FD25P00172 and FD25P00173 - [2025] EWHC 1325 (Fam)

For the purposes of determining the case management issues now before the court, the background can be taken shortly.

B was born male but identifies as female and did so from a relatively early age. She lives at home with her parents. Within this context, since October 2024, B has been prescribed spironolactone and oestrogen for gender congruency by an NHS GP, by way of what is characterised as a “bridging prescription” pending referral to specialist gender services. This treatment has been provided to B based on a “informed consent” model of care, by which B completed a self-assessment form and forged her mother’s signature on 4 September 2024. By letter dated 14 March 2025, CAMHS has now confirmed to the applicants that a consultant psychiatrist is of the view that B experiences gender incongruence with bodily related distress and has recommended referral to the National Gender Incongruence Service.

B’s parents disagree with the General Practitioner’s approach to the treatment of B and the consequent prescription of spironolactone and oestrogen. They contend that B, whilst over the age of 16, lacks capacity to consent to such treatment, arguing that there has been no proper assessment of B’s capacity or a holistic, multidisciplinary, assessment of her overall mental and physical health that would ordinarily precede the treatment that she is receiving.

As I have noted, these proceedings are running in parallel with an application by the father in the Administrative Court for permission to apply for judicial review of the decision of B’s General Practitioner to prescribe HRT to children and young people who seek gender affirming treatment. Within those proceedings, B’s parents contend that her treatment is not in accordance with the recommendations of the Cass Review, the relevant guidance to medical professionals or NHS commissioning policy. In particular, the parents rely on NHS England’s current referral pathway for children and young people’s gender services, the Royal College of Psychiatrists’ good practice guidelines for the assessment and treatment of adults with gender dysphoria, the General Medical Council guidelines on trans healthcare, the British Medical Association guidance on the role of GPs in managing adult patients with gender incongruence, and the updated Position Statement issued in March 2025 by the Royal College of General Practitioners concerning the role of GPs in transgender care, which states that:

“For the care for children and young people, the College advises following national guidance and drawing on the recommendations highlighted in the Cass Review. As well as the provision of holistic, context specific, personalised and respectful care as set out above, the RCGP considers the role of the GP in relation to children and young people to include promptly referring, where appropriate, to the appropriate secondary care paediatric or mental health services. The RCGP does not consider that the GP role in relation to children and young people would include prescribing gender affirming hormones to address gender incongruence in a patient aged under 18.”

Within the foregoing context, by an application under Part 25 of the FPR 2010, the parents seek permission to instruct two experts in these proceedings. First, Dr Paul Moran, Consultant Psychiatrist. The parents contend that Dr Moran is the appropriate expert as he has 24 years of continuous practice as a specialist in Gender Psychiatry, co-founded the Irish National Gender Service, and was lead author and developer of the National Gender Service Model of Care, which was accepted by the Irish Department of Health in 2019. The applicants further point to the fact that Dr Moran has provided acute liaison psychiatry for adolescents aged 16 upwards from 2002 to 2025, and was also extensively involved as an expert member of the Cass Review. Second, Professor Jovanna Dahlgren, Paediatric Endocrinologist. The parents point to the fact that Professor Dahlgren is Head of Department, Institute of Clinical Sciences, and Professor and Chief Physician, Department of Paediatrics, University of Gothenburg, Sweden.

B, with the support of her Children’s Guardian, opposes the instruction of a consultant psychiatrist as being unnecessary. On behalf of B, Ms Fottrell and Ms Baker contend that there is no evidence that B lacks capacity in the relevant decision making domains, nor that her current treatment has or will result in grave psychiatric or psychological harm to her. Were the court to conclude that the instruction of a psychiatrist is necessary in these proceedings (and making clear that B would refuse to participate in such an assessment if directed), Ms Fottrell and Ms Baker submit that it would not be appropriate to instruct Dr Moran in circumstances where, they contend, the documents before the court demonstrate that he seeks to advance a particular viewpoint on the question of gender affirming treatment. They submit that the appropriate expert would be Dr Richard Eyre, a consultant child and adolescent psychiatrist.

Whilst agreeing the need to instruct an expert endocrinologist, B proposes that permission be given to instruct Dr Cotterill, Consultant Specialist in Paediatric Endocrinology based in Brisbane, Australia. Dr Cotterill has been instructed in other cases of this nature in the jurisdiction of England and Wales, including an unreported case before the President of the Family Division, and is able to report within two weeks of receiving his instructions. On behalf of B, Ms Fottrell and Ms Baker submit that Professor Dahlgren should not be instructed as, they contend, articles published by her demonstrate that she has a fixed agenda to advance. B does not oppose her medical records being shared with the endocrinologist instructed to provide an expert report only, and the parents do not seek disclosure of her medical records to themselves.

Finally, and as I have noted, the parents submit that “as a matter of equality of arms” the position should be that “each side” should be granted permission to instruct their own experts. Mr Sachdeva and Mr Hadden submit that this approach is “common place” in cases concerning the medical treatment of children and properly reflects the complexity and range of opinion that exists within the area of medicine with which this case is concerned.