The puberty blockers ruling does not apply in Scotland, and the Sandyford Young People Gender Service is continuing to assess for the treatment. This is from their press statement.

We can expect attacks on this service, and we need support from trans people across the UK.

I've seen very few England-based trans campaigners and organisations talk about this, which is hugely frustrating. What I have seen is Scotland's transphobic activists, journalists and politicians begin ramping up a campaign around it.

The reason that the puberty blocker ruling does not apply in Scotland is that our legal and health systems are partially dissolved, and the ruling court does not legally rule for Scotland. However, higher courts of appeal *do* rule for Scotland.

The capacity of under-16s to legally consent, including to medical treatment, is also enshrined in statute in Scotland (Age of Legal Capacity (Scotland) Act 1991), unlike in England and Wales, where it is based only on case law.

https://www.legislation.gov.uk/ukpga/1991/50/contents

The political climate for trans people is potentially much worse in Scotland, with an explicitly transphobic faction of the SNP, the party of government, recently leading a significant rebellion and seizing party machinery, partly by using trans people as an organising scapegoat.

So, two major threats to puberty blockers in Scotland:

- Transphobic campaigners lobbying NHS Scotland to change its assessment and prescribing policy in light of the GIDS ruling.

- A failed appeal at a higher court shutting down prescribing in Scotland.

How can trans people in England and Wales help?

At a minimum, learn when to say and *think* "England" or "England and Wales". Your campaigning is frequently ignorant of Scottish law, policy and politics, as it often was around the GRA. This misinformation harms our work here.

Know that because of how UK media works, campaigning in Scotland has *much* less reach and power than in England. Our messages don't get out. So when we're fighting, help amplify what we're doing.

If the appeal goes to a high enough court, be aware that losing may well affect Scotland too, when the current ruling doesn't. The stakes are even higher. We have to win this, so campaigning support needs to be much, much better for the appeal than for the original case.

At the moment, the campaign against puberty blockers in Scotland is just social media chatter and a couple of transphobic journalists. But I'm expecting it to build, and we're going to need to strategise around that here. We also need advice & strength from English organisations.

I'm a broken record on this, but please understand that the UK is not one country, England is dominant and the other nations minoritised, and this affects trans campaigning. We need solidarity to flow in all directions, but often it doesn't.

That was a decent final tweet in the thread, but of course there's a correction. Above I wrote "dissolved" when I meant "devolved", the term for powers held by Scotland rather than the UK. All state power should, of course, be dissolved.

Morning! I'm seeing a lot of replies and shares of this with language like "Defend the GIC". We should be absolutely clear that the GIC system is an obstacle to trans healthcare, not an enabler of it. We need to defend & extend trans people's access to healthcare, not the GIC.

What this looks like when the GIC is the only "freely"-provided service, and is under transphobic attack, honestly I don't know. But it means we can't limit our campaigning to defending what currently exists, when that system is one of the reasons we're struggling so much.

One answer to this is campaigning to begin moving services out of the GIC and into general practice, and to fund them. Trans-aware psychological support, speech and language therapy, hair removal: there is no reason interventions like this need to be GIC-gatekept.

Another answer to this is building new services parallel to the GIC system which are trans-centred, employ trans practitioners, and lower gatekeeping. Indigo Gender Service and TransPlus at 56 Dean St are a start at this. We're well behind on this in Scotland.

A third answer is building campaigns for informed consent as the general principle of trans healthcare. WPATH standards apply informed consent to HRT; the UK is well behind on this. But this is a harder campaign, which will face major opposition from transphobes and GP bodies.

I mostly work on adult trans healthcare, and I don't have good knowledge about how related approaches can work for under-18s. I do know that thinking *beyond* the GIC, and understanding the GIC as a system that reduces healthcare and polices gender, is essential at all levels.