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https://www.judiciary.uk/judgments/r-on-the-application-of-quincy-bell-and-a-v-tavistock-and-portman-nhs-trust-and-others/ "for the year 2019/2020, 161 children were referred by GIDS for puberty blockers (a further 10 were referred for other reasons). Of those 161, the age profile is as follows:
3 were 10 or 11 yrs old at the time of referral;
13 were 12 yrs old..
3 were 10 or 11 yrs old at the time of referral;
13 were 12 yrs old..
...10 were 13 years old;
24 were 14 years old;
45 were 15 years old;
51 were 16 years old; 1
5 were 17 or 18 years old."
24 were 14 years old;
45 were 15 years old;
51 were 16 years old; 1
5 were 17 or 18 years old."
"We note here that we find it surprising that such data was not collated in previous years given the young age of the patient group,the experimental nature of the treatment and the profound impact that it has."
"The number of referrals to GIDS has increased very significantly in recent years. In 2009, 97 children and young people were referred. In 2018 that number was 2519."
"Further, in 2011 the gender split was roughly 50/50 between natal girls and boys. However, in 2019 the split had changed so that 76 per cent of referrals were natal females."
"It is recorded in the GIDS Service Specification and the wider literature that a significant proportion of those presenting with GD have a diagnosis of Autistic Spectrum Disorder (ASD)...
...The court asked for statistics on the number or proportion of young people referred by GIDS for PBs who had a diagnosis of ASD. Ms Morris said that such data was not available, although it would have been recorded on individual patient records."
"We therefore do not know the proportion of those who were found by GIDS to be Gillick competent who had ASD, or indeed a mental health diagnosis. Again, we have found this lack of data analysis – and the apparent lack of investigation of this issue - surprising."
"The court asked for statistical material on the number, if any, of young people who had been assessed to be suitable for PBs but who were not prescribed them because they oung person was considered not to be Gillick competent to make the decision...
...whether at GIDS or the Trusts. Ms Morris could not produce any statistics on whether this situation had ever arisen."
"The court gained the strong impression from the evidence and from those submissions that it was extremely unusual for either GIDS or the Trusts to refuse to give PBs on the ground that the young person was not competent to give consent...
...The approach adopted appears to be to continue giving the child more information and to have more discussions until s/he is considered Gillick competent or is discharged."
"Relevant to the evidence of consent is the evidence of Professor Scott (Director of University College London’s Institute of Cognitive Neuroscience). She “seeks to explain, from a neuroscientific point of view, why...
...I have significant doubts about the ability of young people under the age of 18 years old to adequately weigh and appreciate the significant consequences that will result from the decision to accept hormonal treatment for gender dysphoria.” "
"it is my view that even if the risks are well explained, that in the light of the scientific literature, that it is very possible for an adolescent to be unable to fully grasp the implications of puberty-blocking treatment...
... All the evidence we have suggests that the complex, emotionally charged decisions required to engage with this treatment are not yet acquired as a skill at this age, both in terms of brain maturation and in terms of behaviour.”
"There is some dispute as to the purpose of prescribing PBs. According to Dr Carmichael, the primary purpose of PBs is to give the young person time to think about their gender identity. This is a phrase which is repeated on a number of the GIDS and Trust..documents...
...As is clear from the literature and referred to by the HRA, the other purpose of giving PBs is stopping the development of the physical effects of puberty...
...because slowing or preventing the early development of secondary sex characteristics during puberty can make a later transition (both medical and social) to living as the opposite sex easier."
" it is said, it is possible for a young person to come off the PBs at any point and not proceed to taking CSH..However, the evidence that we have on this issue clearly shows that practically all children / young people who start PBs progress on to C[ross]S[ex]H[ormones]."
" the evidence of Dr de Vries...a founding board member of EPATH.. She says that of the adolescents who started puberty suppression, only 1.9 per cent stopped the treatment and did not proceed to CSH. "
"We find it surprising that GIDS did not obtain full data showing the figures and the proportion of those on puberty blockers who remain within GIDS and move on to cross-sex hormones."
"Both WPATH and the Endocrine Society in their documentation describe PBs as fully reversible. Professor Butler says that “we do not know everything about the blocker and as far as we know it is a safe reversible treatment with a well-established history.”...
....However, it is important to note that apart from the Amsterdam study, the history of the use of PBs relied upon in this context is from the treatment of precocious puberty which is a different condition from GD, and where PBs are used in a very different way."
De Vries; “Ethical dilemmas continue to exist around ... the uncertainty of apparent long-term physical consequences of puberty blocking on bone density, fertility, brain development and surgical options.”
GIDS Early Intervention Young Person Information Sheet; "We do not fully know how hormone blockers will affect bone strength, the development of your sexual organs, body shape or your final adult height...
...There could be other long-term effects of hormone blockers in early puberty that we don’t yet know about."
"Thus, the central point made by the claimants is that although most of the physical consequences of taking PBs may be reversible if such treatment is stopped, the child or young person...
...will have missed a period, however long, of normal biological, psychological and social experience through adolescence; and that missed developmentand experience, during adolescence, can never be truly be recovered or “reversed”. "
"A second key part of the argument about reversibility turns on the relationship between PBs and CSH and the degree to which commencing PBs in practice puts a young person on a virtually inexorable path to taking CSH. CSH are to a very significant degree not reversible."
"the lack of a firm evidence base for their use is evident from the very limited published material as to the effectiveness of the treatment, however it is measured. "
"the degree to which the treatment is experimental and has, as yet, an unknown impact, does go to the critical issue of whether a young person can have sufficient understanding of the risks and benefits to be able lawfully to consent to that treatment."
