Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents

Vries, Annelou L.C. de; Richards, Christina; Tishelman, Amy C.; Motmans, Joz; Hannema, Sabine E.; Green, Jamison; Rosenthal, Stephen M.

doi:10.1080/26895269.2021.1904330

Cited by 30 publications

(25 citation statements)

References 39 publications

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“…This decision was met with equivocal support and criticism, not least as it has implications for the broader application of the Gillick framework for consent to medical procedures. (It has since been successfully appealed [15]) A lack of good quality evidence has been acknowledged [16]. A recent review by the Swedish Agency for Health Technology Assessment and Assessment of Social Services [17] indicated that there is very little in terms of empirical evidence in the field, both in terms of overall GD epidemiology, the association of GD with mental health problems, the rate and types of medical interventions provided and outcomes (including outcomes for those not treated medically or surgically) in the longer term.…”

Section: Introductionmentioning

confidence: 99%

A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology

Thompson

Sarovic

Wilson

et al. 2022

PLOS Glob Public Health

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It is unclear whether the research literature on adolescent gender dysphoria (GD) provides sufficient evidence to adequately inform clinical decision making. In the first of a series of three papers, this study sought to systematically review published evidence regarding: the prevalence of GD in adolescence; the proportions of natal males/females with GD in adolescence and whether this changed over time; and the pattern of age at (a) onset (b) referral and (c) assessment. Having searched PROSPERO and the Cochrane library for existing systematic reviews (and finding none), we searched Ovid Medline 1946 –October week 4 2020, Embase 1947–present (updated daily), CINAHL 1983–2020, and PsycInfo 1914–2020. The final search was carried out on the 2nd November 2020 using a core strategy including search terms for ‘adolescence’ and ‘gender dysphoria’ which was adapted according to the structure of each database. Papers were excluded if they did not clearly report on clinically-verified gender dysphoria, if they were focused on adult populations, if they did not include original data (epidemiological, clinical, or survey) on adolescents (aged at least 12 and under 18 years), or if they were not peer-reviewed journal publications. From 6202 potentially relevant articles (post de-duplication), 38 papers from 11 countries representing between 3000 and 4000 participants were included in our final sample. Most studies were observational cohort studies, usually using retrospective record review (26). A few compared to normative or population datasets; most (31) were published in the past 5 years. There was significant overlap of study samples (accounted for in our quantitative synthesis). No population studies are available, so prevalence is not possible to ascertain. There is evidence of an increase in frequency of presentation to services, and of a shift in the natal sex of referred cases: those assigned female at birth are now in the majority. No data were available on age of onset. Within the included samples the average age was 13 years at referral, 15 years at assessment. All papers were rated by two reviewers using the Crowe Critical Appraisal Tool v1·4 (CCAT). The CCAT quality ratings ranged from 45% to 96%, with a mean of 78%. Almost half the included studies emerged from two treatment centres: there was considerable sample overlap and it is unclear how representative these are of the adolescent GD community more broadly. The increase in clinical presentations of GD, particularly among natal female adolescents, warrants further investigation. Whole population studies using administrative datasets reporting on GD / gender non-conformity may be necessary, along with inter-disciplinary research evaluating the lived experience of adolescents with GD.

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Section: Introductionmentioning

confidence: 99%

A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology

Thompson

Sarovic

Wilson

et al. 2022

PLOS Glob Public Health

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“…Bei der Behandlung der GI/GD im Jugendalter müssen ethische Abwägungen von Nutzen und potenziellem Schaden im Falle einer möglicherweise verfrüht ebenso wie einer zu spät indizierten somatomedizinischen Behandlung im Kontext der Adoleszenzentwicklung vorgenommen werden. Dabei geht es auch darum, mit bleibenden Ungewissheiten umzugehen 52 . Im Vordergrund steht die Unterstützung einer schrittweise zu bewältigenden sozialen Transition, zu der das Angebot einer individualisiert zu indizierender psychotherapeutischer Begleitung ebenso gehört wie das Angebot einer entwicklungsorientierten schrittweise gestuften somatomedizinischen Behandlung zur Angleichung des körperlichen Erscheinungsbildes an die empfundene Geschlechtsidentität, bei der wiederum jeder Schritt eine sorgfältige interdisziplinäre Indikationsstellung erfordert.…”

Section: Behandlungsempfehlungen Bei Jugendlichenunclassified

Geschlechtsinkongruenz im Kindes- und Jugendalter

Romer¹,

Lempp²

2022

Nervenheilkunde

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ZUSAMMENFASSUNGIn diesem Artikel wird ein praxisnaher Überblick über den aktuellen Wissensstand zur Geschlechtsinkongruenz und Geschlechtsdysphorie im Kindes- und Jugendalter dargestellt. Ausgehend von dem in der ICD-11 vollzogenen Paradigmenwechsel, wonach die Geschlechtsinkongruenz keine psychische Störung ist, werden die wichtigsten sich daraus ergebenden Neuerungen für den professionellen Umgang mit Geschlechtsdiversität diskutiert. Im Vordergrund steht dabei die Unterstützung geschlechtsdiverser Personen, ein Leben im empfundenen Geschlecht zu führen. Bei einer Geschlechtsinkongruenz im Kindesalter besteht meist kein weiterer Behandlungsbedarf. Im Jugendalter kann die fortschreitende körperliche Reifung zu einem geschlechtsdysphorischen Leidensdruck führen, der neben unterstützender Psychotherapie häufig die Empfehlung für gestufte somatomedizinische Interventionen zum Aufhalten der pubertären Reifung und zur Geschlechtsangleichung begründet. Die Voraussetzungen für individuelle Indikationen werden gemeinsam mit den hierbei zu berücksichtigenden ethischen Maßgaben ausgeführt.

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“…This approach is underpinned by the view that a child or adolescent’s stated gender identity should be endorsed not questioned, and that they should be supported to undertake social transition, medical transition, masculinizing chest surgery, and, some also argue, genital surgery. Those advocating this approach consider these gender affirming treatments medically and ethically essential (Baams, 2021 ; de Vries et al, 2021 ; Transgender Health, 2020 ; Walch et al, 2021 ).…”

Section: The Gender Affirmative Treatment Approach For Gender Dysphor...mentioning

confidence: 99%

The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?

Clayton

2021

Arch Sex Behav

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Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents

Cited by 30 publications

References 39 publications

A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology

A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology

Geschlechtsinkongruenz im Kindes- und Jugendalter

The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?

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