Parents Challenge Daughter’s Consent for Hormone Therapy in Court

In a significant case before the England and Wales High Court, the parents of a 17-year-old girl, referred to as BTN or ‘B’, sought a legal declaration asserting that she lacked the capacity to consent to Hormone Replacement Therapy (HRT). The Family Division issued its ruling in June 2025 after the parents applied for orders under the Children Act 1989 and the inherent jurisdiction of the Court.

The case involved complex issues surrounding gender-affirming treatment, as B, who had been identified as female from an early age, was receiving HRT since October 2024. This treatment included spironolactone and oestrogen, prescribed by a National Health Service (NHS) general practitioner as a preliminary measure prior to referral to specialist gender services. Notably, B reportedly completed a self-assessment form and allegedly forged her mother’s signature to initiate treatment.

The hearing included representation for all parties, with B supported by a court-appointed Children’s Guardian. In parallel to this case, B’s father was pursuing a judicial review of the GP’s decision to prescribe HRT to minors seeking gender-affirming treatment. This judicial review was postponed until the Family Division’s ruling.

The primary focus of the hearing was whether to grant permission under section 13 of the Children and Families Act 2014 for the inclusion of expert evidence. All parties agreed on the necessity of an expert endocrinologist’s involvement, although there was disagreement about the selection of the expert. Additionally, the parents requested permission to engage a psychiatrist to evaluate B’s capacity regarding HRT.

B, with the backing of her Children’s Guardian, opposed the psychiatrist’s involvement, arguing that such an assessment was unnecessary. The parents contended that both sides should be allowed to choose their experts.

Mr Justice MacDonald, presiding over the case, clarified that the Court’s role was not to delve into broader policy issues concerning gender-affirming treatment, which fall under the jurisdiction of Parliament and relevant health authorities. Instead, the Court’s focus remained strictly on B’s best interests, as established by the applications from her parents.

The judge determined that there was no need for a psychiatrist’s assessment, given that B had already been found competent to instruct her legal representative. The Children’s Guardian’s assessment indicated that B was a thoughtful and mature individual who had carefully considered her treatment choices.

The Court granted permission to instruct an endocrinologist selected by B, recognizing the expertise required to address the complexities of her treatment. Both parties had proposed qualified candidates, but the Court favored B’s choice, directing that the expert report should cover the benefits and risks associated with her current HRT, the implications of continuing treatment, and the consequences of ceasing it.

In his ruling, Mr Justice MacDonald reiterated that the case was fundamentally about B’s best interests, countering claims that it represented a landmark ruling. He noted the challenges young people face when their parents engage in legal disputes over their health decisions. The Court emphasized its unwillingness to allow personal matters to become a platform for broader policy debates regarding gender-affirming treatment.

The decision underscores the sensitive nature of cases involving young individuals and medical consent, highlighting the need for careful consideration of their rights and welfare in the legal system.