Medication for Transgender Teenagers
In the last few years, public attention has been increasingly drawn towards the distress of transgender teenagers, particularly following the brutal murder of Brianna Ghey in February 2023. The issue of medication for teenagers with a diagnosis of gender dysphoria has become controversial leading to the Cass Review of Gender Identity Services for Children and Young People in the NHS published in April 2024. Just as that report was being published, the case of Re J (Transgender: Puberty Blocker and Hormone Replacement Therapy) https://www.bailii.org/ew/cases/EWHC/Fam/2024/922.html came before the President of the Family Division but the Cass report has not been formally considered in the judgment. A summary of the case is as follows
Background
This case concerns J, a 16-year-old transgender boy (natal female, affirmed male) who commenced testosterone treatment in January 2023 via the online provider Gender GP. In April 2023, J's father applied to the High Court seeking to prevent J from receiving puberty blockers and testosterone without court approval. J was living with his mother after his parents divorced in 2018. J has been diagnosed with anorexia nervosa and autism spectrum disorder, and was hospitalised under the Mental Health Act in 2021.
Medical History
J began expressing himself as male at age 12, changing his name and pronouns. By October 2022, J engaged with Gender GP, completing an online questionnaire. After a two-month "appraisal pathway" involving only one communication with an unregistered counsellor, Gender GP prescribed testosterone. J's NHS GP administered the first injection in January 2023, with further injections following every three months until August 2023. The court proceedings delayed further treatment.
Expert Evidence
Dr Jacqueline Hewitt, a consultant paediatric endocrinologist, was highly critical of Gender GP's approach, describing it as "negligent" and "unlawful" in Australia. Her concerns included: no physical examination, poor psychological assessment, lack of counselling regarding risks, and prescribing an adult-level testosterone dose without gradual build-up. Dr Richard Eyre, a consultant child psychiatrist, concluded J has gender dysphoria but found his autism and previous anorexia do not render him unable to make decisions about treatment under the Mental Capacity Act 2005.
Legal Framework
The Family Law Reform Act 1969 allows those over 16 to consent to medical treatment, though this does not exclude the High Court's inherent jurisdiction to intervene. The court can override consent where a young person's decision could lead to severe permanent injury or irreversible harm. The father sought wide-ranging declaratory relief regarding treatment for gender dysphoria in under-18s, arguing court approval should be mandatory.
Current Position
Currently, there is no NHS gender service available for J. The parties have agreed that J will undergo assessment with a new London clinic, Gender Plus, potentially taking six months. J's mother has undertaken not to approach Gender GP for further treatment except to maintain the referral with a small monthly fee. The father, while opposed to hormone treatment for under-18s in principle, accepts the Gender Plus assessment as realistic.
Court Decision
Sir Andrew McFarlane, President of the Family Division, limited his judgment to endorsing the agreed plan for J to be assessed by Gender Plus. He declined to determine wider issues regarding J's capacity or the father's legal arguments, stating the court should develop the law incrementally rather than "by judicial diktat." He expressed serious concerns about any young person accessing treatment from "off-shore, online, unregistered private clinics" like Gender GP, urging other courts to proceed with "extreme caution" in such cases.