A 23-year-old woman, who is a witness in a judicial review against an NHS gender clinic, says she should have been challenged more by staff over her decision to transition to a male as a teenager – a choice she now "very seriously regrets".
Keira Bell was referred to the Tavistock clinic - the UK's only gender identity development service (GIDS) for children – after experiencing gender dysmorphia - when a person experiences discomfort or distress due to a mismatch between their sex assigned at birth and their gender identity.
Ms Bell, who now identifies as female, is a witness in a landmark case to stop the NHS prescribing "experimental" puberty blockers and cross-sex hormones to children who wish to undergo gender reassignment.
Ms Bell said she is involved in the case "because I do not believe that children and young people can consent to the use of powerful and experimental hormone drugs like I did".
Bringing the judicial review to the High Court alongside a former psychiatric nurse at the Tavistock is a woman known only as Mrs A, the mother of a 15-year-old autistic girl who is currently on the waiting list for treatment at the service.
At an earlier hearing before the case reached the High Court, Mrs A’s barrister, Jeremy Hyam QC submitted that the way the service obtains informed consent from children is "materially misleading".
He said Tavistock "omit, for example, to explain that nearly 100% of all children who commence hormone blockers go on to take the irreversible cross-sex hormones".
A judge gave the go-ahead this week for a full hearing of the case at the High Court against the Tavistock and Portman NHS Trust, likely to take place in the summer.
Ms Bell claims more should have been done to make her think through her choices before she was prescribed puberty blockers – drugs which are intended to delay the onset of puberty in children to allow them more time to weigh up their options before their body undergoes physical changes.
"There was no challenge to the opinions or perspective that I had of myself and it was assumed I would go on the medical pathway and that's what they took me through.
"I was allowed to run with an idea that I had as a teenager that didn't work out for me in the end and was very detrimental for my health and wellbeing."
She describes her experience as a “torturous and unnecessary path that is permanent and life changing."
Keira Bell says "it's important to look at the big picture":
The 23-year-old says she remembers “insisting on going down the medical pathway” and says she was put on hormone blockers following “a few appointments” within a six-month period at the Tavistock clinic.
Ms Bell says the treatment made her voice drop and facial hair grow.
She went on to have chest surgery and a double mastectomy through the adult clinic – Ms Bell claims this was after just two appointments.
The 23-year-old says the clinic only took a "very brief overview of my history and how I was feeling about my transition".
She’s now supporting the legal action against the NHS Trust as she says patients should be "over 18 in all cases to be able to consent to life-altering drugs.
"I think talking therapies when you're under-18 are always going to be more beneficial than immediately putting yourself on life altering drugs that are doing to affect the rest of your life and I wish that's what I had for example."
She added: "At the time I thought it was the best decision I was making, it's a time will tell sort of situation because nothing else will indicate whether you will stay on that pathway for the rest of your life or not."
The director of the GIDS service at Tavistock clinic, Dr Polly Carmichael, said the service is a "lifeline" for young people wishing to "explore their gender identity” and the "possible pathways they may take".
Dr Carmichael said the service "fully supports the judicial review" and added it was "an exceedingly complex area''.
She said: "In my view, and obviously in the view of the clinic, we feel our approach to consent is robust and young people are able to have capacity under the age of 16."
After the claim was initially filed, a spokesperson for Tavistock and Portman NHS Trust said: "The GIDS is one of the longest-established services of its type in the world, with an international reputation for being cautious and considered."
They added: "Our clinical interventions are laid out in nationally-set service specifications. NHS England monitor our service very closely.
"The service has a high level of reported satisfaction and was rated good by the Care Quality Commission."
Others, however, are happy with the treatment they and their loved ones received at the Tavistock clinic.
Rachel Thomas' son Matt was treated at the clinic and went on hormone blockers at 12-years-old.
Ms Thomas said by the time Matt reached GIDS they were breathing a "sigh of relief because things had been so awful".
Ms Thomas says Matt, who was assigned female at birth and is now 15, was "depressed" before treatment.
"Matt was so down to the point where we were sort of watching him, very, very closely and at one point we even sort of got rid of anything we thought he could use to take his own life".
Rachel Thomas' son Matt was treated at the Tavistock clinic:
Ms Thomas described the "pathway to treatment" at Gids as "intrusive, long, hard" and added they had been told by staff that they should "always leave a pathway back" from treatment for gender dysphoria.
She added: "They certainly weren’t handing blockers out like sweets.
"We were almost worried at one point ‘are they not going to give it to us’."
The mother says Matt had "many sessions of talking about the blocker" before staff at Tavistock moved on to the next stage of prescribing hormone blockers.
Matt has already socially transitioned from female to male but has to wait until he is 16-years-old to take any testosterone that would begin a physical transition.