Intended for healthcare professionals


Puberty blockers: children under 16 should not be referred without court order, says NHS England

BMJ 2020; 371 doi: (Published 02 December 2020) Cite this as: BMJ 2020;371:m4717
  1. Clare Dyer
  1. The BMJ

NHS England has ordered a pause on referrals of children under 16 for puberty blockers, after the High Court ruled that under 16s were unlikely to fully understand the long term effects of the treatment and give informed consent.1

Implementation of the High Court judgment, which will have far reaching consequences for treating children with gender dysphoria, has been stayed until 22 December or until the determination of any appeal by the Tavistock and Portman NHS Foundation Trust.

The trust’s gender identity development service at the Tavistock Clinic in London is the only such facility for children in the UK. Children are referred to paediatric endocrinology clinics at University College Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust.

Three senior judges ruled at the High Court that it was “highly unlikely” that under 13s could give informed consent to taking puberty blockers and that it was “doubtful” that 14 and 15 year olds could do so. For patients aged over 16, where there is a presumption that they can consent to medical treatment, the judges said that clinicians might well want to seek court authorisation first.

After the judgment NHS England said that under 16s must not be referred to endocrinology clinics unless a court has ruled that the treatment is in their best interests. Clinicians will be required to carry out a full review of every patient under 16 who has been receiving puberty blockers. If the lead clinician considers that the patient should continue with puberty blockers or receive cross sex hormones, an application will have to be made to the court.

For patients aged 16 or 17 receiving puberty blockers or cross sex hormones, lead clinicians will be required to review the circumstances and consider a court application if there is doubt about the patient’s best interests.

The Tavistock and Portman trust said that it was “disappointed” with the court’s decision and that it would seek permission to appeal. It said, “Our first duty is to our patients, particularly those currently receiving hormone blocking treatment, and we are working with our partners, University College Hospital NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, to provide support for patients concerned about the impact on their care.”

NHS England said that the independent inquiry into the future of children’s gender dysphoria services—led by Hilary Cass, former president of the Royal College of Paediatrics and Child Health—would consider the implications of the judgment “and any subsequent rulings that may be handed down.” The review is expected to make recommendations next year.


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