A ban on prescribing puberty blockers to children with gender dysphoria in England, Scotland and Wales was lawful, a high court judge has ruled. The Conservative government issued an emergency order on 29 May temporarily outlawing the supply of puberty blockers pursuant to an overseas prescription, in the wake of the review by Dr Hilary Cass into gender medicine. The review criticised the lack of evidence surrounding the benefits and the risks associated with puberty blockers and the legislation was designed to ensure they could only be obtained as part of an authorised clinical trial. The advocacy group TransActual and a young person who cannot be named challenged the decision, claiming it lacked rigour and was motivated by the personal views of the health secretary at the time, Victoria Atkins. They argued that she had not identified the “serious danger to health” needed to justify emergency legislation and that she should have consulted before issuing the order. However, in a judgment handed down on Monday, Mrs Justice Lang said that Atkins had acted in accordance with the law. The judge wrote: “In my view, it was rational for the first defendant to decide that it was essential to adopt the emergency procedure to avoid serious danger to the health of children and young people who would otherwise be prescribed puberty blockers during that five- to six-month period. Under the emergency procedure, there is no requirement to hold a consultation procedure … “In my judgment, the Cass review’s findings about the very substantial risks and very narrow benefits associated with the use of puberty blockers, and the recommendation that in future the NHS prescribing of puberty blockers to children and young people should only take place in a clinical trial, and not routinely, amounted to powerful scientific evidence in support of restrictions on the supply of puberty blockers on the grounds that they were potentially harmful.” Lang said that while the Cass review did not conclude that puberty blockers caused a serious danger to health, that was not the question it was asked to address. She also said that the fact that the review’s findings and recommendations had been acted upon by NHS England, the Royal College of GPs and the General Pharmaceutical Council “gave them considerable further weight”. During last month’s hearing, the court heard that the temporary ban had had “a very real human cost” on more than 1,000 under-18s. Lang said: “I recognise that the claimants’ evidence does show that this cohort has had difficulties in obtaining access to UK-registered GPs and mental health services since the order was made. “In my view, this is essentially an issue about achieving a successful implementation of the new scheme, not the lawfulness of the order. NHS England and the DHSC [Department for Health and Social Care] should consider how implementation can be improved as soon as possible, and in any event, before the next order is made.” The health secretary, Wes Streeting, who is understood to be minded to make the ban permanent, said after the high court ruling: “Children’s healthcare must be evidence-led. “Dr Cass’s review found there was insufficient evidence that puberty blockers are safe and effective for children with gender dysphoria and gender incongruence. “We must therefore act cautiously and with care when it comes to this vulnerable group of young people. “I am working with NHS England to improve children’s gender identity services and to set up a clinical trial to establish the evidence on puberty blockers. “I want trans people in our country to feel safe, accepted, and able to live with freedom and dignity.”