Australian gender clinics are under pressure to change their policies as a result of a landmark case in the UK.

Last year, England’s High Court ruled children under the age of 16 couldn’t fully understand the consequences of their decisions and, as such, were unlikely to be able to give informed consent to treatment with puberty blockers.

Judges also concluded that even for 16 and 17-year-olds, given the long-term consequences of hormonal treatment and its innovative and experimental nature, doctors may want court authorisation before starting it.

Keira Bell began her transition from female to male when she was only 16 years old. She had a double mastectomy at age 20. She later regretted the decision and successfully sued the National Health Service for not being thorough enough with her initially.

She testified it was only recently she had started thinking about having children and whether that was even a possibility as a result of the treatment she had received.

“I have to live with the fact that I will not be able to breastfeed my children,” she said, referring to her double mastectomy at age 20.

The decision is now having a ripple effect in Australia.

Since the ruling, Western Australia’s child and adolescent Gender Diversity Service, which receives an average of four to five referrals a week, has quietly started a review of its policies in a bid to reduce its liability in the event a patient, like Ms Bell, decides to sue them in the future.

Gender services in Victoria and the ACT are also keeping a close eye on developments in the UK and haven’t ruled out making changes to their policies.

The review is still underway and “the changes made as part of the review remain shrouded in secrecy. Not even advocacy groups are aware of their nature”.

Binary spokeswoman, Kirralie Smith, said the lack of transparency is disturbing.

“It is the responsibility of parents and health care workers to protect children,” she said.

“This reeks of protecting themselves from legal ramifications. The process and the science must be transparent, open to critical debate and a wide variety of experts and groups consulted.

“This political ideology must be exposed for the sake of the children.”