Cross-sex hormones will remain available to under-18s in gender treatment after a dramatic High Court ruling threw out a bid to ban their prescription - despite warnings of “permanent risks” and “scandalous oversight.”
Keira Bell – the former Tavistock patient who began transitioning as a teenager and later detransitioned – was behind the legal challenge alongside two parents.
The trio had argued that Health Secretary Wes Streeting acted irrationally by banning puberty blockers while allowing cross sex hormone treatment to continue.
But Lady Justice Whipple and Mr Justice Johnson refused permission for a judicial review, ruling that Streeting’s actions were within his “broad discretionary powers,” especially as the Department of Health is already assessing the risks and benefits of cross sex hormones.
Cross-sex hormones will remain available to under-18s in gender treatment after a dramatic High Court ruling threw out a bid to ban their prescription - despite warnings of 'permanent risks' and 'scandalous oversight'
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However campaigners say the ruling leaves thousands of vulnerable children exposed to serious harm.
"It’s a scandal… and I don’t shy away from that word," said Zoe Gannon, the claimants' barrister during the hearing.
“It’s a scandal. Just as the Secretary of State used that word when banning puberty blockers, we say it’s equally a scandal that this is being allowed to continue for cross-sex hormones.”
The court was told that while puberty blockers - that halt the onset of puberty - were banned in December 2024 following the Cass Review, a different standard was being applied to cross sex hormones.
This lead to the development of sexual characteristics of the preferred gender, which are still allowed to be prescribed with “extreme caution” and after an assessment by a team of mental health experts.
“There is a serious risk to vulnerable children,” Gannon said. “This is an area of particularly weak evidence.”
Bell submitted a personal statement to the court, describing how, as a teenager struggling with trauma, she was swayed by clinicians into making life-altering medical decisions.
“It has been detrimental to my whole life,” she said. “I was just a teenager when I made my decision, and I wasn’t given the space or support to explore other options.”
She added: “I was an unhappy girl who needed help. Instead I was treated as an experiment.”
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The legal team argued the Government’s decision-making lacked consistency. They pointed out that the Cass Review - a landmark independent inquiry - had branded the evidence for both puberty blockers and cross sex hormones as “remarkably weak.”
Yet only puberty blockers - which delay the onset of puberty - had been banned outright.
Barristers also raised concerns about unregulated overseas providers continuing to prescribe cross-sex hormones to British teens which they claimed in some cases was being carried out without proper checks and psychological analysis - even, they claimed, using AI.
“Some of this prescribing is coming from overseas,” they told the court. “Children can still access these powerful drugs with minimal clinical oversight.”
One father, speaking anonymously, submitted evidence to show how his 15-year-old daughter - autistic and recovering from anorexia - secured cross-sex hormones online without his consent.
But defending the Government, the Department of Health’s legal representative insisted that Streeting’s approach was proportionate and justified.
“There is not even an argument but that the defendant has acted rationally,” he said. “It was rational to treat puberty blockers as the most urgent priority and to continue to give cross sex hormones further consideration. This is an area that, to say the very least, divides opinion.”
The judge agreed, stating that decisions around healthcare policy involved complex medical and ethical judgments that ministers were entitled to make.
A working group is already reviewing the safety of cross sex hormones - and its recommendations are expected in July,
Campaigners say the ruling leaves thousands of vulnerable children exposed to serious harm
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The claimants argued that children have been put at risk while the "clock ticks" and the delay is putting their health and lives at risk.
Gannon, the claimant's barrister said: “We don’t know how many are already on the same irreversible pathway Keira Bell was on. There is a clear and present danger to children’s health.”
She added that treating cross sex hormones and puberty blockers as two entirely separate categories, “requires justification and evidence” - yet no such evidence has been produced.
Though they lost the case, Bell’s legal team claimed the fight has already forced ministers to act.
“Without this challenge, the Government might not have started taking this issue seriously,” said Paul Conrathe, solicitor for Ms Bell.
“This ruling has shone a light on a system that is still failing to protect children. We will keep pushing.”
The NHS has now confirmed that all new referrals for cross sex hormones will be reviewed by a national multi-disciplinary panel, with input from an independent chair - a safeguard campaigners insist is long overdue.
Parent group Bayswater Support, which backed the legal action, said: “There is no good evidence these drugs improve mental health—but it is certain they degrade physical health. We do not believe children can consent to the irreversible changes caused by these hormones.”
Meanwhile the Government maintains it is committed to implementing the Cass Review’s findings “in full.”
