Mrs A and the Judicial Review

On Tuesday 1st December 2020, a judgement was handed down from the high court stating that the use of puberty blockers in children with gender dysphoria was experimental and that in most cases the oversight of the court should be sought when they are prescribed.

Mrs A has written this thoughtful piece in response to some of the accusations she has received for bringing this legal case.

 

This week, The High Court will pass judgment in a landmark case brought by Mrs A, the mother of a trans identified teen and Keira Bell, a young woman who detransitioned after taking puberty blockers and cross sex hormones. They asked the court to determine if minors could legally consent to taking puberty blockers to halt the progression of adolescence in young people who identify as transgender.

The parents in this case have been accused of being bigoted, transphobic and even abusive; and in not affirming their daughter as a son, they risk the well-being, and even the life, of their child.

I am this mother, and I want to tell you why I am not any of these.


The media portrayal of a family whose child who has come out as transgender is often celebratory. The child is lauded for their bravery with coming out assemblies at school. National newspapers congratulate the parents for their uncompromising acceptance, and describe the child with new pronouns and picture the child in stereotypical gendered clothing to show who they ‘truly are’.
But for many parents this does not reflect their experience. For some families, like mine, the declaration of a trans identity is the result of a complex interplay of underlying factors. Depression, social isolation or peer alienation are common. Many are looked after children or have suffered significant trauma. Large numbers are autistic. Many do not present as transgender until adolescence but with claims they have always felt this way; they claim an innate gender identity which either they have hidden since early childhood, or only came to realise in their teens. Parental evidence to the contrary may be overlooked or simply ignored.

Exploration of this new persona is inviting and liberating, but it comes at a cost. Parallel to the new identity comes the request for a treatment path that starts with puberty blockers, advances to cross sex hormones and thence to surgical removal of breasts or reproductive organs. Multiple surgical interventions, loss of fertility, loss of sexual function, potential effects on bones and brain: our children dismiss these consequences as trivial. How can they consent to this treatment when they do not understand how significant and life changing it is?

The decision for parents about the course of action to take is not an easy one. We have a binary decision to make: do we accept and affirm the new identity and agree to a referral for medical intervention that may render our child infertile, or do you take a more cautious approach, preferring to watch and wait, whilst exploring underlying causes for the development of this new identity, for which there has often been no prior indicator of distress? Neither path is one any parent wishes to be faced with, but confronted with it we are. And neither parent makes their choice through hate or bigotry. One avenue allows the child to lead the way, ensuring their immediate happiness and validation, the other utilises parental experience to foresee obstacles our child cannot.


When a child declares they are transgender, parents go looking for advice. What we often find is a single narrative that is centred around the risk to our child. If our child is not affirmed, the risk is death by suicide. Would you rather a dead daughter or a live son? It is a line that is irresponsibly overused in much of the pro-affirmative media coverage and often becomes the single most powerful motivator in a parent’s decision.

I can’t think of a more devastating situation than the death of a child, by whatever cause. However, childhood suicide remains extremely rare, and the Samaritans and other suicide prevention organisations have stringent guidelines around attributing suicide to a single risk factor.
It is true that rates of suicidal thoughts and behaviours are higher in those who have a transgender identity, but on a par with other mental health conditions, such as depression. The link between affirmative medical treatment and an improvement in mental health or reduction in suicidality has not been definitively proven, and should not be used to indirectly pressure parents to ignore any doubts they have about the affirmative approach to treatment.

Parents need good evidence on whether one chosen path confers benefits over the other. Carl Heneghan, Professor of Evidence Based Medicine at Oxford University looked at the data on puberty blockers and concluded that ‘the current evidence base does not support informed decision-making and safe practice in children.’ Together with the findings that almost all those who start puberty blockers go on to cross sex hormones, the preliminary data of a study into the use of puberty blockers showed an increase in self harming behaviours, and no reduction in gender dysphoria, raises serious concerns over whether this path could be causing more harm than good.

In asking for a judicial review, we sought an extra safety net for all our children. To allow decisions to be made by the in the best interests of the child, and not because of fear, misinformation or ideology. Parenting is always difficult. We ask ourselves if we have made the right decisions, taken the right path. We are faced with this impossible dilemma: affirmation and some relief from current distress, but ensuring your child has to take body altering medication for life; or watching and waiting, perhaps exacerbating their immediate discomfort, but postponing harms of infertility and irreversible changes their bodies until they have the wisdom of age.

Whatever our differences, we all want the best for our children. We want to help them mature into happy, healthy adults, able to make decisions for themselves. Is that not what parenting is about? But love and support does not have to look like affirmation, it can come in many forms. Now and through whatever decisions our daughter makes for herself in the future, I will always be her mother.


I do not believe that parents who are affirming are doing so from a place of hatred, and I wish others would not accuse me of the same.