This week, Keira Bell etched her name into history. Her legal victory in the British High Court of Justice on Tuesday marked the first time a neutral tribunal has examined protocols for transgender medicine now provided to minors across the West. The court, rather obviously, was appalled.
Bell, now 23, struggled in adolescence. At 14, the daughter of an alcoholic single mother was lonely, anxious and depressed, according to court documents. Always uncomfortable with her femininity, she began spending a lot of time online where she discovered trans influencers and decided she, too, was transgender.
By 15, she was referred to Britain's Gender Identity Development Service, England's national gender clinic, where a few cursory appointments led to a prescription for puberty blockers—medications that shut down the part of a pituitary that stimulates normal puberty. From there, she proceeded through a typical medical regimen for teen girls who identify as transgender: cross-sex hormones (testosterone), and then double mastectomy. By the time she had reached her twenties, she had a deep voice, a male torso, an impressive beard, masculinized facial features and male swagger. But the changes didn't satisfy. She began to "nitpick" her appearance, noticing her hands were smaller than a man's would be and she had a woman's height. In her twenties, she realized that her physical transition had not made her any happier; the peace she had sought, still out of reach.
"There was nothing wrong with my body, I was just lost and without proper support," she recently told Tribuna Feminista. "Transition gave me the facility to hide from myself even more than before. It was a temporary fix, if that."
She quit the testosterone, resumed living as a woman and sued the national clinic, petitioning for judicial review of the "affirmative" medical process that she claims provides no real safeguard for confused adolescents. The court seems to have agreed. Its decision was narrow: Minors under 16 do not have capacity to give "informed consent" to highly experimental and risky hormonal treatments that put their future fertility and sexual function at risk.
The court's careful review of the clinic's "affirmation model," which directs therapists and doctors to agree with the patient's self-diagnosis of "gender dysphoria"—revealed a system recklessly unmoored from the cautious, evidence-based approach that characterizes other areas of medicine. Transgender medicine for minors is dominated by nostrums: puberty blockers are a mere "pause button" on puberty; "kids know who they are"; "affirmation prevents suicide." Each of these is at best, wishful thinking—and at worst, a lie.
When used to arrest precocious puberty in small children—a four-year-old whose overactive pituitary causes her to develop breasts, say—many of the physical effects of blockers have proven reversible. But here, the court noted, puberty blockers were being used "in a very different way"—to interrupt normal, healthy puberty in adolescents. With this population, even the clinic conceded ignorance as to "how hormone blockers will affect bone strength, the development of your sexual organs, body shape or your final adult height."
Compounding these significant physical risks are psychological ones. Stopping a teenager's puberty so that she has, say, the vagina of a ten year old, also renders her out of step from her peers. Far from a "neutral" intervention, the "young person will have missed a period of...normal biological, psychological and social experience through adolescence" which "can never truly be recovered or 'reversed.'"
Each time it lifted an evidentiary rock, the court appears to have sprung back in alarm. The gender clinic could not provide a single instance in which an adolescent had been denied puberty blockers on the grounds that she was not competent to give consent. Rather than finding puberty blockers to be a mere "pause button" on deciding whether to transition, the court noted that "the evidence we have on this issue clearly shows that practically all children/young people who start [puberty blockers] progress on to [Cross Sex Hormones]." A drug that is sold to parents as a neutral intervention "in practice puts a young person on a virtually inexorable path to taking cross-sex hormones," eliminating her future fertility. And according to the clinic's own internal report, "there was no overall improvement in mood or psychological wellbeing" of the surveyed 44 young people put on blockers.
As for the farce of asking for a minor's "informed consent," the court noted: "There is no age appropriate way to explain to many of these children what losing their fertility or full sexual function may mean to them in later years." The court ended on a note of British understatement that no physician who practices in this area could easily miss: for patients aged 16 and 17, it might be a good idea for "authorization of the court" to be "sought prior to commencing the clinical treatment."
Would that Americans were still bound by the current precedent of British courts. Here in the U.S., ideologically driven transgender medicine continues apace, while those doctors who would urge caution are intimidated into silence. As ACLU lawyer Chase Strangio wrote on Twitter, condemning the British court's decision: "Please see this for what it is - an attempt to weaponize our happiness, our hopefulness, and our love of our bodies. This is a dangerous attack on trans survival and it is spreading."
In an America that insists on seeing transgender medical care as a political issue, not a medical one, few safeguards exist to protect teen girls from the decision Bell now refers to as "brash." The age of medical consent varies by state. In Oregon, a 15 year old can legally obtain testosterone, forever altering her body in irreversible ways, putting her future fertility at risk—all without her parents' permission. In Washington state, the age of consent for "gender affirming care" is now 13. And the possibility for regret—endless.
Abigail Shrier is author of Irreversible Damage: The Transgender Craze Seducing Our Daughters.
The views expressed in this article are the writer's own.