The NHS gender identity clinic yesterday defended giving puberty-blocking drugs to children as young as ten.
Some young children are capable of consenting to being given the drugs because they already understand sexual concepts, judges were told.
On the second day of a landmark High Court hearing it was also revealed that three ten-year-olds have been given puberty-blockers after seeking treatment from doctors at the London clinic over the past year or so.
Regrets: The case is also being brought by Keira Bell (pictured), a former GIDS patient who took puberty-blocking and cross-sex hormone drugs as a 16-year-old to try to transition to a boy – a decision the 23-year-old now regrets
Around a quarter of patients given the drugs were 14 or under.
The case has been brought by a mother who is trying to prevent the clinic, run by the Tavistock and Portman NHS Trust, from giving puberty blockers to her 16-year-old daughter.
The drugs halt a child’s normal physical development during puberty, potentially making gender reassignment surgery easier later on.
The woman, who can only be called ‘Mrs A’ for legal reasons, fears her child will be fast-tracked for transgender medical treatment once she is seen by clinicians at the Gender Identity Development Service (GIDS) in London.
Mrs A believes her daughter’s desire to be male is driven by having Asperger’s syndrome, a mild form of autism.
She fears the GIDS will simply ‘affirm’ the girl’s belief that she is really a boy and wants the High Court to rule that hormone-blocker treatments for children under-18 should be subject to approval by the courts.
The case is also being brought by Keira Bell, 23, a former GIDS patient who took puberty-blocking and cross-sex hormone drugs as a 16-year-old to try to transition to a boy, but who now ‘deeply regrets’ undergoing the treatment.
Fenella Morris QC, representing the Tavistock, insisted yesterday that children as young as ten were capable of understanding any future consequences of starting puberty blockers.
She admitted such discussions with young children require ‘imagination’ because their life experience is ‘potentially limited’ and that the Tavistock ‘emphasises the autonomy of the child’.
But youngsters who question their biological gender often suffer anxiety and depression.
As a result, a decision not to give puberty blockers might ‘effectively be a decision to continue distress for the child’.
Asked what type of subjects are discussed with children by doctors while deciding whether they are mature enough to give consent to taking the drugs, she told the court: ‘If a patient was saying something along the lines of “I don’t understand what an erection is, I don’t understand what an orgasm is or how babies are made,” that individual does not have understanding which would allow them to make these choices.
‘Every consent conversation involves saying to the patient, “in X years’ time your decision will mean X”.’
Mrs A and Miss Bell (pictured) have brought the case because, they argue, young children are unable to give ‘informed consent’ to receiving treatments such as puberty blockers and may regret doing so later on in life
Asked what was discussed with ten-year-olds seeking gender treatment, she said: ‘The conversation one can have with a ten-year-old depends on the individual… you will see at all the stages, what is salient for that individual in terms of long-term treatment is part of the conversation.’
She said ‘everybody who starts on blockers knows that one of the possibilities is cross-sex hormones’.
Most patients who start taking puberty blockers after being seen by GIDS doctors go on to take cross-sex hormones, which critics argue can potentially cause infertility.
Mrs A and Miss Bell have brought the case because, they argue, young children are unable to give ‘informed consent’ to receiving treatments such as puberty blockers and may regret doing so later on in life.
This is partly because they lack ‘sufficient maturity’ to understand what is involved.
The Tavistock says the case should be dismissed because children and teenagers can lawfully consent.
It also says ‘parental agreement (or that of carers) is mandatory’ for children under 16 and ‘remains a significant aspect of the consent process’ for those aged 16 to 18.
At the end of the hearing, the judges deferred their ruling to a later date.