If you are a trans child or if you’re the parent or carer of a trans kid, the last 24 hours have been traumatic. England’s High Court has ruled that children seeking puberty-blocking drugs will have to demonstrate a higher level of “Gillick competence”—maturity of thinking and understanding of consequences—than in any other comparable, non-trans circumstance.
A court order will now be required before clinicians will be able to prescribe the life-saving drugs. The Tavistock and Portman NHS Trust, against whom the case was brought, told the BBC it was “disappointed,” but immediately suspended such referrals for under-16s.
Trans children who have waited years for relief from the fear and pain of going through an unwanted puberty have a new and intimidatingly high hurdle to jump. If this smacks to you of discrimination, then that’s because it is. Worse still, it is a decision that stems from the judges swallowing one of the cruellest misinformation campaigns of modern British times.
The impact on families is sickening. Last night I spoke to Jane (not her real name) the mother of a trans child. I’ve known Jane for several years; she is redoubtable and courageous in her love for and defense of trans children but it is obvious that even she is shaken. She told me: “I am watching other parents of trans kids making plans to take their kids abroad, some say they’ll even emigrate if needs be.
“Others are too fearful to even tell their kids about the news, after their children have already undergone the gamut of waiting years for an appointment, undergone psychological and physical scrutiny, to have essential medical support ripped away from them at the last moment. I feel devastated and let down, both by the judicial system and by the Tavistock. It never should have got to this position where established, decades-long, healthcare practices, endorsed and followed internationally, is being removed.”
Walk for a moment in the shoes a parent trying today to reassure their distraught trans child. So far you, your child, and your family will likely have been though the upheaval that follows when a trans child comes out. Not everyone will be accepting, not everyone will be kind, close family, old friends, teachers… sometimes even your co-parent. Open a newspaper and you’ll read little about trans lives but misinformation and naked hatred.
Then there’s the long and painful road to getting medical support and help. Three or more years on an NHS waiting list just to be seen, and then at least 10 appointments with specialist psychologists and doctors—another year vanished—before your child has any chance of seeing an endocrinologist who even then may or may not prescribe puberty blockers.
It’s hardly the conveyor belt speeding naive parents and delusional children to hell that obsesses newspaper columnists and editors, but that’s how it is painted by the people behind this case and it’s a lie that Britain’s shockingly transphobic media is only too willing to propagate. Tragically, it is also apparent that the judges fell for it, too, and among its many negative ramifications for trans families it may mean that any parent who, in line with international treatment standards, accesses puberty blockers for their child could have the child taken into care.
For children who are clear in their gender identity puberty blockers are lifesavers. Instead of developing secondary sex characteristics when puberty strikes, the process is put on hold. They are not ‘experimental’ as the claimants’ representatives told the court. There is no evidence of harm and a great deal of evidence that puberty blockers are a vital tool in making the lives of young trans people tolerable.
With more than 30 years of clinical use puberty blockers are very well tested, safe, and entirely reversible. Stop taking them and puberty will carry on from where it left off, fertility unaffected. For trans girls this means no Adam’s apple, male chin or other male skull development or towering over your cis female peers. For trans boys, it means no periods, hips or breasts.
Above all it means not wanting very much to die as you go through the anguish of watching in the mirror as puberty wrecks your chances of acceptance, blending in and avoiding later surgery. There were no puberty blockers or indeed any help for trans kids in England back in the 1970s, but I wish there had been. I’m trans and I well remember at 14 sitting up all night with a loaded gun in my mouth, deciding whether I should die or live a male life that didn’t feel so much feel like mine as a never-ending torture.
Suicide, self-harm, poor mental health, social ostracism and bullying are all too common when trans kids don’t have options and support.
Time is another option trans kids need. While many trans people report that, like me, they knew from a very early age what gender they were and that it didn’t match what was between their legs, for those whose certainty in their gender identity has never been absolute puberty blockers give an opportunity to learn and reflect on whether how they felt at 6 is the same as they feel at 16. They need time. Without access to puberty blockers they may not get it.
Let us turn to the people who brought the case and those supporting them. Who would sue a gender identity clinic for giving life-supporting treatment when you needed it? One of the litigants is Keira Bell, a 23-year-old de-transitioner who is a former Tavistock and Portland patient. She claimed that she was pressured into taking puberty blockers, a claim the clinic denied.
Appearing on the court steps after the judgement Bell was flanked by her solicitor, Paul Conrathe, an evangelical Christian with direct links to the U.S.-based Alliance Defending Freedom, an organization designated as an anti-LGBTQ hate group by the Southern Poverty Law Center.
Bell, who said her case “wasn’t political,” then posed for pictures cuddling some of the most hateful and mendacious of the U.K.’s anti-trans campaigners who have made curtailing trans children’s access to medical help their priority. The other litigant, who cannot be named, is the mother of a trans child who opposes their child’s request for treatment.
I asked Jane how she feels about Bell. “I feel sorry for Keira, she is so obviously being used by a group of people wanting to use her for their own ideological aims,” she told me. “I understand she finds herself in a place and is unhappy with the destination. But she is not our children, nor does she know them. Yet she claims to speak in their ‘best interest’ knowing nothing about our children or the everyday challenges they face.”
Parents are deeply upset at the Tavistock for not fighting harder for trans kids. “It could have prepared better for the case, and then jumping to cancel appointments and impose sanctions, even to over-sixteens who weren’t included in the verdict,” Jane told me. “I am now taking steps to ensure my own child’s healthcare is secure and ongoing, but I am incredibly worried about the future for many young trans children, not only in securing their healthcare, but also growing up in a country where this could happen.”
The Tavistock and Portman NHS Foundation Trust said that it recognized the anxiety that the outcome would cause for patients and their families and would appeal the decision and the Good Law Project, a not-for-profit that uses litigation to defend human rights, challenge abuses of power and protect the interests of the public said it was taking advice from leading public and healthcare legal experts.
“What we can do to protect trans young people from institutional transphobia we will do,” Good Law Project barrister Jo Maugham tweeted. “The decision yesterday was a shameful moment for our legal system and I will not rest until it is overturned.”
That’s heartening and I have confidence that a judgement as harmful and as rooted in misinformation and outside of international best practice as this will not be allowed to stand. In other countries, notably Australia, this has already been tested and eventually the law settled on the side of trans kids and their families and not those who would deny them health care.
But for the children and parents who will now have to navigate months or years of restriction and uncertainty it is still a cruel, cruel blow and must be endured when endurance is already beyond any safe or normal bounds. For the anti-trans campaigners, tied as they are to the Christian right and a gruesome international cast of players that have applauded Trump’s performative transphobia, the cruelty has always been the point.