Exclusive: Online clinic willing to prescribe sex change drugs to children without asking them to talk to doctor

A controversial online clinic is willing to prescribe sex change drugs and puberty blockers to children without asking them to talk to a doctor, a Telegraph investigation has found.

A GenderGP doctor told undercover reporters posing as the parents of a 12-year-old that their son may be able to obtain the drugs after only a few Skype appointments with a counsellor.

Staff at the clinic admitted the puberty blockers could damage his bone density and there was too little clinical evidence to say whether they would affect his ability to have children.

However, they played down the potential negative impact and told the reporters that the 12-year-old could potentially start on puberty blockers within six weeks and cross-sex hormones within seven and a half months of signing up to the clinic.

GenderGP's doctor said the potential effect on the boy's fertility was the "very tiny part that is very sensitive" about taking the medication.

The clinic's lead counsellor told the reporters that if the 12-year-old took cross-sex hormones it would be "no different" to a post-menopausal woman going on hormone replacement therapy (HRT), despite the fact that they would prompt him to irreversibly develop breasts and could leave him infertile.

The revelations will fuel concerns about the level of medical oversight at the clinic, which flouts NHS rules by exploiting a legal loophole that makes prescriptions signed by doctors registered anywhere in the EU valid for use at British pharmacies.

The Telegraph disclosed last week that GenderGP used a geriatrician in Romania to prescribe testosterone to a female reporter posing as a 15-year-old without parental involvement. The clinic defended the practice, saying "not all parents are supportive" and that when young patients are able to consent to treatment "in their own right" it can be "appropriate and necessary".

In the second part of The Telegraph's investigation, reporters posed as the parents of 12-year old Alfie, born a boy, who approached GenderGP on his behalf. They had two online appointments with a counsellor and one with a doctor, over the course of which they said the child – not present on any of the calls – had told them for the first time that he identified as female.

The counsellor, Marianne Oakes, told the reporters they would not necessarily have to speak to a doctor before the child started on puberty blockers, saying: "It's a choice of yours. You can read about the medication that we're minded to give you. We've got it all on the website."

Gender GP's doctor Yasmeen El Rakhawy confirmed that the 12-year-old could potentially obtain puberty blockers and cross-sex hormones without ever having an appointment with one of the clinic's doctors. She said consultations with a doctor are "an option at any point" and that the Skype sessions the child would have to have before obtaining the drugs could all be with a counsellor.

Responding to The Telegraph's findings, GenderGP said that "not everyone needs in-person consultations" with its doctors, but they have "the ultimate authority on all treatments".

'We would always advise our members to seek medical advice'

Debbie Hayton, a teacher and transgender rights campaigner, said it was "appalling" that children could access cross-sex hormones without seeing a doctor and called for the loophole to be closed.

Dr Jane Hamlin, the president of transgender support group the Beaumont Society, said online clinics have flourished because of "horrendous" waits for NHS treatment, adding: "We would always advise our members to seek medical advice when doing anything to their bodies."

The lack of medical oversight at the online clinic is in stark contrast to rules in England and Wales, which were tightened in December. Doctors can only prescribe puberty blockers to children under 16 where the decision, taken jointly by at least two specialist doctors directly involved in their care, is endorsed by a court order.

GenderGP's apparent willingness to prescribe drugs to children who have not seen a doctor is not the only issue likely to concern parents and medical practitioners.

Ms Oakes, who has a post-graduate diploma in gender sexuality and diverse relationships, also told the reporters that children who are transitioning are not required to have regular counselling if they do not want it because it might put them off having therapy later. "It's not mandatory," she said. "We do not force children to have therapy because we believe if they don't want it there could be a time later in life where they need it and they won't access it because their experience of it was traumatic."

She urged the reporters not to delay until the boy was around 16 if he wanted to progress to cross-sex hormones, saying: "If Alfie was to access puberty blockers at 12, she shouldn't be on until she's 16… That's where damage is caused to bone density. And that's where it can be dangerous."

Children treated according to 'stage not age'

But whilst she was alert to some risks, she appeared to downplay others. The counsellor, who according to the GenderGP website has gone through her own transition to female, said giving the boy cross-sex hormones was "no different" to giving a post-menopausal woman HRT.

"If this was any other condition that Alfie had, they would provide hormones – with no training and with no specialist knowledge," she said. "If there's a woman that goes in there that's been through the menopause and hormone levels are low, they wouldn't send you to an endocrinologist [hormone specialist]. They would just give you HRT based on what – I hate to say it, I don't want to trivialise it, but this is no different."

GenderGP said 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 while there were "no formal qualifications in this field", its practitioners were "very experienced and fully educated in transgender healthcare" and were regulated in their respective countries.