by Daphna Whitmore
Can a child of 13 or 14, or younger, consent to treatment with puberty blockers which will likely lead to a lifetime of medical treatments and surgery, which in turn will affect their ability to have sex and may leave them sterile? The British Courts on 1 December ruled that they are unlikely to be competent to make that decision. Even for 16 and 17 year olds doctors may need to consult the courts for approval before medical intervention. Janice Turner in The Times captured the moment: “like 1950s lobotomies, paediatric transition is increasingly exposed as a grotesque medical fad”.
Keira Bell is the young woman who took legal action against the Tavistock Clinic and Portman NHS Foundation Trust which specialises in gender dysphoria. Keira, now 23, had been put on puberty blockers just before turning 16 after just three visits to an Endocrine Clinic*, and testosterone at the age of 17. When she was 20 she had a double mastectomy. Keira said as a young teenager who didn’t conform to stereotyped gender roles she felt ‘wrong’. She argued she never received adequate counselling to address the root causes of her gender discomfort. Instead, she had medical treatments that have permanently altered her body and may have left her sterile.
The NHS in Britain has said they welcomed the clarity this judgment brings.
As New Zealand often follows Britain’s medical protocols the ruling will have repercussions in this country. Here puberty blockers are used even more liberally than in Britain. Earlier in 2011 the consent form in New Zealand for puberty blockers (GnRH agonists) asked the patient to: “understand that the medical effects and safety of long term use of GnRH blockers are not fully understood and there may be long term risks that are not yet known.” Around 2018 the NZ Ministry of Health website revised its advice to say that “Blockers are a safe and fully reversible medicine….to help ease distress and allow time to fully explore gender health options”. The British court heard the evidence that they are not fully reversible and there are risks involved. In fact, the British NHS in June 2020 had already changed their guidance to acknowledge that “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria”.
How does someone under 16, or even as young as 10 in some cases, weigh up what it means to give up their fertility? At 13 they may feel sure they do not wish to have children, but they cannot know how they will feel in a decade or more when they are an adult.
Nor can someone who has not gone through puberty and not had an adult sex life know what they are potentially giving up with the alteration or loss of sexual function. It is astounding how cavalier the attitude is to this treatment when so little is known about the effect of puberty suppression on the development of sexual desire and the capacity to orgasm. Michael Biggs, the Associate Professor of Sociology at the University of Oxford, writing on the Tavistock case noted: “This was revealed in the proceedings when the judges asked for evidence that the development of sexuality was unimpaired by puberty blockers. The question stumped the barrister for University College London Hospitals NHS Foundation Trust, which prescribes the drugs on behalf of the GIDS. One clue is that GnRHa is prescribed to chemically castrate sex offenders in Broadmoor—a use for which it is licensed, unlike for gender dysphoria. It seems implausible that an adolescent’s sexuality would be unaffected by several years of chemical castration.”
It would be expected that a story of this importance would have been picked up by New Zealand media. Press releases and background information were supplied to all the major outlets yet not a single organisation reported on the ruling. Instead many covered the story of Canadian actor Ellen Page, who six years earlier came out as a lesbian, and has now declared she is Elliot Page and is male and uses the pronouns he and they. Stuff, the Herald, and Radio New Zealand all thought the announcement from this actor was more newsworthy than the watershed case in Britain.
In New Zealand puberty blockers are used in children and adolescents, and hormone therapy in older adolescents and adults. The unquestioning affirmation approach is promoted and it has been quietly inserted into proposed legislation. The Conversion Bill was to outlaw the practice of “treating” homosexual or bisexual people, sometimes coercively, with a view to “converting” them to a heterosexual orientation. Conversion therapy of this sort is seen as unethical and ineffective. A petition addressed this harmful practice and underpinned the Conversion Bill. The Bill however ended up including gender identity, ignoring the fundamental differences between sexual orientation and gender identity. Speak Up For Women have opposed this aspect of the Bill and say “it is a serious mistake to equate them in this context. It is an ideological position, not a scientific one, and it obscures the growing concern about the extraordinary increase in children and adolescents presenting for gender identity treatment (particularly girls) … the absence of any consensus as to treatment approach; and the paucity of good quality data.”
The most common argument used to support the use of puberty blockers is that if the children don’t get blockers and cross sex hormones they will suicide. “I’d rather have a living trans child than a dead one” is repeated so often it is rarely challenged. However, it is nothing more than a myth. The Gender Identity Development Service GIDS states clearly that “suicide is extremely rare”.
What the courts have done is look at the evidence and weighed in favour of protecting children.
Activist pressure, deplatforming and hounding those who want to talk about the issue of gender identity has created an atmosphere where discussion is difficult and sometimes career-ending. It has made it difficult for the rights of children to be protected. At last an ideology that promoted the use of pharmacological and highly invasive surgeries to deal with a complex psychiatric condition is being brought into the open to be examined rationally.
*Keira was seen at the Gender Clinic over a period of nearly two years prior to her getting puberty blockers from the Endocrine clinic.