When young people receive gender-affirming medical care, questions sometimes arise about safeguarding responsibilities and the legality of prescribed treatments. It is important to approach these cases with accurate information, respect for the young person’s identity, and a focus on their wellbeing.
Medications Involved
- The UK has recently placed restrictions on the use of GnRHa (puberty blockers) in young people.
- Prescriptions are for Cyproterone, Spironolactone, Raloxifene, Testosterone and Estradiol are regulated medicines, lawfully available in the UK and Europe, and are used safely in multiple contexts, including gender-affirming care.
- There is no legislation prohibiting the prescription of These. Accessing medication via an independent or overseas prescriber is not unlawful.
Evidence Base for Gender-Affirming Care
Research consistently shows that gender-affirming care is:
- Safe and effective when prescribed appropriately.
- Associated with significant improvements in mental health and wellbeing.
- Shown to reduce depression, anxiety, and suicidality, and to improve self-esteem and functioning.
Major international medical organisations, including the World Health Organisation, the Endocrine Society, the American Academy of Pediatrics, and the Royal College of Psychiatrists, endorse gender-affirming care as best practice. These organisations stress that withholding such care places young people at heightened risk of harm.
Safeguarding Considerations
Social workers and safeguarding professionals should focus on legitimate safeguarding concerns, such as:
- Ensuring safe access to care and ongoing medical monitoring.
- Supporting the young person’s mental health and family environment.
- Protecting against stigma, bullying, or discrimination.
Risks of Interference
Interference with established gender-affirming care can itself cause harm:
- Physical harm: Sudden withdrawal of hormones can destabilise physical health.
- Psychological harm: Denying or undermining gender identity increases risks of depression, anxiety, and suicidality.
- Trust: Misinformed or biased professional interventions can lead to disengagement from health and safeguarding services.
Ethical and Legal Principles
Safeguarding assessments must respect:
- Autonomy: Young people have a right to be heard in matters affecting their health and identity.
- Best Interests: All decisions must prioritise the young person’s welfare.
- Equality and Non-Discrimination: Gender identity is protected under the Equality Act 2010. Singling out a trans young person without evidence of harm risks breaching these protections.
Gender-affirming care using regulated medicines is not illegal. Safeguarding assessments should focus on whether care is provided safely and supportively, not on unfounded assumptions of illegality. The greater safeguarding risk lies in obstructing access to appropriate medical care and failing to support a young person in their gender identity.