Puberty blocker case must provoke a rethink in Scotland

“I made a brash decision as a teenager (as a lot of teenagers do) trying to find confidence and happiness, except now the rest of my life will be negatively affected.

“I cannot reverse any of the physical, mental or legal changes that I went through. Transition was a very temporary, superficial fix for a very complex identity issue.”

That is the heartbreaking testimony of Keira Bell, a 23-year-old woman who, while identifying as a boy, between the ages of 15 and 20 took puberty blockers, testosterone and had her breasts removed, before in her early 20s she “started to realise that the vision I had as a teenager of becoming male was strictly a fantasy and that it was not possible”.

Her name has become well known because of her part in a case in the High Court in England which ruled earlier this month that children under 16 are unable to consent to taking puberty blockers.

Three judges concluded that it was “highly unlikely” that a child aged 13 or under would ever be competent to give informed consent and it was “very doubtful” those aged 14 and 15 could do so.

They raised concerns, too, about decisions made by those between 16 and 18.

And that case must provoke a rethink in Scotland as well.

One expert witness, a neuroscientist, told the court she had “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”, noting that the neurological development of adolescents’ brains leads to teenagers making more risky and less rational decisions than adults.

There are potential life-long implications for this decision. Puberty blockers act on the pituitary gland to prevent the release of chemical signals which stimulate the production of oestrogen and testosterone, halting the changes of puberty.

It is claimed that these drugs are safe and fully reversible, allowing the young person hormone-free time to consider their options, but in reality little is known about the long-term effects, either physical or psychological.

As well as potential short-term side-effects such as mood changes, fatigue and hot flushes, there are possible long-term impacts on bone density, development of sexual organs, height, body shape and neurological development.

But the case raised other long-term implications too. It suggested that far from creating a neutral hormone-free time, the treatment might be responsible for “generating persistence”, that gender dysphoria which might have resolved itself continues due to the treatment.

The court judgment said that the “treatment may be supporting the persistence of GD [gender dysphoria] in circumstances where it is at least possible that without that treatment the GD would resolve itself”.

And even more seriously, far from pressing pause, the evidence suggested that taking puberty blockers will lead almost automatically to taking cross-sex hormones, which cause irreversible physical changes and may lead to infertility.

The court considered that the two are so closely linked that they should be considered one clinical pathway because “once on that pathway it is extremely rare for a child to get off it”.

Puberty blockers should be viewed “as a stepping stone to cross-sex hormones”, it said.

With such serious potential effects, it is simply unthinkable for Scotland not to look again at the ethics of prescribing these drugs, which may have major life-long physical and psychological impacts, to children and teenagers at an age when they are unable to fully weigh up the consequences.