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J (Transgender: Puberty Blocker and Hormone Replacement Therapy), Re

[2024] EWHC 922 (Fam)
A 16-year-old boy got testosterone from an online doctor without his dad's permission. The judge said it's too soon to decide if the boy can make his own medical decisions or if the dad can stop him. Instead, the judge said he should go to a real doctor for a check-up first. The judge also warned against using online doctors for this kind of treatment because it's dangerous.

Key Facts

  • J, a 16.5-year-old natal female, identifies as male and has received testosterone injections from Gender GP, an unregulated online clinic.
  • J's parents are separated, and there is a dispute regarding J's access to hormone treatment.
  • Gender GP's treatment of J is under scrutiny due to concerns about the dosage, lack of proper medical supervision, and inadequate assessments.
  • J is currently being assessed by Gender Plus, a London-based clinic.
  • The court is considering J's capacity to consent to hormone treatment and whether to intervene under the inherent jurisdiction or the Children Act 1989.

Legal Principles

Capacity to consent to medical treatment is decision and time specific. For those over 16, the Family Law Reform Act 1969, s 8 applies unless they lack capacity under the Mental Capacity Act 2005.

Family Law Reform Act 1969, s 8; Mental Capacity Act 2005

The inherent jurisdiction of the High Court allows intervention to override a minor's consent to medical treatment if the consequences are sufficiently grave (e.g., severe permanent injury).

Re W (A Minor) (Medical Treatment – Court’s Jurisdiction) [1993] Fam 64

Parents retain parental responsibility for children over 16, but the court can control their ability to consent to medical treatment through orders under the Children Act 1989, s 8, particularly in exceptional circumstances.

Children Act 1989, s 8; Children Act 1989, s 9(6)

Even with Gillick competence, the court may intervene if there's a dispute about diagnosis or treatment, considering the child's best interests.

Gillick v West Norfolk and Wisbech AHA [1986] AC 112

Outcomes

The court deferred making a decision on J's capacity to consent to treatment and the father's wider legal arguments, focusing instead on the agreed plan for J to undergo an assessment with Gender Plus.

The court opted for an incremental, case-by-case approach, avoiding unnecessary judicial pronouncements on broader legal issues, especially given the evolving legal landscape and the recent Cass Review.

The court endorsed the plan for J to be assessed by Gender Plus.

This was an agreed plan by all parties except for the father's concerns about Gender Plus' appropriateness. The assessment is to continue for six months.

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