It is imperative that the Court must be held to account for its egregiously transphobic, discriminatory, and logically dishonest conclusion.

The Court states that:

(a)    Gillick competence must be demonstrated for the consent of both hormone blockers and HRT

(b)    Those under 16 are unlikely to be able to give said consent

This is a horrific attack on the rights and safety of transgender youth, which defies all medical advice, which was provided throughout this case by multiple experienced Doctors.

Gender Dysphoria is an incredibly serious condition and must be treated as such, with the appropriate access to treatment provided. There are numerous studies to demonstrate both the positive effect of transition in alleviating gender dysphoria, and the negative effect of any type of conversion therapy or delay to treatment.

A key “fact” upon which the case was decided, is that nearly 100% of patients who take puberty blockers then go on to transition, and therefore must also consent to HRT. This is logically fallacious; patients who are diagnosed with a lifelong condition will of course continue to treat it throughout their lives. If anything, this would indicate the incredible accuracy of diagnosis.

Point 9 in the judgement is extremely hypocritical – it rightly states that the Court is unqualified to determine the effectiveness of Puberty Blockers in treating Gender Dysphoric patients. Why then, has it passed a judgement that effectively bars the usage of such medication during the critical stages of development? The Court claims that a child cannot consent to the use of Puberty Blockers – how then can anyone under the age of 16 be prescribed drugs of any nature? How is it that those children undergoing precocious puberty are able to take the exact same drug if they are unable to consent? This is a blatant display of transphobia. These rigid guidelines have been applied to only a singular medical disorder.

Point 28 in the judgement – what would be this experimental or profound impact mentioned? And again, why is it irrelevant in those undergoing suppression of precocious puberty?

Points 45 and 46 – Similarly, why is such procedure not applied to any other medication? There are multiple medications prescribed for psychiatric and physical health which may cause extreme effects.

Point 65 – A transgender child forced through an incorrect puberty will suffer lifelong physical and ensuing mental health effects, in addition to losing a socially normative puberty. Why is it deemed acceptable that transgender people should suffer deeply in order to try and protect a vanishing minority of misdiagnosed cisgender people?

Point 79 to 83 – The claimant herself admits that she chose to discard the advice given to her by Doctors at the trust and continue on the path she wanted to. She is also in an extreme minority of less than 1% and her experience is in no way reflective of the overwhelming outcomes of treatment.

The judgement then goes on to provide the statements of a greater number of successful transitioners, in addition to a statement by Woman A, which can be disregarded as she has zero experience of the clinic and its procedures.

Point 103 – Contrary to the judgement, “Transgender Trend" does not use evidence based information and has gone as far as to promote the idea of “ROGD” – a concept for which all supposed evidence was anonymously retrieved in the form of anecdotal accounts of parents from anti trans websites.

Throughout the judgement, it has been reiterated that judges are not competent to determine the efficacy of medical treatments. However, all through the conclusions, the medical impacts and the studies are discussed, which in fact indicates that the Court has taken it upon itself to provide a medical judgement.

135 claims that GD has no direct physical manifestation, whereas treatment does. However, this fails to take into account the potential physical implications of self harm and suicide in those that fail to receive the correct treatment. Additionally, by denying PBs, there is a direct physical manifestation of an unwanted puberty. If a child is unable to understand the impacts of CSH, they must also be unable to understand the irreversible impacts of natal hormones. In short; PBs are largely reversible, whereas natal puberty is decidedly irreversible.

To the Court, and the claimants: I would again like to reiterate that rates of detransition are vanishingly small, whereas the denial of PBs will have a significant impact on vulnerable children and young people. When these children go on to transition, after being wrongfully denied PBs by the court, what compensation will you provide? What compensation will you provide for the effect of lifelong distress as a result of unwanted physical characteristics and the vicious discrimination that follows? What compensation will you provide for the cost of taking time off work to undergo corrective surgeries such as Facial Feminisation and mastectomy that were rendered essential by the blocking of access to PBs? What compensation will you provide for the lost years of anguish while waiting for such surgeries? What compensation will you provide for the children who are forced to suffer through abject body horror and sustain permanent physical characteristics they will always regret?

Do you really believe you are more competent by the children, clinicians, and families, to determine their treatment? It is easy for you to pass this judgement, safe in the comfort and ignorance of correctly sexed bodies. You will not be the one watching your body mutate into an undesired form. You will not be the one undergoing the pain of surgery. You will not be the one missing days of education and enjoyment due to the severe psychological, traumatic, impacts of gender dysphoria. You will not be the one trying to comfort your child as they cry for days, heartbroken.

This decision is marred by the stench of ignorance and the discriminatory protection of the 1% of cisgender people, at the expense of the 99% of transgender people, who have just as much right to feel comfortable in their bodies. The logical fallacy that a child cannot consent to the future potential of CSH, but can consent to the crippling impact of natal puberty. The misguided belief that the withholding of PBs has no real consequences; the consequences are numerous and they include death.

I will reiterate again my final question:

When transgender people suffer physically, mentally, socially, and financially as a result of this decision:

How will you pay?

Scientific Support:

A systematic literature review of all peer-reviewed articles published in English between 1991 and June 2017 that assess the effect of gender transition on transgender well-being. We identified 56 studies that consist of primary research on this topic, of which 52 (93%) found that gender transition improves the overall well-being of transgender people, while 4 (7%) report mixed or null findings. We found no studies concluding that gender transition causes overall harm. This search found a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals. The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender. Link below includes further links to referenced studies.

https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

The following studies display the positive effects of CSH and dramatically reduced suicide rates:

Gorton, 2011 (Prepared for the San Francisco Department of Public Health): “In a cross-sectional study of 141 transgender patients, [ Kuiper and Cohen-Kittenis] (https://www.ncbi.nlm.nih.gov/pubmed/3219066 found that after medical intervention and treatments, suicide fell from 19 percent to zero percent in transgender men and from 24 percent to 6 percent in transgender women.)”

[Murad, et al., 2010](https://www.ncbi.nlm.nih.gov/pubmed/19473181): "Significant decrease in suicidality post-treatment. The average reduction was from 30% pretreatment to 8% post treatment."

[De Cuypere, et al., 2006](http://www.sciencedirect.com/science/article/pii/S1158136006000491): Rate of suicide attempts dropped dramatically from 29.3% to 5.1% after receiving medical and surgical treatment among Dutch patients treated from 1986-2001.

[UK study](http://www.gires.org.uk/assets/Medpro-Assets/trans_mh_study.pdf): "Suicidal ideation and actual attempts reduced after transition, with 63% thinking about or attempting suicide more before they transitioned and only 3% thinking about or attempting suicide more post-transition.

[Richard Bränström, Ph.D., John E Pachankis, Ph.D., 2019] (https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080 Transgender individuals who undergo surgery that affirms their gender identity can experience significant mental-health benefits down the line, a new study suggests.

 [Hughto, Reisner, 2016] (https://www.liebertpub.com/doi/10.1089/trgh.2015.0008 Uncontrolled prospective cohort studies suggest that hormonal therapies given to individuals diagnosed with having gender identity disorder (i.e., gender dysphoria) likely improve psychological functioning 3–12 months after initiating hormone therapy. Findings from the review support current clinical care guidelines such as the WPATH Standards of Care, which recommend the use of hormone therapy as a treatment option to reduce gender dysphoria.

 [Unger 2016] (http://tau.amegroups.com/article/view/11807/13169 Hormone therapy improves transgender patients’ quality of life. Longitudinal studies also show positive effects on sexual function and mood.

[Ulrike Ruppin, Friedemann Pfäfflin, 2015] (http://link.springer.com/article/10.1007/s10508-014-0453-5 Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation.

[Maja Marinkovic, et al, 2015] (https://www.eurekalert.org/pub_releases/2015-03/tes-sdc030615.php Allowing Transgender Youth To Transition Improves Their Mental Health, Study Finds

[de Vries, et al., 2014](http://pediatrics.aappublications.org/content/134/4/696 studied 55 trans teens from the onset of treatment in their early teenage years through a follow-up an average of 7 years later. They found no negative outcomes, no regrets, and in fact their group was slightly mentally healthier than non-trans controls.

 [Heylans et al., 2014](http://onlinelibrary.wiley.com/doi/10.1111/jsm.12363/abstract): "A difference in SCL-90 [a test of distress, anxiety, and hostility] overall psychoneurotic distress was observed at the different points of assessments (P = 0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P < 0.001)...Furthermore, the SCL-90 scores resembled those of a general population after hormone therapy was initiated."

[Nataša Jokić-Begić, Anita Lauri Korajlija, and Tanja Jurin, 2014] (https://www.hindawi.com/journals/tswj/2014/960745/ Despite the unfavorable circumstances in Croatian society, participants who had SRS demonstrated stable mental, social, and professional functioning, as well as a relative resilience to minority stress.

[Heylens, Verroken, De Cock, T'Sjoen, De Cuypere, 2014] (https://www.sciencedirect.com/science/article/pii/S1743609515305336?via%3Dihub A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy.

[de Vries, McGuire, Steensma, Wagenaar, Doreleijers, Cohen-Kettenis,] (http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958.abstract After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved.

[Colizzi et al., 2013](http://onlinelibrary.wiley.com/doi/10.1111/jsm.12155/abstract): "At enrollment, transsexuals reported elevated CAR ['cortisol awakening response', a physiological measure of stress]; their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy [at followup, 1 year after beginning HRT], transsexuals reported significantly lower CAR (P < 0.001), falling within the normal range for cortisol levels. Treated transsexuals showed also lower perceived stress (P < 0.001), with levels similar to normative samples."

[Gomez-Gil et al., 2012](http://www.ncbi.nlm.nih.gov/pubmed/21937168): "SADS, HAD-A, and HAD-Depression (HAD-D) mean scores [these are tests of depression and anxiety] were significantly higher among patients who had not begun cross-sex hormonal treatment compared with patients in hormonal treatment (F=4.362, p=.038; F=14.589, p=.001; F=9.523, p=.002 respectively). Similarly, current symptoms of anxiety and depression were present in a significantly higher percentage of untreated patients than in treated patients (61% vs. 33% and 31% vs. 8% respectively)."

[Colton Meier, Fitzgerald, Pardo, Babcock, 2011] (https://www.tandfonline.com/doi/full/10.1080/19359705.2011.581195 Results of the study indicate that female-to-male transsexuals who receive testosterone have lower levels of depression, anxiety, and stress, and higher levels of social support and health related quality of life. Testosterone use was not related to problems with drugs, alcohol, or suicidality. Overall findings provide clear evidence that HRT is associated with improved mental health outcomes in female-to-male transsexuals.

[Annika Johansson, Elisabet Sundbom, Torvald Höjerback, Owe Bodlund, 2010 ] (http://link.springer.com/article/10.1007%2Fs10508-009-9551-1 In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.

[Lawrence, 2003](http://link.springer.com/article/10.1023/A:1024086814364 surveyed post-op trans folk: "Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret."

[Bauer, et al., 2015] (http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2): Transition vastly reduces risks of suicide attempts, and the farther along in transition someone is the lower that risk gets.

[de Vries, et al, 2014] (http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958): A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides trans youth the opportunity to develop into well-functioning young adults. All showed significant improvement in their psychological health, and they had notably lower rates of internalizing psychopathology than previously reported among trans children living as their natal sex. Well-being was similar to or better than same-age young adults from the general population.

[Heylens, 2014](https://www.ncbi.nlm.nih.gov/pubmed/24344788): Found that the psychological state of transgender people "resembled those of a general population after hormone therapy was initiated."

[Perez-Brumer, 2017] (https://www.sciencedirect.com/science/article/pii/S0890856717303167?via%3Dihub): "These findings suggest that interventions that address depression and school-based victimization could decrease gender identity-based disparities in suicidal ideation."

Debunking “ROGD"

The University suppressed the study because it got butchered in peer review for a frankly embarrassing methodology with massive flaws in internal validity. None of the findings have been replicated with better methodologies and multiple studies have since been published that refuted the findings.

 From ThinkProgress, a Summary (https://thinkprogress.org/transgender-children-desistance-a5caf61fc5c6/

Rebuttal to the dissonance study - [Learning to listen to trans and gender diverse children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018)] (https://www.tandfonline.com/doi/abs/10.1080/15532739.2018.1471767?src=recsys&journalCode=wijt20  Kelley Winters, Julia Temple Newhook, Jake Pyne, Stephen Feder, Ally Jamieson, Cindy Holmes, Mari-Lynne Sinnott, Sarah Pickett & Jemma Tosh. International Journal of Transgenderism.

[Transgender youth have consistent views on their gender over their lifetimes] (https://pubmed.ncbi.nlm.nih.gov/25749700/  Kristina Olson,  Nicholas Eaton, Aidan Key

The Negative Effects of Discrimination

This is critical as discrimination will inevitably increase towards people who were denied puberty suppression and ended up with characteristics that make them identifiably trans as a result.

[A. Williams et al, 2017] (https://www.sciencedirect.com/science/article/abs/pii/S0924933817318357): “The literature review showed several unique risk factors contribute to the high rate of suicide in this population: lack of family and social supports, gender-based discrimination, transgender-based abuse and violence...”

[Bauer, et al., 2015] (http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2 “Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk”

A wide range of data showing the impact of societal oppression that is associated with being visibly trans (https://williamsinstitute.law.ucla.edu/publications/suicidality-transgender-adults/

And of course many of the articles listed previously, about the positive effects of CSH, also note social support as a protective factor against suicide.