Court of Appeal orders greater oversight as teenager blocked from being given irreversible hormone therapy

The case centres on a mother’s battle to prevent her teenage daughter—referred to as “Q” for legal reasons—from being given powerful, potentially irreversible hormone therapy at a private clinic known as GenderPlus.

Despite the young person’s intelligence, age, and lack of any diagnosed mental health problems, the Court found that the matter was too serious and complex to be left to clinician discretion alone.

Instead, it stressed that further scrutiny is necessary to ensure the treatment serves the child’s best interests.

“Today’s judgment has left me feeling hopeful for my daughter’s future,” the mother said in a statement after the ruling.

“I am so pleased that the court has carefully considered the evidence and made the best possible decision for her safety, and for the safety of all children who are struggling with their identity as they go through puberty.”

The mother, who has fought a two-year legal and emotional battle, expressed relief, saying: “I miss my daughter horribly and can only hope that one day she will realise how very hard her Mum has worked to keep her safe… There is still a long way to go before all our children are safe, but the tide has turned.”

The Court of Appeal’s judgment has been seen as a shift in how the courts weigh up whether a 16-year-old is competent to make their own decision on gender-changing hormones.

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This is especially the case because medical reports have stated the child is bright, physically healthy, and has no underlying mental health diagnoses.

Historical medical disputes have either involved critically ill children or those with severe mental health conditions.

Paul Conrathe, Senior Consultant Solicitor at Sinclairslaw, who represented the mother, welcomed the decision.

He said: “It can no longer be assumed that just because a young person is 16 years old, intelligent, and in good health that their decision to proceed with cross-sex hormones is the end of the matter.

“The Court’s concern and insistence on judicial scrutiny is a recognition of the irreversible and life-altering nature of these treatments.”

According to Conrathe, the ruling aligns with the cautious approach advocated by a review by Dr Hilary Cass, which carried out an independent examination of gender identity services for children and young people.

The Cass Review, published in recent years, has recommended stricter protocols and a more evidence-based approach to prescribing puberty blockers and cross-sex hormones.

The private sector, often viewed as operating outside rigorous NHS safeguards, was highlighted as especially vulnerable to failing these standards.

The Court’s ruling comes amidst growing anxiety about private clinics offering gender-related treatments without adhering to the rigorous guidelines and ‘multi-disciplinary’ mental health assessments now required within the NHS.

The mother’s legal team argued that private entities are not being held to the same level of oversight, which can put vulnerable young people at risk.

Although the Court acknowledged these risks, it stopped short of mandating universal judicial approval for all private-sector hormone treatments.

Instead, it left such regulatory measures to the Care Quality Commission (CQC) and ultimately the Government.

Conrathe expressed disappointment that the Court did not extend protective measures more broadly.

He said: “The Court was asked to take a protective role and require court approval for any hormonal treatment in the private sector.

“It refused to offer that protection, stating this was a matter for Government and regulators.”

The decision follows the earlier Keira Bell litigation, in which the courts failed to impose special protections on children considering puberty blockers, treating them as no different from other medication.

However, since then, the Government has imposed a ban on certain treatments and described the practices as a “medical scandal”.

With this new judgment, the Court of Appeal has set a new precedent: even older teenagers cannot be assumed to be able to consent to irreversible treatments without external checks.

Gender Plus has insisted it follows all the guidance outlined by the Cass review and emphasised that it is properly regulated by the healthcare regulator, the Care Quality Commission.

Dr Aidan Kelly, a clinical psychologist and director of Gender Plus said: “While we cannot comment on this specific case, we did want to offer a point of clarification which appears to have been missed.

“All young people that are assessed and deemed appropriate for consideration of gender-affirming hormones, must then be presented at a national Multidisciplinary Team (MDT) for review by non-treating clinicians.

“The MDT, which includes an independent child and adolescent psychiatrist, must review all referrals prior to being accepted onto the hormone pathway.”