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The Tavistock Controversy: A Follow-Up Report

The Tavistock Controversy: A Follow-Up Report
February 9, 2021

By Dr. Paul R. Eddy and Dr. Preston Sprinkle


In September, we posted a piece on the controversy involving the Tavistock’s London-based Gender Identity Development Service (GIDS), the primary UK gender clinic serving gender-nonconforming children.[i] We noted that the controversy was gaining increased public attention due to a lawsuit filed against the GIDS. The claimants in the suit are Keira Bell, a 23-year-old former GIDS patient who, at 16, was prescribed puberty blockers after three one-hour appointments, and “Mrs. A,” the mother of a 15-year-old GIDS patient with autism who has chosen to remain anonymous to protect her daughter’s identity. A central concern of these claimants is that adolescents experiencing gender dysphoria who come to the GIDS for treatment are often fast-tracked toward a gender transition without being offered an adequate assessment of whether other, less invasive, means of treatment could alleviate the dysphoria. In Bell’s words, “I should have been challenged on the proposals or the claims that I was making for myself. And I think that would have made a big difference as well. If I was just challenged on the things I was saying.”[ii]

 

At the time we posted this piece, a High Court judge had been given the go-ahead to begin a judicial review against the Tavistock. In this post, we provide an update on this legal controversy surrounding the GIDS.

  

The Heart of the Controversy: Puberty Blockers

 

At the heart of the controversy is the GIDS’s practice of prescribing puberty suppression drugs – or puberty blockers (PBs) – for gender nonconforming children seeking treatment. Puberty suppression drugs, known medically as a gonadotropin-releasing hormone analogues (or GnRHa) can serve to suppress the release of sex hormones (i.e., testosterone or estrogen), which, among other things, prevents the development of secondary sex characteristics that naturally come with puberty (e.g., beard growth and deepening voice for males and breast development for females).[iii] PBs are officially approved for use with children who experience “precocious puberty,” that is, an unusually early onset of puberty (usually before age eight for girls and before age nine for boys). However, in the 1990s, published studies from the Netherlands began reporting on the “off-label” use (i.e., using a drug for a purpose for which it has not been officially approved) of PBs with children experiencing gender dysphoria in order to temporarily postpone the onset of puberty.[iv] Since then, this off-label use of PBs has become one of the standard treatment protocols for childhood gender dysphoria.[v]

 

We’ll discuss PB’s (what we know and don’t know) in a future post. For now, we want to look at the High Court’s ruling and the responses.

 


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The UK High Court Ruling

 

On October 7th and 8th, the case against the Tavistock was finally presented in court.[vi] According to the court itself: “The issue at the heart of this claim is whether informed consent in the legal sense can be given by such children and young persons.”[vii] Keira Bell and Mrs. A. were represented by barrister Jeremy Hyam. In court, Hyam argued that:

 

[t]he idea that young people were fully able to give consent was “simply a fairy tale . . . . Nobody could sensibly think that a child of 13 or under who cannot in law give valid consent to sexual acts could possibly give informed consent to treatment of dubious benefits … and lifelong consequences.”[viii]

 

As the lead claimant, Bell made a statement to the court in which she explained that, due to the gender affirming treatment that began when she was seen as a gender-nonconforming child at the GIDS, she had been left with

 

no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered . . . . 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.[ix]

 

Bell explained her story more fully at CrowdJustice, a platform dedicated to crowd-funding for legal cases:

 

I was a gender non-conforming child and later struggled with hatred for my female body, low self-esteem and found it hard to connect with people throughout my teens. At the age of 14 I really began to struggle with my sense of identity and especially the thought of becoming a woman. I thought I found the answer to my problems when I discovered transsexualism and stories of transsexual people on the internet. Soon after, I began to pursue this path. This led to the GIDS where I was welcomed and affirmed as a boy. It wasn't long before I was injecting GnRHa analogues ("puberty blockers"), then cross sex-hormones and when I was 20 a double mastectomy procedure. By then I had believed a lie (that my real problem was being trapped in the wrong body) and had been helped to believe that lie by the very people who were meant to help me. I was initially very happy with my decision, the results of cross-sex hormones and surgery. I felt that finally I could start to live in peace as a man. However, some years later this began to wear off and I realised that the real distress I was experiencing (and had experienced as a child) was connected to the trauma & many challenges of my childhood and adolescence. I began ‘detransitioning’ (stopped the process of medical transition) over a year ago. In my tormented state of mind I was not able to identify how incredibly destructive transition was. As an adult I now realise that medical transition was unnecessary and something I wish I had avoided. However I have now been left with the life-long consequences of medical treatment for gender/sex dysphoria (including a deep voice, facial hair and no breasts) . . . .

This case is not about compensation. There is no pay-out with this type of case. This case is challenging the policy of the NHS that prevents clinicians from helping children suffering from gender dysphoria be at ease in their sex.[x]

 

On December 1, 2020, the much-anticipated ruling on the case was publicly announced in a 38-page verdict.[xi] In the course of making their case, the claimants argued that the GIDS’s use of PB medications to halt puberty in gender dysphoric young people is “experimental” in nature, that it lacks an adequate evidence base, and that its long-term risks and negative consequences are simply not known.[xii] The court essentially sided with the claimants on this matter, as seen in the following statement from the Conclusions of the ruling:

 

The starting point is to consider the nature of the treatment proposed. The administration of PBs to people going through puberty is a very unusual treatment for the following reasons. Firstly, there is real uncertainty over the short and long-term consequences of the treatment with very limited evidence as to its efficacy, or indeed quite what it is seeking to achieve. This means it is, in our view, properly described as experimental treatment. Secondly, there is a lack of clarity over the purpose of the treatment: in particular, whether it provides a “pause to think” in a “hormone neutral” state or is a treatment to limit the effects of puberty, and thus the need for greater surgical and chemical intervention later, as referred to in the Health Research Authority report. Thirdly, the consequences of the treatment are highly complex and potentially lifelong and life changing in the most fundamental way imaginable. The treatment goes to the heart of an individual’s identity, and is thus, quite possibly, unique as a medical treatment.[xiii]

 

The court also noted that, while it is commonly claimed that PBs provide the child additional “time to think” about “whether or not to proceed to cross-sex hormones or to revert to development in the natal sex,” in fact, the use of PBs generally leads to the child being solidified in their cross-sex identity. The ruling states:

 

[T]he use of puberty blockers is not itself a neutral process by which time stands still for the child on PBs, whether physically or psychologically. PBs prevent the child going through puberty in the normal biological process. As a minimum it seems to us that this means that the child is not undergoing the physical and consequential psychological changes which would contribute to the understanding of a person’s identity. There is an argument that for some children at least, this may confirm the child’s chosen gender identity at the time they begin the use of puberty blockers and to that extent, confirm their GD and increase the likelihood of some children moving on to cross-sex hormones. Indeed, the statistical correlation between the use of puberty blockers and cross-sex hormones supports the case that it is appropriate to view PBs as a stepping stone to cross-sex hormones.

 

In the written ruling, the judges express “surprise” at several points in relation to the lack of data made available to the court from the GIDS in regard to the young people they treat.[xiv] In the end, the three senior judges of the High Court assigned to the case ruled in favor of the claimants, concluding that children under the age of 16 are unlikely to be mature enough to give informed consent in order to be prescribed PB drugs.[xv] Specifically, the Overall Conclusion section of the ruling summarizes the judgment as follows:

 

151. A child under 16 may only consent to the use of medication intended to suppress puberty where he or she is competent to understand the nature of the treatment. That includes an understanding of the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life changing consequences for a child. There will be enormous difficulties in a child under 16 understanding and weighing up this information and deciding whether to consent to the use of puberty blocking medication. It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.

152. In respect of young persons aged 16 and over, the legal position is that there is a presumption that they have the ability to consent to medical treatment. Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.

153. We have granted a declaration to reflect the terms of this judgment.[xvi]

 

In her public statement after winning the case, Keira Bell said:

 

I am delighted at the judgment of the court today. It was a judgment that will protect vulnerable young people – I wish it had been made before I embarked on the devastating experiment of puberty blockers. My life would be very different today . . . . My hope was that outside the noise of the culture wars the court would shine a light on this harmful experiment on vulnerable children and young people. These drugs seriously harmed me in more ways than one . . . and they have harmed many more, particularly girls and young women. This judgment is not political. It is about the protection of vulnerable children.[xvii]

 

When asked in a recent interview why she thought we are “witnessing a worldwide push to consider children and teenagers ‘adult enough’ to consent to life-altering treatments,” Bell simply responded: “Follow the money!”[xviii]

 

The other claimant, Mrs. A, also expressed her delight:

 

I hope this judgment will provide a safety net to prevent the unsupervised medical experimentation on children, like my daughter, by an institution charged with helping to alleviate her distress.[xix]

 

One of the claimants’ lawyers, Paul Conrathe, stated that the court ruling was a “historic judgment that protects children who suffer from gender dysphoria.” Had the court failed to decide in Bell’s favor, this could have “led to hundreds of children receiving this experimental treatment without their properly informed consent.[xx] In Conrathe’s view, the court’s decision “opens the floodgates for expensive clinical negligence claims,” and he issued a call for the UK government to launch a public inquiry.[xxi]


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Other Responses to the Ruling

 

Responses to the ruling from around the world were swift and varied. Many have voiced appreciation for the court’s ruling. A spokeswoman for the UK’s National Health Service (NHS), the umbrella under which the Tavistock’s GIDS operates, said that the “clarity” brought about by the ruling was welcomed.[xxii] Susan Evans, an employee at the Leeds GIDS from 2003-07 and one of the original claimants in the case, stated that she was “relieved” by the verdict:

 

The real scandal is that the treatment pathway of children with gender dysphoria became ever more politicised, and moved away from high standards of clinical mental healthcare with good assessment and psychotherapeutic treatment . . . .  As soon as clinicians hear the words ‘gender dysphoria’, they refer children to GIDS, as if this is something separate from all the other issues in the child’s life.[xxiii]

 

Many other voices and organizations were also pleased. The UK-based Transgender Trend, an organization of parents, academics and childcare professionals who are critical of medical transitioning of children, posted a statement in strong affirmation of the ruling:

 

We are delighted that the High Court has handed down judgment to protect children from experimental medical interventions with serious known and unknown risks and lifelong consequences . . . . Children must be treated as children, not as political mascots for an ideology . . . . The judgment today is a watershed moment. As a society we must ask ourselves how we allowed this to happen. The threats, bullying and the silencing of alternative views must stop here. Today the right judgment has been handed down in the High Court. But we should never have had to learn about the dangers of institutional capture in this way.[xxiv]

 

A UK-based parents’ support group called Our Duty also expressed support for the court’s decision:

 

For parents of children who have post-pubertal gender dyphoria (often called ROGD), this judgment might seem on the face of it to be too little, too late. Such parents are more concerned with the potential harms of cross-sex hormones and surgeries than of puberty blockers. However, this judgment does offer some cause for hope in that regard.[xxv]

 

A number of sexuality researchers and clinicians have also voiced their appreciation of the UK court’s ruling. The Society for Evidence Based Gender Medicine (SEGM) sees the ruling as reflecting a “growing concern among a significant number of researchers and clinicians about the poorly understood rapid rise in the number of adolescents with gender dysphoria, and the marked lack of evidence that hormones and surgery improve long-term health outcomes.”[xxvi] The SEGM statement goes on to say:

 

The prescription of puberty blockers to gender-dysphoric young people with normally-timed puberty is experimental. Thus, puberty blockers should only be offered in formal, approved research settings, with rigorous study designs capable of generating useful information. Overconfidence is dangerous in science and medicine. All ethical practitioners must humbly recognize the significant uncertainties in the field of gender medicine. We sincerely hope that the judgement of the High Court will mark the beginning of international commitment to rigorous clinical investigation into the most effective treatments for children and adolescents experiencing gender dysphoria. Until a reliable, quality evidence base emerges, young patients and their families should be supported in exploring all available options before undergoing invasive, often irreversible interventions with unknown long-term implications.[xxvii]

 

A number of UK feminists and feminist organizations have registered their support for the decision, including Julie Bindel and Woman’s Place UK.[xxviii] Interestingly, left-leaning lesbian feminists, right-leaning cultural conservatives, and a range of gender-critical researchers and clinicians have become a broad coalition of strange bedfellows in their united agreement over the high court ruling.[xxix] British media across the left-right political spectrum also praised the court’s decision, to the dismay of Grace Lavery, a transwoman, who writes:

 

The court’s decision was lauded not just by the British right-wing press like the Spectator but, more strikingly, by center-left media like the Observer, which applauded the decision, suggesting that it will “ensure that children will now receive the protection to which they are legally entitled.[xxx]

 

But support for the court’s ruling has not been shared by all. The GIDS itself was less pleased with the ruling:

 

The Trust is disappointed by the judgment on 1 December 2020 . . . and we understand that the outcome will be unsettling news for patients and their families. Our first duty is to our patients, particularly those currently receiving hormone blocking treatment and we are working with our partners, University College London Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, to provide support for patients concerned about the impact on their care.

For existing patients please be reassured: there are no immediate plans to stop your treatment with puberty blockers or cross sex hormones.

The Court ruled that there will be a stay on implementation of its judgment until the determination of any appeal . . . . We will not be making new referrals to endocrinology until we have more clarity and future referrals will require a court order for under-16s . . . . The Trust confirms its ongoing support for the review commissioned by NHS England being led by Dr Hilary Cass . . . . [xxxi]

 

The Tavistock also announced that it has filed an appeal motion in court. Many gender-affirmative advocates have offered severe criticisms of the ruling. The World Professional Association for Transgender Health (WPATH) and its affiliates posted an official response to the court decision, stating that they

 

strongly disagree with the recent judgment of the London High Court in Bell v. Tavistock. We believe this decision will result in significant harm to the affected children and their families. We oppose this ruling and urge that this ruling be appealed and overturned.[xxxii]

 

Similarly, in its posted statement on the court decision, trans-led UK-based charity, Gendered Intelligence proposed that what trans children need “is timely, robust, and less onerous access to healthcare, not to be patronised and stonewalled by judges who believe they know better than medical doctors and clinicians.”[xxxiii] This, of course, is a good point; judges are judges, not medical professionals. But the pushback fails to note that the court ruling was based on evidence and testimonies from medical professionals who are professionally informed about the pros and cons of giving PB’s to young teens. Moreover, the court’s ruling wasn’t about the efficacy of PB, but about the ability of young teens to make an informed decision about such medical interventions. In their own words:

 

The court is not deciding on the benefits or disbenefits of treating children with GD with PBs, whether in the long or short term. The court has been given a great deal of evidence about the nature of GD and the treatments that may or may not be appropriate. That is not a matter for us. The sole legal issue in the case is the circumstances in which a child or young person may be competent to give valid consent to treatment in law and the process by which consent to the treatment is obtained.

 

In any case, many others have voice concerns about the court’s ruling. Nancy Kelley, Chief Executive of the UK-based LGBTQ advocacy group Stonewall, stated:

 

Today’s Court ruling about the prescription of puberty blockers is both deeply concerning and shocking. We’re worried this judgment will have a significant chilling effect on young trans people’s ability to access timely medical support. We welcome the Tavistock & Portman NHS Trust’s stated intention to appeal this ruling.[xxxiv]

 

Mermaids, a leading UK-based support organization for trans kids, characterized the ruling as a “dangerous betrayal of trans youth”:

Today’s judgment from the High Court risks untold, irreparable damage to young trans people in England and Wales. It heralds nothing less than a new era of discrimination, treating trans youth differently from all other young people and barring them from accessing life-saving care.[xxxv]

 

Several trans youth have also expressed disappointment in the ruling, since some of them were wishing to go on PB’s but now may not be able to.[xxxvi] Some parents of trans kids have described the ruling as “‘devastating,” “discriminatory,” and “cruel.”[xxxvii] And the British advocacy groups Amnesty International UK and Liberty issued a joint statement expressing their disappointment in the court’s decision:

 

We are concerned not only for what this means for the health and well-being of trans young people, but the wider implications this will have on the rights of children and young people of all genders, particularly on consent and bodily autonomy.[xxxviii]

 

One particularly searing critique came from Grace Lavery (mentioned above), a transwoman and professor at UC Berkeley. Grace warns that the court decision will place “trans people everywhere at risk”[xxxix] and goes on to say:

 

The decision is an unprecedented juridical attack on the LGBT community in the U.K. . . . It also reflects a disturbing escalation of anti-transgender policy across the United Kingdom . . . . [T]he court in Bell v. Tavistock [made] an erroneous decision that endangers the lives and well-being of sexual minorities . . . .[xl]

 

Jesse Singal – an investigative journalist who’s written extensively on medical intervention for transgender children – posted a detailed rebuttal to Lavery’s claims, pointing out several, rather embarrassing, mistakes in Lavery’s article.[xli] Lavery and Singal got into an ongoing exchange on Twitter,[xlii] which caught the attention of other commentators.[xliii]

  

Who’s Causing Harm?

 

One interesting point to note is that both sides of this debate appeal to the “harm argument,” rendering it as nearly useless as an ethical staring point.

 

For instance, those who disagree with the court’s ruling say that this decision will harm trans* kids by preventing them from receiving the medial attention they need. PBs, they said, are a necessary step in helping kids figure out their identity. If they really are trans and they go through puberty as their birth sex, this will make it more difficult to transition later and will therefore potentially damage their mental health and increase their suicidality.

 

Those who agree with the court’s ruling say the opposite. PB’s almost always lead to cross-sex hormones, young teens lack the capacity to truly make an informed decision with life-altering and irreversible consequences. Plus, PB’s are largely untested and experimental, and the knowledge we do have about PB’s is alarming (as we’ll discuss in a future post). If harm is being done to trans-identified teens, it’s at the hands of those who give (not withhold) PB’s from these kids. Kiera Bell’s story is case in point, as are many others with similar stories. 

 

Which viewpoint is right? Who’s actually doing the harm? And why? This is where the dialogue needs to start. Simply crying “harm” contributes nothing to the conversation and can fail to actually keep the well-being of teens themselves front and center. People who care for the well-being of kids should be eager to scrutinize all the evidence before forming a particular view.

 

In the current culture war, where the accusation of “harm” is being used as a rhetorical barb by both sides against the other, each viewpoint is responsible to defend its own perspective with demonstrable evidence, while refuting other viewpoint with, again, evidence-based data and arguments. Simply slinging “harm” rhetoric—or other slogans—in the place of robust evidence might itself be harmful.




[i] Paul R. Eddy and Preston Sprinkle, “Tavistock: A Microcosm of the Debate on How Best to Care for Trans* Kids,” Center for Faith, Sexuality & Gender (September 23, 2020), https://www.centerforfaith.com/blog/tavistock-a-microcosm-of-the-debate-....

[ii] Alison Holt, “NHS gender clinic ‘should have challenged me more’ over transition,” BBC News (March 1, 2020), https://www.bbc.com/news/health-51676020

[iii] For studies supportive of the use of puberty blockers, see Butler, at al., “Assessment and support of children and adolescents with gender dysphoria”; Rosalia Costa, Michael Dunsford, Elin Skagerberg, Victoria Holt, Polly Carmichael, and Marco Colizzi, “Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria,” Journal of Sexual Medicine 12/11 (2015), 2206-14; Annelou L. C. de Vries, Jenifer K. McGuire, Thomas D. Steensma, Eva C. F. Wagenaar, Theo A. H. Doreleijers, and Peggy T. Cohen-Kettenis, “Young Adult Psychological Outcome after Puberty Suppression and Gender Reassignment,” Pediatrics 134/4 (2014), 696-704.

[iv] Louis Gooren and Henriette Delemarre-van de Wall, “The Feasibility of Endocrine Interventions in Juvenile Transsexuals,” Journal of Psychology and Human Sexuality 8/4 (1996), 69-74; Peggy T. Cohen-Kettenis and S. H. M. van Goozen, “Pubertal Delay as an Aid in Diagnosis and Treatment of a Transsexual Adolescent,” European Child and Adolescent Psychiatry 7/4 (1998), 245-48 (here see p. 2612).

[v] Carla M. Lopez, Daniel Solomon, Susan D. Boulware, and Emily Christison-Lagay, “Trends in the ‘Off-Label’ Use of GnRH Agonists Among Pediatric Patients in the United States,” Clinical Pediatrics 57/12 (2018), 1432–35. This is certainly not the only off-label use of GnRHa. As one researcher put is: “The way research in this area of medicine is moving, there is almost no subspecialty of medicine that will be left untouched by the GnRH and its analogues.” Navneet Magon, “Gonadotropin Releasing Hormone Agonists: Expanding Vistas,” Indian Journal of Endocrinology and Metabolism 15/4 (2011), 261-67.

[vi] Clare Dyer, “Hormone Blockers: Judges Assess Whether Children Should be Treated,” BMJ 371 (October 9, 2020), m3940; doi: https://doi.org/10.1136/bmj.m3940. For a brief video news report that presents both sides of the controversy, see “Transgender ruling: Clinic defends hormone treatment,” Sky News (October 8, 2020), https://www.youtube.com/watch?v=wb6cVfHzKEE

[vii] This quote is taken from the eventual court ruling. See Courts and Tribunals Judiciary, “R (on the application of) Quincy Bell and A -v- Tavistock and Portman NHS Trust and others,” (December 1, 2020), https://www.judiciary.uk/judgments/r-on-the-application-of-quincy-bell-a...

[viii] Alexandra Topping, “UK court hears children cannot consent to puberty blockers,” The Guardian (October 7, 2020), https://www.theguardian.com/society/2020/oct/07/court-hears-children-can...

[ix] Ibid.

[x] Keira Bell, “Protect Gender Dysphoric Children from the Affirmation Model,” crowdjustice, https://www.crowdjustice.com/case/challenge-innate-gender/. The NHS policy that Bells refers to at the end of this quote is tied to the “Memorandum of Understanding on Conversion Therapy in the UK,” file:///C:/Users/16514/Downloads/201907_MoU2%20Revision%20A_WEB.pdf. This document was originally produced in 2015 to prevent therapeutic practices involving sexual orientation change efforts. In 2017, the document was revised to apply these restrictions to those struggling with gender identity issues as well. Bell goes on to explain her concerns with this new application: “This limits the ability of clinicians to help children with [gender identity conflicts] to be reconciled to their natal sex. If a clinician tries to challenge a child's misguided belief or explore its causes with a view to alleviating gender/sex confusion they run the risk of being accused of conversion therapy. This pressurises clinicians to adopt an affirmative approach to the beliefs of children and young people, affirming the gender they believe they are. This addition of gender identity to the document reinforces the pseudoscientifc idea that gender (in terms of a gendered brain) is real and innate.” For a recent interview with Bell, see Keira Bell and Raquel Rosario Sánchez, “Kiera Bell: ‘There Was Nothing Wrong with My Body,’” Woman’s Place UK (November 30, 2020), https://womansplaceuk.org/2020/11/30/keira-bell-there-was-nothing-wrong-...

[xi] Courts and Tribunals Judiciary, “R (on the application of) Quincy Bell and A -v- Tavistock and Portman NHS Trust and others,” (December 1, 2020), https://www.judiciary.uk/judgments/r-on-the-application-of-quincy-bell-a.... For a two-page summary of the ruling, see https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Cli.... For a fairly even-handed summary analysis of the case, see Kitty Leask, “Keira Bell vs the Tavistock Centre,” LGBT Lawyers (December 14, 2020), https://lgbtlawyers.co.uk/2020/12/14/keira-bell-vs-the-tavistock-centre/

[xii] More than a month after the ruling, the British newspaper, The Daily Mail, reported on expert testimony offered during the case that had, until then, been kept from the public by court order. Among those offering testimony in support of the claimants was Christopher Gillberg, a renown Swedish professor of child and adolescent psychiatry. According to the report, Gillberg testified that he believes prescribing puberty blockers amounts to “a live experiment” on vulnerable children: “In my years as a physician, I cannot remember an issue of greater significance for the practice of medicine.” Sanchez Manning, “‘A live experiment on children’: Mail on Sunday publishes the shocking physicians' testimony that led a High Court judge to ban NHS's Tavistock clinic from giving puberty blocking drugs to youngsters as young as 10 who want to change sex,” Daily Mail (January 9, 2021), https://www.dailymail.co.uk/news/article-9130157/The-physicians-testimon...

[xiii] Courts and Tribunals Judiciary, “R (on the application of) Quincy Bell and A -v- Tavistock and Portman NHS Trust and others.”

[xiv] At issue here was the following lack of data: (1) The age distribution of young people treated with puberty blockers at the GIDS in the years 2011 to 2020. (2) Statistics on the number/proportion of young people treated with puberty blockers at the GIDS who had a diagnosis of ASD. (3) Data on the proportion of those treated with puberty blockers who then go on to use cross-sex hormones.

[xv] Owen Bowcott, “Puberty blockers: under-16s ‘unlikely to be able to give informed consent,’” The Guardian (December 1, 2020), https://www.theguardian.com/world/2020/dec/01/children-who-want-puberty-....

[xvi] Courts and Tribunals Judiciary, “R (on the application of) Quincy Bell and A -v- Tavistock and Portman NHS Trust and others,”

[xvii] “Keira Bell statement on High Court ruling,” Safe Schools Alliance UK (December 3, 2020), https://safeschoolsallianceuk.net/2020/12/03/keira-bell-statement-on-hig...

[xviii] Bell and Sánchez, “Kiera Bell: ‘There Was Nothing Wrong with My Body.’”

[xix] “NHS Trust pauses hormone service referrals after puberty blockers court ruling,” Express and Star (December 1, 2020), https://www.expressandstar.com/news/uk-news/2020/12/01/nhs-trust-pauses-...

[xx] “High Court ruling on puberty blockers protects teenagers, says woman who sued NHS,” Sky News (December 1, 2020), https://news.sky.com/story/high-court-ruling-on-puberty-blockers-protect... Michael Cook, “Huge setback for transgender activism in UK: A young woman who regrets her ‘transition’ has taken on government doctors and won,” Mercatornet (December 2, 2020), https://mercatornet.com/huge-setback-for-transgender-activism-in-uk/68657/

[xxi] “London court ruling casts doubt on puberty blockers for under-16s,” Irish Times (December 1, 2020), https://www.irishtimes.com/news/world/uk/london-court-ruling-casts-doubt...

[xxii] Bowcott, “Puberty blockers: under-16s ‘unlikely to be able to give informed consent,’”

[xxiii] Josephine Bartosch, “Why I was right to blow the whistle on the Tavistock Clinic over puberty blockers:Seeing distressed youngsters pushed towards transitioning drove Susan Evans to the High Court – its ruling is her vindication,” The Telegraph (December 5, 2020), https://www.telegraph.co.uk/health-fitness/body/right-blow-whistle-tavis...

[xxiv] “Keira Bell: The High Court hands down a historic judgment to protect vulnerable children,” Transgender Trend (December 1, 2020), https://www.transgendertrend.com/keira-bell-high-court-historic-judgment...

[xxv] “Keira Bell Judgment – First Impressions,” Our Duty (December 1, 2020), https://ourduty.group/2020/12/01/keira-bell-judgment-first-impressions/

[xxvi] “UK High Court Ruling on the Use of Puberty Blockers in Gender Dysphoric Minors (Bell v. Tavistock): SGM Position Statement,” Society for Evidence Based Gender Medicine (December 3, 2020), https://segm.org/UK_HighCourt_Rules_PubertyBlockers_Experimental

[xxvii] Ibid.

[xxviii] Julie Bindel, “Keira Bell’s victory over Gender Identity Development Service in court will give teenagers better protection,” Evening Standard (December 2, 2020), https://www.standard.co.uk/comment/comment/keira-bell-court-gender-ident... “Keira Bell v. Tavistock: Women’s Rights, Healthcare, and the Law,” Woman’s Place UK (November 20, 2020), https://womansplaceuk.org/2020/11/29/womens-rights-healthcare-and-the-la...

[xxix] E.g., Julia D. Robertson and William J. Malone. “Landmark Case in the Fight to Protect Nonconforming Youth.” Velvet Chronicle (November 30, 2020), https://thevelvetchronicle.com/landmark-case-in-the-fight-to-protect-non.... See also “Keira Bell v. Tavistock: Women’s Rights, Healthcare, and the Law,” Woman’s Place UK.

[xxx] Lavery, “High Court Decision in Britain Puts Trans People Everywhere at Risk.”

[xxxi] GIDS, “Information following the Judicial Review judgment, December 2020,” https://gids.nhs.uk/information-following-judicial-review-judgment-decem...

[xxxii] “WPATH, EPATH, USPATH, AsiaPATH, CPATH, AusPATH, PATHA Response to Bell v. Tavistock Judgment: Statement Regarding Medical Affirming Treatment including Puberty Blockers for Transgender Adolescents,” WPATH, https://www.wpath.org/media/cms/Documents/Public%20Policies/2020/FINAL%2...

[xxxiii] “Bell v Tavistock outcome,” Gendered Intelligence (December 1, 2020), https://genderedintelligence.wordpress.com/2020/12/01/bell-v-tavistock-o...

[xxxiv] “Stonewall statement on High Court puberty blockers ruling,” Stonewall (December 1, 2020), https://www.stonewall.org.uk/about-us/news/stonewall-statement-high-cour...

[xxxv] “Response to High Court Decision on Trans Access to Hormone Blockers: A Dangerous Betrayal of Trans Youth.” Mermaids (November 27, 2020), https://mermaidsuk.org.uk/news/tavistock-case/

[xxxvi] E.g., Vic Parsons, “Heartbroken trans teen in ‘unbearable pain’ after ‘devastating’ High Court puberty blockers ruling,” PinkNews (December 7, 2020), https://www.pinknews.co.uk/2020/12/07/puberty-blockers-high-court-ruling... Lucy Diavolo, “English Teen Alex Vellins Says Puberty Blocker Ruling Will Make a Difficult System Harder for Trans Youth,” Teen Vogue (December 4, 2020), https://www.teenvogue.com/story/english-puberty-blocker-ruling-trans-you...

[xxxvii] Vic Parsons, “Heartbroken parents of trans kids slam High Court puberty blockers ruling as ‘devastating, discriminatory and cruel,’” PinkNews (December 3, 2020), https://www.pinknews.co.uk/2020/12/03/puberty-blockers-high-court-ruling...

[xxxviii] “Amnesty International UK and Liberty Joint Statement on Puberty Blockers,” (December 3, 2020), https://www.libertyhumanrights.org.uk/issue/amnesty-international-uk-and...

[xxxix] Grace Lavery, “A High Court Decision in Britain Puts Trans People Everywhere at Risk,” Foreign Policy (December 15, 2020), https://foreignpolicy.com/2020/12/15/uk-transphobia-transgender-court-ru...

[xl] Ibid.

[xli] Jesse Singal, “A Response to Foreign Policy's Deeply Misleading Article, ‘A High Court Decision in Britain Puts Trans People Everywhere at Risk,’” jessesingal.substack.com (December 17, 2020), https://jessesingal.substack.com/p/a-response-to-foreign-policys-deeply.

[xliii] E.g., “Like It or Not, Keira Bell Has Opened Up a Real Conversation About Gender Dysphoria,” Quillette (December 18, 2020), https://quillette.com/2020/12/18/like-it-or-not-keira-bell-has-opened-up.... It is worth noting that Singal appears to be one of the more balanced social commentators working on this issue today, as demonstrated by the fact that his prior writing in this area has posed challenges to those on the right and on the left alike. See e.g., Jesse Singal, “Why The Hard Age Caps On Youth Gender Transition Being Proposed by Conservatives Are a Very Bad Idea,” jessesingal.substack.com (May 4, 2020), https://jessesingal.substack.com/p/why-the-hard-age-caps-on-youth-gender; Jesse Singal, “It Would Be So Easy For Liberal Outlets To Do A Better Job Covering Gender Dysphoria,” jessesingal.substack.com (February 5, 2019), https://jessesingal.substack.com/p/it-would-be-so-easy-for-liberal-outlets