Children under-16 CAN take life-changing puberty blockers without their parents' consent, rules Court of Appeal as it overturns landmark verdict against Tavistock gender clinic

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Children under-16 can now take puberty blockers without their parents' consent as the Court of Appeal overturned landmark ruling against an NHS gender clinic.

In an historic ruling last December, the High Court ruled that children under 16 with gender dysphoria could only consent to the use of hormone-blocking treatments if they understood the 'immediate and long-term consequences'. 

The judges said it was 'highly unlikely' that a child aged 13 or under would be able to consent to the treatment, and that it was 'doubtful' that a child of 14 or 15 would understand the consequences. 

But 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, finding doctors should instead exercise judgment about whether their patients can properly consent.

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' - against the Tavistock and Portman NHS Foundation Trust, which runs the UK's only gender identity development service for children.

Critics had argued that puberty blockers could leave youngsters infertile and have longer-term effects on sexual function and bone density. 

Ms Bell today said she was 'obviously disappointed' with the ruling, and said the case had 'shone a light into the dark corners of a medical scandal that is harming children.'

She added: '[Today's ruling] did not grapple with the significant risk of harm that children are exposed to by being given powerful experimental drugs.

'I am surprised and disappointed that the court was not concerned that children as young as 10 have been put on a pathway to sterilisation.'

High Court ruled it was 'unlikely' a child aged 13 or under could consent to puberty-blocking treatment. But the Tavistock and Portman NHS Foundation Trust (pictured) brought an appeal

A mother of an autistic teenager who is on the waiting list for treatment, only known as Mrs A, supported Ms Bell in their successful legal challenge. 

Hormone, or 'puberty', blockers pause the physical changes of puberty, such as breast development or facial hair.

In Friday's 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.'

They added: 'It placed patients, parents and clinicians in a very difficult position.'

During the two-day appeal earlier this year, 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.

But Jeremy Hyam QC, representing Ms Bell and Mrs A, argued 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. 

The case was brought by Keira Bell (pictured), a woman who began taking puberty blockers when she was 16 before 'de-transitioning', and mother of a teenager who is on the waiting list

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. 

The chief executive of LGBT charity Stonewall welcomed the Court of Appeal's ruling.

But Keira Bell said she was 'surprised and disappointed' in the decision but said she had no regrets in bringing the case.

Adding that she believed the medical service had become 'politicised', Ms Bell said she will be seeking permission to appeal to the Supreme Court.

She said: 'I am obviously disappointed with the ruling of the court today and especially that it did not grapple with the significant risk of harm that children are exposed to by being given powerful experimental drugs. 

'I am surprised and disappointed that the court was not concerned that children as young as 10 have been put on a pathway to sterilisation.' 

'It has shone a light into the dark corners of a medical scandal that is harming children and harmed me,' she continued. 

Ms Bell also said: 'A global conversation has begun and has been shaped by this case. There is more to be done. 

'It is a fantasy and deeply concerning that any doctor could believe a 10-year-old could consent to the loss of their fertility.' 

Adding that she believed the medical service had become 'politicised', Ms Bell said she will be seeking permission to appeal to the Supreme Court.

After the ruling, a Tavistock and Portman NHS Foundation Trust spokesperson said: 'We welcome the Court of Appeal's judgment on behalf of the young people who require the GIDS (Gender Identity Development Service), and our dedicated staff.

'We recognise the work we do is complex and, working with our partners, we are committed to continue to improve the quality of care and decision making for our patients and to strengthen the evidence base in this developing area of care.' 

An NHS spokesperson said: 'The NHS commissioned Dr Hilary Cass to review gender identity services prior to the original High Court ruling to ensure the best model of safe and effective care is delivered - this will set out wide-ranging recommendations, including on the use of puberty blockers and the many contested clinical issues identified by the court.

'An independent multi-professional review group will continue to confirm whether clinical decision making has followed a robust consent process now that the endocrine pathway has been reopened by the Tavistock.'

In a judgment on Friday, the Court of Appeal said it was inappropriate for the High Court to give the guidance. Pictured: Supporters of Gendered Intelligence at the Royal Court of Justice

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'.

Liberty director Gracie Bradley said: 'This ruling is a positive step forwards for trans rights in the UK and around the world.

'As the court has recognised, trans children should be able to choose and receive the healthcare they need on the same basis as all other children. 

'Access to treatment is life-affirming for trans children and young people - without it the risk of serious, long-term harm dramatically increases. 

'This case has implications for trans children not just in the UK, but also all over the world. Other countries had already started using the UK ruling to restrict trans rights - now they must take note of this judgment, too. 

'Liberty has a long and proud history of standing up for trans rights and we will keep working with others to build a society where trans rights are recognised as human rights.'

According to the World Professional Association for Transgender Health (WPATH) guidelines, very few people regret treatment of their gender dysphoria, the court heard. 

'They refer to satisfaction rates across studies ranging from 87% in male to female patients and 97% of female to male patients and regrets were extremely rare,' Fenella Morris QC, for the trust previously said in court.

Ms Bell's lawyers previously argued there is 'a very high likelihood' that children who start taking hormone blockers will later begin taking cross-sex hormones, which they say cause 'irreversible changes'.

But the Court of Appeal previously heard it is not inevitable that a young person will move from puberty blockers to cross-sex hormones - which will only be prescribed to those over 16 - with even fewer going on to have surgery.

Ms Morris later said that puberty blockers are said to be 'fully reversible' in international guidelines relied upon by the trust.

She added that children or young people who are considering going on to puberty blockers are told about the effects on their fertility that may be caused by later stages of transition.

Highlighting that it is not inevitable that a young person will continue on to cross-sex hormones after puberty blockers, she added: 'The question is whether a child is counselled about fertility implications at the next stage and you can see from the material ... all of that is explained at the initial stage 

'There is no suggestion anywhere that this is one pathway ... there is no shying away from explaining to children and young people what the possibilities are.'

Why did the NHS let me change sex? Keira Bell tells her story in the hope that it will 'serve as a warning to others'

IT engineer Miss Bell is pictured outside the Royal Courts of Justice in London in January

In an interview earlier this year, Keira told the Daily Mail what happened to her, in order to highlight her plight and, she said, serve as a warning to others. 

Keira was brought up in Hertfordshire, with two younger sisters, by her single mother, as her parents had divorced. Her father, who served in the U.S. military in Britain and has since settled here, lived a few miles away.

She was always a tomboy, she said. She did not like wearing skirts, and can still vividly remember two occasions when she was forced by her family to go out in a dress.

She told the Daily Mail: 'At 14, I was pitched a question by my mother, about me being such a tomboy. She asked me if I was a lesbian, so I said no. She asked me if I wanted to be a boy and I said no, too.'

But the question set Keira thinking that she might be what was then called transsexual, and today is known as transgender.

'The idea was disgusting to me,' she tells me. 'Wanting to change sex was not glorified as it is now. It was still relatively unknown. Yet the idea stuck in my mind and it didn't go away.'

Keira's road to the invasive treatment she blames for blighting her life, began after she started to persistently play truant at school. An odd one out, she insisted on wearing trousers — most female pupils there chose skirts — and rarely had friends of either sex.

When she continually refused to turn up at class as a result of bullying, she was referred to a therapist.

She told him of her thoughts that she wanted to be a boy.

Very soon, she was referred to her local doctor who, in turn, sent her to the child and adolescent mental health service (CAMHS) near her home. From there, because of her belief that she was born in the wrong body, she was given treatment at the Tavistock.

Keira had entered puberty and her periods had begun. 'The Tavistock gave me hormone blockers to stop my female development. It was like turning off a tap,' she said.

'I had symptoms similar to the menopause when a woman's hormones drop. I had hot flushes, I found it difficult to sleep, my sex drive disappeared. I was given calcium tablets because my bones weakened.'

Keira claimed she was not warned by the Tavistock therapists of the dreadful symptoms ahead.

Her breasts, which she had been binding with a cloth she bought from a transgender internet site, did not instantly disappear. 'I was in nowhere land,' she said.

Yet back she went to the Tavistock, where tests were run to see if she was ready for the next stage of her treatment after nearly a year on blockers. 

A few months later, she noticed the first wispy hairs growing on her chin. At last something was happening. Keira was pleased.

She was referred to the Gender Identity Clinic in West London, which treats adults planning to change sex.

After getting two 'opinions' from experts there, she was sent to a hospital in Brighton, East Sussex, for a double mastectomy, aged 20. 

By now, she had a full beard, her sex drive returned, and her voice was deep.

After her breasts were removed, she began to have doubts about becoming a boy.

Despite her doubts, she pressed on. She changed her name and sex on her driving licence and birth certificate, calling herself Quincy (after musician Quincy Jones) as she liked the sound of it. She also altered her name by deed poll, and got a government-authorised Gender Recognition Certificate making her officially male. 

In January last year, soon after her 22nd birthday, she had her final testosterone injection. 

But, after years of having hormones pumped into your body, the clock is not easily turned back. It is true that her periods returned and she slowly began to regain a more feminine figure around her hips. Yet her beard still grows.

'I don't know if I will ever really look like a woman again,' she said. 'I feel I was a guinea pig at the Tavistock, and I don't think anyone knows what will happen to my body in the future.' 

Even the question of whether she will be able to have children is in doubt.

She has started buying women's clothes and using female toilets again, but said: 'I worry about it every time in case women think I am a man. I get nervous. I have short hair but I am growing it and, perhaps, that will make a difference.' 

By law she is male, and she faces the bureaucratic nightmare of changing official paperwork back to say she is female.