In a legal case of international importance, detransitioner Keira Bell, 23, appeared in the Royal Courts of Justice in central London this week to challenge the policies of the Tavistock clinic, the UK’s leading provider of gender identity "medicine" to children.
The claimant's council told the court it was a "fairy tale" that children could know what they were signing up to when they begin medical transition.
Bell, who is a woman, was 14 when she began to believe she had been "born in the wrong body." She said "I was going through a lot of problems and had been gender nonconforming." She said "When I came across transsexualism online it just made sense to me, I thought that was me at the time."
Her family doctor and children's mental health services quickly referred her to the Tavistock gender identity clinic where, then aged 16, she was subjected to experimental medical procedures to make her body look more like a male's.
However, she now regrets those life-changing procedures, and wishes that she had instead been offered psychiatric support.
Bell said "it was the affirmation model they worked by, so when I came there presenting with gender dysphoric feelings, my claims of being male, and feeling that I should transition, there wasn't any psychiatric investigation or anything like that."
It was January when Keira first attended the clinic. Without investigating the many potential causes of her mental health problems over five appointments, in October staff prescribed puberty blockers.
The impact on her physical health was marked. She experienced menopausal symptoms, insomnia, appetite loss, and reduction in bone density.
As regards the long term impact of the treatment, over the past decade the number of girls referred to Tavistock climbed by 4,400 percent, yet the clinic failed to undertake followup studies to track the health impact of their experiments on children.
The drugs that are used to halt puberty, known as "puberty blockers" are actually prostate cancer chemotherapy drugs that have been tested on adult men. These are now routinely used off-label on children as young as eight to halt natural pubertal development, as a prelude to administering mega-doses of opposite sex hormones.
Evidence is mounting that 'gender identity' medical regimens cause a range of serious health problems, including cognitive impairment and permanent atrophy of vital organs. And yet, gender clinics around the world are still handing out these powerful, untested pharmaceuticals to young people whose psychosocial struggles can be caused by a wide range of reasons, including autism, a history of abuse, and reacting defensively to intense societal misogyny and homophobia.
While some of the causes of body dysmorphia focussed on the sexed body tend to resolve over time with a watchful waiting approach, the medical interventions cause irreversible changes to the body.
Keira Bell said "it puts you on a path that changes your life forever… As a minor you can’t consent to that, and often outgrow gender dysphoric feelings. They have no idea whether I can have children."
The issue in the legal case was whether or not children under 18 are capable of giving informed consent to experimental medical treatments with profound, irreversible lifelong consequences. The problem, for the defendant clinic, is that they have not based treatment on evidence showing what puberty blockers and cross-sex hormones actually do the the developing child's body. Tavistock has no evidence to show that these drugs are safe.
The court heard evidence that the Tavistock clinic gave children materials which said "as far as we are aware the blockers will not harm your physical or mental development." Given that the clinic previously admitted on a television investigation that it did not undertake follow-up studies of the children they treated, the clinic was in no position to make such a safety claim. Therefore, it was withholding the possibility of informed consent from the patient, even if she was technically competent to make an informed decision.
The court heard that an early intervention study ended in February 2019, and was in the process of peer review. However, the defendant did not share the results of the study with the court. Three times, a judge asked the defendant the question "Does a ten year old girl get told that she won’t be able to be a mother?" No answer was forthcoming.
Bell said "I want to prevent minors from being prescribed these blockers which the NHS recently admitted are experimental. I want to raise awareness and encourage detransitioners to speak up. I want to see more research into gender dysphoria, and more robust mental health services, to prevent kids even considering medical changes."
Between 85-90 percent of minors subject to gender identity-affirmative medical protocols desist in their belief that they were "born in the wrong body" once they emerge from puberty. Their discomfort with their sexed body—'gender dysphoria'—resolves as they come to accept their own sex, and sexual orientation.
Bell said that it can be difficult for some individuals to admit to themselves that they were, in effect, lead astray by adults who were supposed to have their best interests at heart. "When you’'re on that pathway it's hard to basically admit you've gone down the wrong path," Bell said.
For her, it was only a year after her mastectomy surgery, at the age of 20, that she began to reflect on how she had lived in a state of dissociation from her body, and how taking cross-sex hormones made that condition worse.
When a TV interviewer suggested to her many that medical transitioners claimed the procedures save their lives, and that it was a controversial claim that people could not change sex, Bell was clear.
She said "You cannot change sex, you can appear a certain way… If you'd had me on a couple of years ago I would have been in the position of saying it changed my life, but teens can't comprehend how it's going to affect their adult life. There needs to be explorative therapy, I don't think changing your body is going to help a psychological condition."
"I've got to accept myself as I am," Bell continued. "There need to be some institutional changes, there are so many factors influencing kids to transition."
"I'm in a lot better position now, off the hormones for two years. I feel very healthy. It's good to be grounded back in reality, focussed on my own development, getting back on my feet."
At the court hearing in London, the key issue was whether a child is capable of consenting to medical procedures which leave them lifelong medical patients, sterile, and with irreversible damage to brain, heart, bones and at elevated risk of iatrogenic disease.
In English law there is a principle called Gillick Competence which means that children can, in some circumstances, give informed consent to medical treatment without their parents’ permission needing to be sought. However, there has always been scope within the law for a court to step in and find that informed consent is not possible in a given situation.
This week the court considered whether a child under 18 can give informed consent to life-changing, irreversible procedures when either clinics do not give full information, or the child is too young to understand the full import of the concept of, e.g. not being able to become a mother.
The claimants—Keira Bell, and the mother of an autistic girl caught up in the gender identity medical system, Mrs. A—invited the court to find that a child could not consent to the types of life-long health and fertility impacts seen with "trans" procedures.
The claimants pointed out that it is not possible to discuss what loss of adult sexual function really means, with children who find sex, and their own bodies, disgusting. They noted that there is no age-appropriate language for such a discussion and that it would be impossible for a child to be deemed able to consent if they don't even have the language to conceptualize what they stand to lose.
The claimants gave evidence that most children desist from their belief they are "born in the wrong body" and that, for that reason, it oversteps the mark to enable them to make such life-changing decisions.
Even where children do not proceed all the way to so-called "gender affirmative" surgeries, they may still end up needing operations: the consequences of starting hormone regimes include inability to reach orgasm, vaginal atrophy, compromised cognitive function, lifelong reliance on medication and repeated surgical intervention to deal with the cumulative effects of these iatrogenic harms.