Is puberty delaying treatment ‘experimental treatment’?

Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents

“…A medical ethics approach is also relevant, one that appreciates gender diversity as an expected aspect of human diversity, rather than something to be avoided at all costs, including the cost of significant psychological decompensation of gender diverse individuals in the absence of affirmative treatments. It is important to realize that allowing puberty to progress in adolescents who experience gender incongruence is not a neutral act and may have lifelong harmful effects for a transgender young person such as stigmatization, personal physical discomfort, difficulty with sexual function, and difficulty with social integration (Giordano, 2008;Giordano & Holm, 2020;Kreukels & Cohen-Kettenis, 2011). In addition, individuals may have to endure expensive and invasive medical procedures when they are older, such as hair removal or feminizing facial surgery for women, and mastectomy for men, interventions that can be avoided by the use of puberty blockers.…”

The rights and interests of trans and intersex children: considerations, conflicts and implications in relation to the UNCRC

“…This is particularly clear from the recent English and Welsh High Court judgement (Quincy Bell and Mrs A v The Tavistock and Portman NHS Foundation Trust, 2020), about the ability of children and young people under the age of 16 to give fully informed consent to treatment with medication to pause puberty. Although the effects of this treatment are generally considered reversible, with puberty recommencing if it is stopped (Kim & Lee, 2012;Kuper, 2014), the court also took into consideration the fact that most children who have consistently maintained a cross-gender identity into early adolescence, and who therefore qualify for puberty blockers, tend then to go straight on to take cross-sex hormones, usually from age 16, followed by surgery from age 18 (Brik, Vrouenraets, de Vries, & Hannema, 2020;Giordano & Holm, 2020;Kuper, 2014), the effects of which cannot be reversed.…”

“…At time of writing this is a highly controversial judgement that is likely to be appealed, and I will not discuss it in detail further, except to note that some of the statements quoted here are themselves strongly contested (de Vries & Cohen-Kettenis, 2012;Giordano & Holm, 2020). It is clear, however, that the judgement is focused around the idea that puberty suppression, which is the first nonpsychological treatment given to trans children, is something that has such serious potential consequences, including loss of fertility, that 'it is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences' (Quincy Bell and Mrs A v The Tavistock and Portman NHS Foundation Trust, 2020: para 151).…”

“…Both trans and intersex children are likely to need a considerable amount of education in fertility and fertility preservation, and the effects of different interventions on this. For example, most children who have a sufficiently strong and persistent cross-sex identity to be prescribed puberty blockers go on to take cross-sex hormones from around age 16-18 (Brik et al, 2020;Giordano & Holm, 2020;Kuper, 2014;Meoded Danon, 2019;Pyne, 2017). If a trans male adolescent does not undergo puberty in the gender he was assigned at birth, he will be unable to conceive children without intervention (Giordano & Holm, 2020).…”

GnRHa (‘Puberty Blockers’) and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression

“…For example, in 2008 Giordano, the bioethicist, who had an influential role in the UK adoption of GnRHas at GIDS, claimed that 'anything (sic) is better than life in an alien (sic) body ' (cited in Biggs 2019; see also Giordano 2008 andGiordano andHolm 2020). However, in clinical practice, and case by case, there is no confident basis from which to test this dogmatic claim.…”