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UK announces indefinite ban on puberty blockers for children under 18

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UK announces indefinite ban on puberty blockers for children under 18

The UK government on Wednesday placed an indefinite ban on puberty blockers for children under 18 years of age following the advice of a requested consultation by medical experts. An emergency prohibition on puberty blockers is currently in place and will expire on December 31. The emergency ban will be replaced with The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Restrictions on Private Sales and Supplies) Order 2024, which is due to come into force on January 1, 2025.

In March, the NHS restricted the prescription of puberty blockers to minors. In May, the UK government placed an emergency ban on access to puberty blockers by minors through private prescriptions, which was extended three times. The ban was based on the advice provided in Dr. Hilary Cass’ recommendations. A claim was soon brought to the UK High Court by transgender activist group TransActual, who alleged that the ban was unlawful. However, the claim failed on all grounds and the ban continued.

The targeted consultation by the independent Commission on Human Medicines built upon the findings of the Cass Review, and made the following conclusion:

This review found puberty blockers to have no statistically significant impact on gender incongruence and/or gender dysphoria, mental health, body image and psychosocial functioning in children and adolescents. [The National Institute for Health and Care Excellence] found the quality of evidence for all these outcomes to be low and noted that GnRH analogues may reduce the expected increase in lumbar or femoral bone density during puberty.

The consultation also noted the Cass Review findings in April 2024, which found that:

…the use of puberty blockers in these circumstances blocks the normal rise in hormones that should occur into teenage years, and which is essential for psychosexual and other physical developmental processes such as brain and cognitive development and bone health. It also has implications for fertility, and the use of puberty blockers may also reduce psychological functioning.

The report clarified that young people who are already taking puberty-blocking medications or were prescribed those medications six months prior to June 2024 can continue to do so once their prescriber is UK-registered. Dr. Cass recommends that if puberty blockers are prescribed, they are only done “following a multi-disciplinary assessment within a research protocol”.

In terms of providing care to the LGBTQIA+ community, the government outlined a holistic approach to supporting patients affected by this ban, with eight regional mental health centers being established.

TransActual criticized Dr. Cass’s findings in October 2024, expressing concern that trans people were “specifically excluded from the review process”, and that Dr. Cass was not “as neutral as previously claimed.” The group requested transparency from the government as to how the Cass Review was commissioned, that the ban be suspended and that it instead support the British Medical Association’s “ongoing review of the [Cass] Review’s methodology and conclusions.”

The new legislation is set to be reviewed in 2027, and NHS England will be commencing further research trials into puberty blockers next year.

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ECtHR: W.W. v Poland 11 July 2024 – Refusal to allow transgender person to continue hormone therapy in prison: violation of Art. 8 ECHR

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ECtHR: W.W. v Poland 11 July 2024 – Refusal to allow transgender person to continue hormone therapy in prison: violation of Art. 8 ECHR

Legal summary

July 2024

W.W. v. Poland – 31842/20

Judgment 11.7.2024 [Section I]

Article 8

Article 8-1

Respect for private life

Refusal to allow transgender person to continue hormone therapy in prison: violation

Facts – The applicant is a transgender woman who at the time of lodging the application was legally recognised as a male. Her request for legal recognition was granted in 2023. Between 2013 and 2024 she served several terms of imprisonment in male prisons. In June 2018 the applicant was hospitalised after performing a bilateral orchiectomy on herself. Upon the request of the governor of the prison where she was then detained, she was examined by a medical expert who recommended that she pursue hormone replacement therapy associated with gender reassignment. The prison governor allowed the applicant to undergo such treatment.

In May 2020 the applicant was transferred to Siedlce Prison. Her request to that prison’s governor for permission to be sent the necessary medication to continue her treatment was left without examination pending a further opinion of an endocrinologist. The applicant submitted such an opinion which prescribed her hormone therapy. The applicant ran out of medication on 18 July 2020 and her hormone treatment was interrupted as of that date.

On 30 July 2020, under Rule 39 of the Rules of Court, the Court indicated to the respondent Government to “administer the applicant … with the hormones prescribed by her endocrinologist … in doses prescribed, at her own expense, until otherwise decided by an endocrinologist”.

The applicant received the medication on 31 July 2020.

Law – Article 8:

(a) Interference or positive obligation – The applicant had undergone hormone replacement therapy associated with gender reassignment for nearly one and half years in two previous prisons and had been refused such therapy only when she had been transferred to Siedlce Prison. Thus, she had not complained of inaction on the part of the domestic authorities, but rather of the fact that the Siedlce Prison authorities had prevented her from continuing the treatment which she had initially been allowed to undergo. Therefore, the Court approached the case as one involving an interference with the applicant’s right to respect for her private life.

(b) Compliance with Article 8 § 2 – The interference at issue had been “in accordance with the law” and had pursued the legitimate aim of protecting the applicant’s health. The remaining question was thus whether it had been “necessary in a democratic society”.

The prison authorities’ decision, which had concerned access to hormone treatment, had touched upon the applicant’s freedom to define her gender identity, one of the most basic essentials of self-determination. In that regard, the Court also noted the impact of that decision on the applicant’s right to sexual self-determination; it had repeatedly held that given the numerous and painful interventions involved in gender reassignment and the level of commitment and conviction required to achieve a change in social gender role, it could not be suggested that there was anything arbitrary or capricious in the decision taken by a person to undergo such a procedure.

The applicant had been diagnosed with gender dysphoria after she had performed genital self‑mutilation and had been prescribed hormone replacement treatment, which, according to the medical reports, had had beneficial effects on her physical and mental health. The doctors who had prescribed the hormone replacement therapy had considered it to be necessary.

Therefore, the domestic authorities had had strong elements before them indicating that hormone therapy had been an appropriate medical treatment for the applicant’s state of health. That therapy had been provided to her in previous prisons and had had a beneficial effect on her. At Sieldlce Prison the treatment had been interrupted before she could be consulted. The burden that had been placed on the applicant to prove the necessity of the prescribed medical treatment by undergoing an additional consultation with an endocrinologist appeared disproportionate in the circumstances. In any event, the endocrinologist’s opinion she had submitted to the prison authorities confirming the necessity of the hormonal therapy had not resulted in her request being granted.

The Government had not referred to any detrimental effects which the therapy might have had on the applicant’s physical and mental health, nor had they maintained that allowing her to continue the therapy would have caused any technical and financial difficulties for the prison authorities. Indeed, the applicant had borne the cost of the medications herself, thus imposing no additional costs on the State. Although her hormone treatment had been interrupted only for a relatively short period, between 18 July and 31 July 2020, the applicant had submitted that since the beginning of July 2020 she had been taking half of the prescribed dose of medication. Most importantly, she had eventually received the medication, not because of a sudden change of approach on the authorities’ part, but as a consequence of the Court’s indication of interim measures under Rule 39.

Accordingly, the authorities had failed to strike a fair balance between the competing interests at stake, including the protection of the applicant’s health and her interest to continue the hormone therapy associated with gender reassignment. In so concluding, the Court bore in mind the applicant’s particular vulnerability as an imprisoned transgender person undergoing a gender reassignment procedure, which had required enhanced protection from the authorities. The Government’s preliminary objection relating to the applicant’s victim status, which had been joined to the merits, was therefore dismissed.

Conclusion: violation (six votes to one).

Taking into account that the applicant had received the necessary medical treatment since 31 July 2020, the Court decided, unanimously, to lift the interim measure indicated to the respondent Government under Rule 39 of the Rules of Court.

Article 41: EUR 8,000 in respect of non-pecuniary damage.

Source: https://hudoc.echr.coe.int/eng?i=002-14358