The Court of Appeal has ruled that further examination must be carried out before a 16-year-old child can receive private gender treatment.
The decision states that the child can only have sex hormone treatment under careful judicial and NHS supervision.
This case marks a significant shift in how courts view medical interventions for young people seeking cross-sex hormones.
The case centers on a mother’s fight to prevent her teenage daughter – called “Q” for legal reasons – from receiving powerful and potentially irreversible hormone treatment at a private clinic known as GenderPlus.
Despite the youth’s intelligence, his age and the absence of any diagnosed mental health problems, the Court found that the matter was too serious and complex to be left to the sole discretion of the clinician.
Instead, he emphasized that further review is needed to ensure treatment serves the best interests of the child.
Court of Appeal orders increased monitoring when adolescent cannot receive irreversible hormone therapyGETTY“Today’s judgment gives me hope for my daughter’s future,” the mother said in a statement after the ruling.
“I am very pleased that the court carefully considered the evidence and made the best decision possible for his safety and for the safety of all children who struggle with their identity as they go through puberty.”
The mother, who fought a two-year legal and emotional battle, expressed relief, saying: “I miss my daughter horribly and can only hope that one day she will realize how hard her mother worked to keep them safe… There is still a long way to go before all our children are safe, but the tide has turned.
The Court of Appeal’s ruling was seen as a change in how courts assess whether a 16-year-old is competent to make his or her own decision about gender reassignment hormones.
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Aidan Kelly (left) with consultant nurse Paul Carruthers – members of staff at the first private gender clinic for young people in England to be registered with the health watchdog, The Gender Plus Hormone Clinic, based in Birmingham. The clinic was registered with the Care Quality Commission (CQC) in January and treats people aged 16 and over, including prescribing gender-affirming hormones – masculinizing or feminizing.
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This is especially true because medical reports indicate that the child is bright, physically healthy, and has no underlying mental health diagnosis.
Historical medical conflicts have involved either seriously ill children or children with serious mental health problems.
Paul Conrathe, senior consultant lawyer at Sinclairslaw, who represented the mother, welcomed the decision.
He said: “It can no longer be assumed that just because a young person is 16, intelligent and healthy, that means their decision to use cross-sex hormones is the end of the matter.
“The Court’s concern and insistence on judicial review demonstrate recognition of the irreversible and distressing nature of these treatments. »
According to Conrathe, the decision aligns with the cautious approach advocated by a study by Dr Hilary Cass, who led an independent review of gender identity services for children and young people.
The Cass Review, published in recent years, recommended stricter protocols and a more evidence-based approach to prescribing puberty blockers and cross-sex hormones.
Protest against puberty blocker ban in London earlier this year
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The private sector, often seen as operating outside the rigorous safeguards of the NHS, has been highlighted as particularly vulnerable to failure to meet these standards.
The Court’s decision comes amid growing concern about private clinics offering gender-related treatment without adhering to the rigorous guidelines and “multidisciplinary” mental health assessments now required within the NHS.
The mother’s legal team argued that private entities are not subject to the same level of oversight, which can put vulnerable young people at risk.
Although the Court recognized these risks, it did not go so far as to mandate universal judicial approval for all private sector hormone treatments.
Instead, it left these regulatory measures to the Care Quality Commission (CQC) and ultimately the government.
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Conrathe expressed disappointment that the Court had not extended the protective measures more broadly.
He said: “The Court has been asked to play a protective role and require court approval for any hormonal treatment in the private sector.
“He refused to offer this protection, saying it was a matter for the government and regulators.”
The ruling follows previous Keira Bell litigation, in which courts failed to impose special protections on children considering puberty blockers, treating them as the same as other medications.
However, since then the government has banned certain treatments and called the practices a “medical scandal.”
With this new ruling, the Court of Appeal has created a new precedent: even older adolescents cannot be presumed capable of consenting to irreversible treatments without external control.
Gender Plus insisted it followed all the guidance outlined by the Cass review and stressed it was properly regulated by the healthcare regulator, the Care Quality Commission.
Dr Aidan Kelly, clinical psychologist and director of Gender Plus, said: “While we cannot comment on this specific case, we wanted to make a clarification which appears to have been overlooked.
“All young people who are assessed and deemed appropriate for consideration of gender-affirming hormones should then be presented to a national multidisciplinary team (EMT) for review by non-treating clinicians.
“The MDT, which includes an independent child and adolescent psychiatrist, must review all references before being accepted onto the hormonal pathway.”