Cutting access to puberty blockers undermines young trans people’s autonomy

Photography via Unsplash / Grace Madeline

Last week, the UK’s High Court of Justice gave a landmark ruling prohibiting the administration of puberty blockers to transgender people under the age of 16, unless they have a court order before receiving treatment. Meaning that trans children will have to get approval from a judge before they can start the life-saving medication, on top of the long waiting lists to see a gender specialist.

The ruling makes children and their families jump through even higher hoops to essentially prove their identities in court — another hurdle in an already arduous process to begin transitioning through the NHS. By restricting access to puberty blockers, the High Court of Justice has essentially curtailed trans kids’ right to exist as themselves.

Used to treat gender dysphoria in kids, puberty blockers are redeemed generally safe, reversible and medically necessary. Designed to stave off puberty, they give trans kids time to explore their identity and if they wish to proceed with medical transitions in the future. So why has the High Court Justice restricted access to them?

It all started when 23-year-old Kiera Bell brought legal action against the Tavistock and Portman NHS Trust, who funds the NHS’s only gender identity clinic. Kiera received puberty blockers at 16 and, having now detransitioned, argues that the clinic should’ve scrutinised her former identity as a trans man and desire to medically transition more than they did. Regretting her transition, she feels it necessary to ensure that trans kids don’t have the same access.

Bell brought the case against the Trust together with another claimant known to the public as Mrs A, a woman trying to prevent her daughter from receiving puberty blockers. Mrs A’s child is a 15-year-old autistic girl who is awaiting treatment at the clinic. Ruled in their favour, their case argued that anyone under 16 is unable to give informed consent about the risks associated with the medication and that a judge, rather than a clinician, should decide whether they are necessary.

Having effectively banned puberty blockers, the High Court ruling means that trans people have to prove their identities in court to receive the treatment they need. Putting trans kids at the mercy of a cisnormative legal system that is now further empowered to decide who qualifies for treatment — a process that is inherently demeaning and likely only afforded to those who have the access, time and resources to go to court. Also, it exacerbates existing inequalities in access to trans health care.

“Framing puberty blockers as somehow leading youth down a treacherous transgender path is almost comical if the impacts weren’t so grave”

What’s most devastating about this case is that the experience of an extreme minority has been used to determine access to healthcare for the vast majority of trans kids in England and Wales. It’s true that some trans people change their minds about medical transitions, but out of all of the trans patients who had appointments through the NHS’s adult gender identity clinic between 2016 and 2017, less than 1% of them expressed transition-related regret and even fewer began the process of detransitioning. The reasons for why someone regrets their transition are varied and many. A study in Sweden found that the biggest reason trans people regret their transition is because they subsequently lost the support of their family and friends.

The functioning premise of the ruling is that trans kids need to have a court approval order to gain access to the medication, because it’s highly unlikely that they will understand the risks associated with the treatment and that puberty blockers will likely precede patients moving on to taking cross-sex hormones and having gender affirmation surgery. This demonises trans health care by positioning medical transitions as a last resort, rather than a vital resource for many trans people’s mental health and embodiment.

Yet capitalising on the deeply transphobic belief that trans youth are simply going through a phase and must be “protected” from their whims of gender freedom, undermines young people’s self-knowledge and autonomy. It smoothly aligns with the transphobic logics leveraged against queer youth: children are unable to know themselves and influenced by the Transgender Trend™. As a result, they should not be afforded the healthcare they need.

Framing puberty blockers as somehow leading youth down a treacherous transgender path is almost comical if the impacts weren’t so grave. It signals to trans youth that they cannot be trusted to make their own medical decisions by restricting their bodily rights. The High Court is essentially saying: “protect the children, even from themselves!”, further perpetuating the idea that trans people are dangerous, that there is something to be protected from. This belief fuels justifications for transphobic violence and abuse.

What gets lost in conversations about medical transitions, a topic transphobes love to harp on about, is that they’re a tool of self-realisation. It’s one of the methods by which we are known to ourselves and those around us. As such, the state’s policing of trans bodies is an infringement upon our existence in the most literal sense.

Transphobic handwringing ultimately protects cis people and the naturalisation of the gender binary. It further constructs trans people as a threat to society, when the truth is that we as trans people, especially kids, deserve access to health care. It cannot be understated how this basic need correlates to our mental health, wellbeing, safety and ability to live our lives in the fullness of who we are from a young age. The need for assessing trans health care on an individual basis is undermined by this ruling because it prohibits puberty blockers almost entirely. The High Court’s insistence on stripping this access is indicative of its own limited imagination, the inability to support and affirm trans kids in their identities, rather than an impetus for social good.

And what happens now? The NHS Tavistock Trust will seek permission to appeal the ruling and campaigns to support trans people have already begun. The Good Law Project is currently crowd funding to build a legal defence fund for transgender lives. Together with two firms of solicitors and three counsellors, they are putting together legal responses to the ruling and interventions in the event of an appeal.

Mermaids UK is a charity that does vital work in supporting trans kids and their families.