Online clinic prescribes sex-change drugs to children without parents’ consent

FOREIGN doctors are prescribing powerful sex-change hormones to 15-yearolds in England without their parents’ involvement, an investigation by The Daily Telegraph has found.

Gendergp, an online clinic, uses a legal loophole to bypass NHS rules to issue valid prescriptions that can be used to obtain the drugs in Britain.

The sex-change, or “cross-sex” hormones, irreversibly change users’ bodies over the course of treatment and can also leave them infertile.

An undercover reporter posing as a 15-year-old girl was prescribed testosterone, a controlled drug, after just two Skype appointments with counsellors and one Skype appointment with a doctor at the online clinic.

Staff never asked to speak to her parents or demanded proof that any adult knew of her plans, beyond a single email from a 20-year-old half-brother confirming he would pay for treatment.

Marianne Oakes, the lead counsellor, said they did not require her parents’ “permission”. Staff accepted at face value the reporter’s stated belief that she was really male.

Gendergp defended its practices, claiming that “not all parents are supportive” and that when a young patient is able to consent to their treatment “in their own right, then that treatment can be appropriate and necessary”.

It also said it treats children based on “stage not age” and confirmed that it has prescribed cross-sex hormones to children as young as 12, and puberty blockers to children as young as 10.

The rules around prescribing the drugs to children in England and Wales were tightened last December.

The reporter received a prescription for a four-month supply of “Testogel”, during which time her voice could irreversibly deepen and facial hair start to grow. It was signed by a doctor in Romania, who The Telegraph identified as a geriatrician, also trained in using Botox.

Debbie Hayton, a transgender rights campaigner and teacher, said the loophole should be closed. “For a doctor in Eastern Europe to prescribe a … controlled drug to a child they have never spoken to is an egregious breach of protocol and safeguarding,” she added.

Gendergp said it was a global organisation and its specialists were regulated in their home countries. It said there were “no formal qualifications in this field”, but that its practitioners were “very experienced and fully educated in transgender healthcare”.

Dr Jane Hamlin, of transgender support group the Beaumont Society, said online clinics had flourished because of long waits for NHS treatment.

SPEAKING over Skype, the doctor assured the 15-year-old that the wait was nearly over. “I have no concern that this is absolutely the right path for you … getting to that first prescription is on the horizon now. You can anticipate that and I appreciate the excitement.”

The prescription concerned was for testosterone gel, or “T” as it is colloquially known, a controlled medication that contains the male hormone and that “Charlie” had requested in order to help her transition from female to male.

It would allow the teenager – who was born with a girl’s body – to grow facial hair, become more muscular, and for her voice to drop. The changes happen more quickly for some people than others, but her beard could start to grow and her voice start to break before her four-month supply would run out.

Those particular effects would be irreversible. If she used the drug for long enough, the T could also make Charlie infertile, but the 15-year-old told the doctor that she had no plans to have children. “That’s excellent,” declared Dr Yasmeen El Rakhawy, upon the news that the teenager had already decided never to become a parent. She stressed that Gendergp, the online clinic she worked for, did not need to go into the same level of detail on certain issues “as other practices will do, or will demand”.

Neither would they insist on regular appointments with medical staff once Charlie started taking the testosterone. “At no point will counselling sessions be enforced. At no point will the medical consultations be, you know, required regularly. It’s only if there’s ever a concern.”

Sure enough, Charlie received a valid prescription – signed by another Gendergp doctor – and secured the lifealtering medication without her parents’ involvement. The process had been relatively simple for the teenager. All it had taken was three Skype appointments and some emails, which she had been able to do from her bedroom. The clinic had not required proof that her parents knew of her plans.

Perhaps if it had, it would have noticed that something was amiss.

“Charlie” was a reporter who had gone undercover as part of an investigation into the lack of medical checks that some online clinics have in place for young patients seeking to transition.

We started to look at Gendergp after finding comments online that suggested that children under the age of 16 were able to obtain drugs, and that some patients were given prescriptions without even talking to a doctor.

We were also made aware of messages posted on a moderated chat forum hosted by Mermaids, a support group for trans minors that has ties with schools, where children had described how they had been able to obtain prescriptions from Gendergp.

Mermaids said last night that it had no affiliation with Gendergp but that it was aware that some young transgender people sought private treatment because of the “considerable barriers” if they go via the NHS. It “closely and carefully” monitors any discussions about medical journeys that take place on its platform, it added.

Gendergp is no stranger to controversy. Its founder, GP Dr Helen Webberley, has been suspended by the Medical Practitioners Tribunal Service since 2018 after she prescribed hormones to a child aged 12 – although no finding of fact has been made against her practice. She was later fined for running an unlicensed trans clinic from her home in Monmouthshire, and is due to face a “substantive” General Medical Council hearing in July.

Eventually she relocated to Spain and the company was reinvented as a complex international structure that navigates around the rules in England and Wales, and exploits a loophole that makes prescriptions signed by doctors registered anywhere in the EU valid for use at British pharmacies.

It has won a lot of devotees. Last year, Gendergp started more than 1,800 patients on cross-sex hormones, according to a report published on its website. It does not state how many it started on puberty blockers, but it has separately admitted that it has prescribed them to a child aged 10. Nearly one in six of its patients is under the age of 16.

Patients seeking medical appoint have ments are directed to Dr El Rakhawy in Cairo, whose specialism, if she has one, remains unclear: there is a block of Latin dummy text next to her name on the Gendergp website and her Linkedin profile reveals that she only finished the university portion of her medical training in 2017.

Prescriptions are signed by a geriatrician in Romania whose identity Gendergp does not readily disclose – a move that a Gendergp staff member admitted was “cloak and dagger”.

This set-up allows children under the age of 16 to order life-altering drugs from their own bedrooms, without any oversight or involvement by a parent or guardian.

They circumvent NHS rules in England and Wales that since December last year have required a court order before doctors can prescribe cross-sex hormones or puberty blockers to anyone under 16. Even before that, doctors could not prescribe cross-sex hormones to people until they were “around 16” and met stringent criteria.

When “Charlie” first contacted the organisation, she told the clinic that her mother and father did not support her decision to transition – believing that her desire to become a boy was something she would simply grow out of.

The reporter said her support network was so limited that she depended on her half-brother, a university student, to fund the process. The medicine cost £112 from a pharmacy, but between the £195 Gendergp set-up fee, its £30 monthly subscription and three consultations, the process had so far cost £682.

Over virtual appointments, two Gendergp counsellors and a doctor asked the reporter questions to satisfy themselves that this would not cause problems. They checked that her brother would keep on making the payments, and that the 15-year-old’s parents would not eject her from the family home when the effects of the testosterone became evident. “What we don’t want to do is be involved in a family row,” explained Marianne Oakes, its lead counsellor, in another Skype session.

“Charlie” did her best to allay any concerns. At Gendergp’s request, her “half-brother” sent a single email confirming that payments would continue uninterrupted. She also told staff via the internet that her parents would eventually come around, and that even if they did not fully endorse her decision, they would not force her to leave home.

No one at Gendergp asked to speak to the brother in person. Nor did they seek any form of contact with Charlie’s parents, or ask for any evidence that they even knew she was seeking treatment. Gendergp also appeared to fall short of its own stated precautions for patients. Despite requesting in an email that patients under the age of 18 who support should have an adult with them for part of their Skype calls, the reporter posing as Charlie conducted all of her appointments alone. Gendergp said yesterday that it was not “an absolute requirement”.

Precautions are there for good reason. Alongside the life-changing physical effects, puberty blockers and cross-sex hormones come with risks – some well-chronicled on the NHS website and some where the severity is still unknown because there is little information about their use in children.

Even the makers of Testogel caution against using it on under 18s, because there is “no clinical information” available for such children.

Some of the effects of the hormones – such as facial hair and a deeper voice – are permanent, even if users stop taking the medication.

They undoubtedly have a huge positive impact on the lives of many people who take them, but there is also a welldocumented minority who feel that they were put on to them too readily and have come to deeply regret the decision.

The best-known example is Keira Bell, a former patient of the Tavistock clinic, who was prescribed puberty blockers at the age of 16, testosterone the following year and subsequently took the clinic to the High Court for failing to “challenge” her sufficiently. “I made a brash decision as a teenager, (as a lot of teenagers do) trying to find confidence and happiness, except now the rest of my life will be negatively affected,” she told the court, describing her regret.

The NHS has strict protocols in place to guard against this sort of situation, even if they failed in her case. Children in England and Wales should not be prescribed cross-sex hormones until “around 16”, and after a year on puberty blockers and an extended period of assessment by a multidisciplinary team. Any decision to prescribe puberty blockers or hormones before their 16th birthday must be overseen by at least two specialist doctors directly involved in their care, including a consultant endocrinologist and a senior psychosocial clinician.

It must also be endorsed by a court order, following a high court ruling in the Keira Bell case last December, where judges ruled that it was “doubtful” that 14 and 15-year-olds could “weigh the long-term risks and consequences”. However, as The Telegraph’s investigation found, Gendergp provides a shortcut.

While Gendergp confirmed the evidence that The Telegraph uncovered, yesterday it defended its practice. It said that it treats children according to “stage not age” and that there may “occasionally be compelling reasons” to prescribe cross-sex hormones to a 12-year-old who is “completely aligned with their gender identity”.

It added that it assesses patients’ capacity to consent in a number of ways, including email messaging, questionnaires and consultations, but that “not all parents are supportive, and when a young patient is able to consent to their treatment in their own right, then that treatment can be appropriate and necessary.”

“Gendergp operates according to a gender-affirming model of care.

“Transgender patients of all ages who come to our service can be assured of receiving belief, support and compassionate access to medical care,” it said.

The clinic also subscribes to an “informed consent” model, in which the patient makes their own decision about what treatment they should pursue, “using a combination of their own understanding of their situation and needs, and the medical advice supplied to best inform them”.

The clinic believes that children are capable of giving their “informed consent” – even, it would seem, under the age of 16, operating alone from their childhood bedroom, and without an adult present.

‘What we don’t want to do is be involved in a family row’

‘When a young patient is able to consent, then that treatment can be appropriate’