender youth receiving hormone blockers will know how patently false these statements are, as will the vast majority of their parents. The effects of the hormone blockers are life changing in a positive way and in numerous cases life saving for suicidal transgender youth. No mention is made of the 50% suicide rate if young people are not given appropriate support in line with the evidenced based guidelines.
5. The court judgement ignores the proven benefits and over-emphasizes fears of the unknown, concluding that there is real uncertainty of the short- and long-term consequences of treatment, and that the treatment is ‘experimental’. This ignores the fact that transgender youth have been put on hormone blockers for over 20 years now and the outcomes are overwhelmingly positive, among a group of teenagers with a very high risk of poor mental health outcomes without these interventions. There is a major concern about evidence base in the literature from the Tavistock and the judgement ignores the fact that the WPATH protocols with hormone blockers are now practiced all over the world, as not doing so is clearly unethical in terms of poor outcomes for the transgender youth involved. The well understood and proven risks of not giving them to appropriately assessed and supported transgender youth far outweigh the possible risks of giving them, which have so far been shown to be minimal in comparison. There are numerous studies to support the WPATH guidelines.

This judgement has profoundly serious and damaging consequences to the future health and happiness of transgender youth, not only in the UK, but potentially all over the world. They appear to have relied heavily on information from transphobic ‘experts’ who have presented a very inaccurate picture of the reality of why hormone blockers are standardly used in gender clinics all over the world. The language used is at times transphobic and disrespectful of young transgender youth’s gender identity. (e.g. natal girls and natal boys as opposed to birth assigned girls and boys.)

The conclusions drawn in this judgement indicate that these judges have failed in several ways to understand transgender youth and their needs.

We, as PATHSA, strongly oppose this appalling judgement and support the appeal with the hope that the judgement will be overturned.