Teen prescribed ‘dangerously high’ hormone dose by online clinic

A teenager was prescribed “dangerously high” levels of hormones that could have resulted in sudden death, a judge said as he warned of the perils of online transgender treatments.

Sir Andrew McFarlane, the president of the family division of the High Court, said in a ruling on Wednesday that there was “very significant concern” over children “accessing cross-hormone treatment from any offshore, online, unregulated private clinic”.

McFarlane had heard evidence from an expert witness that the dosage of hormones prescribed to the teenager by GenderGP after just a single online consultation with a counsellor was so high it was “highly abnormal and frankly negligent”.

Jacky Hewitt, a consultant paediatric endocrinologist based in Melbourne, told the court that in 20 years of practice she had never seen such a “massive” dose given to a child, and that such treatment would be “unlawful” in her native Australia.

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She said that the teenager was immediately prescribed levels of testosterone that would normally be administered only to an adult, after a period of steady escalation over the course of two or three years.

“Not only did GenderGP prescribe this top-end dosage to a testosterone-naive child, but they did so by directing a ‘loading’ [double] dose at the commencement of the treatment,” Hewitt added.

The teenager’s blood was later assessed by Russell Keenan, a consultant paediatric haematologist at Alder Hey Children’s Hospital in Liverpool, who advised that the results were effectively normal when compared with reference points relevant to an adult male.

At the heart of the case was a 16-year-old, referred to in the ruling as J, who was born female before beginning a course of cross-hormone treatment at the start of last year.

The autistic teenager is biologically female and has a history of anorexia and self-harm.

J’s last testosterone injection was in August and the next was scheduled for November. But further treatment was postponed, with J’s agreement, after the teenager’s father raised objections, which the judge was asked to rule on.

In his judgment, McFarlane delayed ruling on the dispute over whether J, as a minor, had the capacity to consent to life-changing treatment, as it was agreed that no further medical action was required for six months.

It was also noted that there was the possibility that, when the time came, J could continue treatment with a UK provider.

But the judge went on to signal deep concern over the use of online gender-treatment clinics that are based abroad.

McFarlane said that it was “right to record” that if J considered resorting to using GenderGP, which is based overseas, for further prescriptions, “then there will be a need to consider very carefully … his capacity to consent to that particular option and … whether the circumstances are such that the court should exercise the inherent jurisdiction to prohibit him from doing so”.

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GenderGP describes itself as a “worldwide transgender clinic” that provides “advocacy, support, advice, healthcare and access to a range of complementary services, which enable trans people to live their lives more easily”.

The judge said that there “must be very significant concern about the prospect of a young person such as J accessing cross-hormone treatment from any offshore, online, unregulated private clinic”.

He added that the “evidence relating to GenderGP that is available … 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 GenderGP 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.”

And speaking directly to judges in future cases, McFarlane said: “Whilst further evidence may … 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 GenderGP to proceed with extreme caution before exercising any power to approve or endorse treatment that that clinic may prescribe.”

Paul Conrathe, the solicitor representing J’s father, called for the government to issue a formal warning to pharmacies not to honour hormone prescriptions from providers such as GenderGP.

He added that the case had “exposed a dangerous gap in NHS provision, which urgently needs to be remedied”.

GenderGP was contacted for comment.