President of the Family Division issues warning against GenderGP


A judgment was handed down on Wednesday by Sir Andrew McFarlane, President of the Family Division, on a case in the family court concerning an adolescent girl (J) who had accessed testosterone from GenderGP at age 15, with support from the mother. The parents are separated and the case was brought by the father who also sought judgment on the wider issue of blockers and hormones being prescribed to under-18s. The full judgment can be read here.

[note: the judge refers to Child J as ‘he.’ We refer to Child J as a girl, for clarity of understanding]

The case concerns an autistic adolescent girl with significant mental health problems who was given dangerous levels of testosterone as a treatment by an unregulated private provider in partnership with a UK GP on the basis of an online questionnaire and a single online session with an unregistered counsellor, without the most basic medical checks.

The father’s concerns have been completely vindicated about what was described by the Court appointed expert as a ‘highly abnormal and frankly negligent approach’ offered by GenderGP, the online unregulated gender clinic operating out of Spain.

The ruling in this case is highly significant regarding:

  • That it may be legally appropriate for the court to override a child’s consent to medical intervention in the form of cross-sex hormones even over the age of 16.
  • The position of private gender clinics, specifically in regard to the warning issued by the President of the Family Division about the negligence of GenderGP.
  • Cases where one parent supports and the other parent opposes hormone medication for their child. Given the new NHS service specification restricting prescription of blockers and hormones, it is likely that future cases will involve private providers.

It is also significant that the judge chose to go ahead with this case. He need not have taken the case further once Child J had backed down on the issue of continuation with testosterone injections, and reached an alternative agreement to undergo a six month assessment at new private clinic Gender Plus.

The Court ruling was essentially that there was an acceptance of this way forward between the parties so there was no need at present for further action. However, the case may be reopened if the option of Child J resorting again to GenderGP for a further prescription is raised.

Given the shocking details of the ‘treatment’ administered by GenderGP, the judgment states:

Both parents, J, his guardian and the court now have significant concerns over the involvement of Gender GP to date.

The judge clarified that a court may overrule a child’s capacity to give consent for an over 16 year-old, even where there is no issue of mental capacity:

In Re W the Court of Appeal [Lord Donaldson MR, Balcombe and Nolan LJJ] held that the inherent jurisdiction remains available for a court to intervene and override consent given by an over 16-year-old where the consequences of the young person’s decision are of sufficient gravity to justify the court’s intervention. Examples of the level of gravity necessary are where the young person is likely to suffer severe permanent injury or irreversible mental or physical harm.

The final draft of the judgment had been largely completed before the Cass Review final report had been published, and the judgment is based only on the evidence and submissions that were before the court at the conclusion of the February hearing. The judge notes that:

In the circumstances, other than summarising the father’s wider legal case for the record, it is neither necessary nor appropriate to analyse and determine the issues he raises in any detail in this judgment.

And concludes:

Finally, and in the knowledge that the court’s approach to the determination of issues relating to gender dysphoria in children and young people under the age of 18 years is still developing, the court has been asked to provide some guidance in the light of lessons that may have been learned during the present proceedings.

The evidence presented in the judgment of this case is highly disturbing. The teenager at the centre of the case fits the picture of one of the most vulnerable cohorts identified in the Cass Review, a girl with significant mental health issues who began to identify as a boy at age 12:

Since 2020, he has been diagnosed with anorexia and autistic spectrum disorder. There have been bouts of self-harming and, in September 2021, J was detained under the Mental Health Act 1983, for treatment pursuant to s 3 for 9 months. As a consequence of his difficulties, J did not attend mainstream schooling in 2021 and 2022 but returned to school in early 2023.

The revelation that GenderGP thought it appropriate to prescribe testosterone to a child experiencing such severe mental health problems should be cause for urgent investigation. But what is truly horrific is that this decision was made based only on a self-completed online form and an online consultation (described as ‘extremely poor quality’ in the judgment) with a counsellor who is not registered with the Health and Care Professions Council regulator.

There was no medical examination, blood testing or other clinical evaluation and Child J had not had any direct communication with a doctor at any stage during the referral to GenderGP.

The judgment has exposed the extent of the medical malpractice by GenderGP in this case. It is striking that no UK-based endocrinologists could be found who were willing to be expert witnesses. Details were given by expert witness Dr Jacqueline Hewitt, a consultant paediatric endocrinologist based in Melbourne, Australia:

Dr Hewitt’s principal criticism of Gender GP’s intervention, however, relates to the dose of testosterone that was prescribed. She explained that the dosage of intra-muscular injection of testosterone [Nebido] at 1000mg/4ml every 6 weeks was at the level that one would administer to an adult only after a course of treatment that would have started at a much lower dose but built up to 1000mg/4ml over the course of two or three years.

Not only did Gender GP prescribe this top-end dosage to a testosterone-naïve child, but they did so by directing a ‘loading’ (double) dose at the commencement of the treatment. Dr Hewitt advised ‘with confidence’ that ‘there is no professional society of paediatric endocrinologists internationally who would consider this anything other than a highly abnormal and frankly negligent approach’. She stated that ‘in Australia, the treatment provided by Gender GP would be unlawful’.

Dr Hewitt continued to be concerned about the very high level of testosterone registered during regular testing of Child J’s blood:

In October 2023, Dr Hewitt advised that the level of testosterone in the blood was ‘dangerously high’ and that, apart from the potential for adverse long-term consequences of such a level, J was ‘presently at risk of sudden death due to thromboembolic disease’, meaning the potential for the hormone to cause thickening of the blood.

Yet, despite the risk of sudden death, there was no gender emergency service nationally that could offer urgent assessment and treatment other than basic blood testing. This represents a dangerous gap in NHS provision for young people put at risk from unregulated private gender clinics.

During the course of these proceedings, particularly after receipt of Dr Hewitt’s worrying advice that J may be at risk of imminent death, concerted attempts were made to engage the NHS in offering assessment and, if advised, treatment for J. These efforts were unsuccessful in achieving more than basic blood testing. The reality, reluctantly accepted by the parties and the court, is that, currently, there is no relevant NHS service available for J.

Subsequently, Dr Russell Keenan, a consultant paediatric haematologist at Alder Hey Children’s Hospital, Liverpool, advised that blood results were effectively normal when ‘compared to reference points relevant to an adult male.’

The judgment notes that Dr Keenan considered that an adult male is the appropriate comparison with an adolescent girl. Alder Hey is the site for one of the new gender clinic hubs for children. Can we expect safe treatment for children when paediatric doctors do not recognise the difference between adolescent female and adult male bodies? Would a doctor normally compare a teenage girl’s blood results with those of an adult man?

It is noticeable throughout the judgment that, with the exception of her father, all adults around Child J, including professionals, have failed to safeguard her.

Dr Richard Eyre, a consultant child and adolescent psychiatrist at the Oxford Health NHS Foundation Trust, judged that Child J’s diagnosis of autism, anorexia and social anxiety disorder did not impact on her ability to make a decision about treatment for gender dysphoria. It would be interesting to know just how serious a child’s mental health issues would have to be before he would consider a child incapable of consent to powerful hormonal medication with serious life-changing and irreversible effects.  

Child J’s guardian, Sarah Gwynne, is clear that it is in Child J’s “best interests to access further hormone treatment for gender dysphoria” having been in the role of guardian for less than a year and without any basis, before the child has even been assessed.

The testosterone prescribed by GenderGP was dispensed and administered through Child J’s local NHS GP who must have been fully aware of her troubled background and physical health condition after suffering anorexia.

This girl has been spectacularly failed. She is lucky that she has a father who has tried to protect her, a legal team fully briefed on the issues and a judge who clearly recognises the importance and implications of this case and the need for continued caution:

Before concluding this judgment, it is right to record (by way of preliminary indication, albeit firmly given) that, on the basis of the evidence currently available, if the option of J resorting once again to Gender GP for a further prescription is raised, then there will be a need to consider very carefully (a) his capacity to consent to that particular option and (b) whether the circumstances are such that the court should exercise the inherent jurisdiction to prohibit him from doing so.

On the subject of GenderGP the judgment concludes:

There must be very significant concern about the prospect of a young person such as J accessing cross-hormone treatment from any off-shore, online, unregulated private clinic. The evidence relating to Gender GP that is currently available, as analysed by Dr Hewitt, gives rise to additional serious concerns as to the safety of patients accessing cross-hormone treatment from that particular clinic. If a further referral to Gender GP is to be proposed by any party, the court will expect a detailed account from the clinic setting out their proposed course of assessment and treatment.

Whilst further evidence may, of course, alleviate the concerns that I have described, on the experience in these proceedings thus far, I would urge any other court faced with a case involving Gender GP to proceed with extreme caution before exercising any power to approve or endorse treatment that that clinic may prescribe.

In light of this damning criticism and the disturbing facts recorded in this judgment, it is time for the Secretary of State to intervene to stop the operation of unregulated private clinics like GenderGP that recklessly risk the lives of vulnerable young people. A teenage girl could have died.

But NHS failings also played a part in this case and must not be overlooked: from the failure of the service to provide emergency assessment, to the actions of the various NHS medical professionals involved, there appears to be a reverence towards ‘gender’ that precludes normal standards of judgment. Urgent action is required before any more children are harmed. What will it take?

This Post Has 3 Comments

  1. Lyndsey Snow

    This is so incredibly sad and utterly frustrating! How come the doctors did not “affirm” child J’s anorexia? After all. Children are right aren’t they?…

  2. charles lewis

    What a frightful tale of child abuse and how well exposed and vilified by the most senior family judge in the country! Now we need to be told the names and qualifications and experience of the wretched people running this particular so-called clinic, indeed of all the medical personnel involved in this abuse. You would not believe this could happen in a so-called civilized country. The father of the child most certainly merited the commendation the court afforded him. Si sic omnes!

  3. Carol Lawrence

    Beyond startling. Thank you for bringing to attention.

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