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Keira Bell, a patient who started to take puberty blockers at the age of 16 years for gender dysphoria (GD), recently won a legal battle against the Tavistock and Portman National Health Service (NHS) Trust Gender-Identity Development Service (GIDS), on the basis that she should have been challenged more before being allowed to start treatment. The High Court ruled that children aged 16 years old and under 16s are unlikely to provide informed consent, and they are not fully capable of understanding the long-term effects of the treatment.1 As a consequence, NHS England has ordered that children and adolescents under the age of 16 years should not be referred by a GIDS to a paediatric endocrinology clinic for puberty blockers unless a court has ruled that it is in their best interest to receive puberty-blocking treatment.2 This is a milestone decision considering that puberty blockers have been used in GD for many years in several countries. It is also unclear what this means …