If the effect of the Tavistock JR is that GIDS is even more restrictive in prescribing puberty blockers, the practical result is that rich trans kids will get blockers elsewhere and grow up more cis-passing, and poor trans kids won't and will suffer more adolescent dysphoria.

Because the JR doesn't and can't actually ban puberty blockers, it functions as an obstacle to adolescent transition which rich people can circumvent and poor people can't: it's a decision about *who* can access treatment, not whether the treatment exists.

Other practical effects include: more grey market blockers and hormones, more unmonitored transitions in younger people, more family conflict escalated to court level, more opportunities for coercive control, more profiteering by private psychiatrists.

You can't ban transition, and you can't ban child and adolescent transition. The deep wish of the people bringing these cases is to make transness impossible, to hide what's now unhidden, but (short of massive fascist takeover) they can't. We're here now.

So the effect of the JR is probably to make GIDS *more like it is already*. NHS pathways to trans healthcare were already deeply raced and classed. Which fraction of children do you think actually got blockers before this?

This means that trans campaigners have to centre the lives of all trans young people: safety, support and healthcare for *all* trans youth, which can only be achieved by centering the needs of the most oppressed. That was never going to happen solely through defending GIDS.

It's also impossible as clinicians or peer supporters to have meaningful discussions with trans youth about puberty blockers when the role of courts, parents and clinicians is to be gatekeepers. If you're asked to jump through hoops, you don't present honestly in these settings.

Truly? I don't actually want puberty blockers to become the gold standard, the only way trans youth transition. I want to affirm all possible transitions and bodies. I want better research. But you can't get there while it's subject to these pathologising restrictions.

The gatekeeping of trans health, in a world where everyone from kids up knows about transition and can get the blockers & hormones on the internet, is actually the gatekeeping to *support* for healthcare. Kids are going to transition. Do you want them to do it well, with options?