Emergency puberty blocker ban was lawful, High Court rules

A ban on puberty blockers introduced by the Conservative government with emergency legislation was lawful, the High Court has ruled.

Campaign group TransActual, and a young person who cannot be named, made a bid to challenge the decision of now-shadow health secretary Victoria Atkins to impose a so-called “banning order” on puberty blockers, which suppress the natural production of sex hormones to delay puberty.

At a hearing on July 12, the High Court in London heard the secondary legislation prevents the prescription of the medication from European or private prescribers and restricts NHS provision to within clinical trials.

Lawyers for the group and young person had argued that the order made by the previous government on May 29 was unlawful.

The Department of Health and Social Care (DHSC) and the Department of Health in Northern Ireland defended the claim and said the case should be dismissed.

In a ruling on Monday, Mrs Justice Lang dismissed the challenges.

She said: “This decision required a complex and multi-factored predictive assessment, involving the application of clinical judgment and the weighing of competing risks and dangers, with which the court should be slow to interfere.”

The judge added that the two departments “were entitled to rely upon the precautionary principle when making their judgments” with a “rational and balanced approach to the assessment of risk in this context, where there remains scientific uncertainty”.

The legislation came after the publication of the long-awaited Cass Review by Dr Hilary Cass into children’s gender services in the NHS, which said children have been let down by a lack of research and evidence on the use of puberty blockers and hormones.

Jason Coppel KC, for the group and young person, previously told the court that Ms Atkins had “acted on the basis of her personal views about the conclusions of the Cass Review”.

He also said there was no ministerial submission setting out her reasoning about why puberty blockers were considered a “serious danger to health” – the standard needed for the emergency legislation to be used.

But in her 62-page ruling, Mrs Justice Lang said: “In my judgment, the Cass Review’s findings about the very substantial risks and very narrow benefits associated with the use of puberty blockers, and the recommendation that in future the NHS prescribing of puberty blockers to children and young people should only take place in a clinical trial, and not routinely, amounted to powerful scientific evidence in support of restrictions on the supply of puberty blockers on the grounds that they were potentially harmful.

“Although the Cass Review did not state in terms that puberty blockers cause ‘a serious danger to health’, that was not the question that the Cass Review was asked to consider.

“That was a matter for the defendants to determine on all the evidence before them. It would have been premature to do so before the final report had been published.”

Although the emergency ban was implemented by the previous Conservative government, the court previously heard that it might be made permanent by new Labour ministers.

Children’s healthcare must be evidence-led

Health Secretary Wes Streeting later said he was “treading cautiously” in his decision amid “lots of fear and anxiety”.

Following the High Court’s decision, Mr Streeting said he welcomed the ruling.

He continued: “Children’s healthcare must be evidence-led.

“Dr Cass’s review found there was insufficient evidence that puberty blockers are safe and effective for children with gender dysphoria and gender incongruence.

“We must therefore act cautiously and with care when it comes to this vulnerable group of young people.

“I am working with NHS England to improve children’s gender identity services, and to set up a clinical trial to establish the evidence on puberty blockers.

“I want trans people in our country to feel safe, accepted, and able to live with freedom and dignity.”

We are seriously concerned about the safety and welfare of young trans people in the UK

TransActual’s director for healthcare, Chay Brown said after the decision: “This is a disappointing result. Defence evidence makes clear that they decided on an emergency ban first and sought ways to justify it second.”

He continued: “We are seriously concerned about the safety and welfare of young trans people in the UK.

“Over the last few years, they have come to view the UK medical establishment as paying lip service to their needs; and all too happy to weaponise their very existence in pursuit of a now discredited culture war.

“It is essential that NHS England and the Department of Health and Social Care now take urgent steps to reverse this perception.”

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