Trans children under the age of 16 can only consent to puberty blockers if they understand the nature of the treatment, a High Court has ruled.

The ruling was given during a landmark case, in which Keira Bell, 23, brought legal action against Tavistock and Portman NHS Trust, which runs the UK’s only gender identity development service for children.

Ms Bell, who has since detransitioned, began taking puberty blockers at 16, and went on to take cross-sex hormones and undergo a double mastectomy. A second legal challenge was also put forward by Mrs A, the mother of a trans autistic girls, 16.

Both Ms Bell and Mrs A asked the High Court to rule it unlawful for trans children to be prescribed hormone blockers without an order from the court that such treatment is in their ‘best interests’.



In response, the Tavistock and Portman NHS Trust said the claimants were trying to ‘impose a blanket exclusion’ on children under the age of 18 being able to consent to medical treatment, which they described as a ‘radical proposition’.

In a judgement today, Dame Victoria Sharp – sitting with Lord Justice Lewis and Mrs Justice Lieven – said that children under 16 needed to understand ‘the immediate and long-term consequences’ of puberty blockers before they receive them.

She described a child’s ability to give ‘valid consent’ as being able to ‘understand, retain and weigh’ a number of factors involved in the treatment.

These would include understanding ‘the immediate consequences of the treatment in physical and psychological terms’, and the fact that ‘the vast majority of patients taking puberty blocking drugs proceed to taking cross-sex hormones’, meaning they were a ‘pathway to much greater medical intervention’, she noted.

Dame Victoria also said children would need to understand the impact of the ‘treatment pathway’ on ‘future and life-long relationships’, and be aware of the ‘unknown physical consequences of taking puberty blocking drugs and the fact that the evidence base for this treatment is as yet highly uncertain’.

She added that the court was only ruling on the informed consent of a child to take puberty blockers and not the ‘benefits or disbenefits’ of the treatment.

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