Medically assisted gender affirmation: when children and parents disagree

Dubin, Samuel; Lane, Megan; Morrison, Shane D; Radix, Asa; Belkind, Uri; Vercler, Christian J.; Inwards-Breland, David J.

doi:10.1136/medethics-2019-105567

Cited by 25 publications

(22 citation statements)

References 42 publications

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“…The displacement of parental and family consultation and counseling by imposition of the conclusions of politicians and governments raises ethical concerns regarding conformity with law. The guidelines of the World Professional Association for Transgender Health (WPATH), a multidisciplinary standard‐setting society of engaged transgender‐care practitioners, provide that “the current gender‐affirming medical practice includes hormonal and surgical therapy, along with individual or family counselling and supportive social transition” 23 . Individual practitioners and professional associations fall under legal and ethical pressure to decide whether passively to comply with disruptive, dysfunctional, or counter‐therapeutic laws that obstruct professional care, or for instance to seek resources and fortitude to challenge them in court.…”

Section: Adolescents’ Treatmentmentioning

confidence: 53%

Transsexuality: Legal and ethical challenges

Dickens

2020

Intl J Gynecology & Obste

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Sex‐change procedures, better described as gender‐change procedures, involve preparing patients psychologically and surgically for gender transition to treat their gender dysphoria. Physical treatment might include hysterectomy for female to male transition, and post‐castration fashioning of an artificial vagina for male to female transition. Conservative opposition to accommodating and recognizing such procedures remains in some countries, and where treated, transgender individuals might face social hostility and oppression. However, human rights laws increasingly provide for transgender non‐discrimination and government re‐issue of official documents such as birth certificates and social insurance cards in the changed gender. A UK legal decision required a transgendered male who retained his ovaries and uterus to be registered as mother on the birth certificate of the child he bore. Most challenging are decisions on adolescents’ requests for gender transition, especially over parents’ objections. Laws increasingly recognize that legal minors with sufficiently evolved intellectual and emotional capacity can make decisions for themselves.

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Section: Adolescents’ Treatmentmentioning

confidence: 53%

Transsexuality: Legal and ethical challenges

Dickens

2020

Intl J Gynecology & Obste

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“…This holding pattern can come with potential harm to their mental health as they struggle with increased levels of gender dysphoria and distress in the face of one or both parents' refusal to allow them to go forward with medical affirming medical care. 22,41,42 Courts or legal statutes may be called into play to protect the youth in those situations, with mental health professionals stepping in to work with the entire family to move beyond the impasse. It behooves clinicians to pay attention to these significant risk factors and potential barriers to care as they consider the ethics of their assent/consent practices for taking the T out or putting the T in among our transgender/gender-nonbinary youth.…”

Section: 8mentioning

confidence: 99%

“…On the other hand, if support is not forthcoming for beginning a course of gender‐affirming hormones, the youth may find themselves treading water until they old enough to legally consent to their own treatment. This holding pattern can come with potential harm to their mental health as they struggle with increased levels of gender dysphoria and distress in the face of one or both parents’ refusal to allow them to go forward with medical affirming medical care 22,41,42 . Courts or legal statutes may be called into play to protect the youth in those situations, with mental health professionals stepping in to work with the entire family to move beyond the impasse.…”

Section: Introductionmentioning

confidence: 99%

Take the T out, put the T in: Gender‐affirming hormones in youth

Ehrensaft

Tishelman

2021

Andrology

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Background: An increasing number of adolescents are seeking gender care at clinics and hospital programs, and requesting gender-affirming hormonal treatment. The interventions can either include suppression of testosterone and introduction of estrogen, or suppression of estrogen and introduction of testosterone.Aims: This review article focuses on the psychosocial experiences of youth who have completed their endogenous puberty and are now requesting one of these two forms of gender-affirming hormonal treatment. We investigate the comparative profiles of these two subgroups of transgender/gender-expansive youth. Materials and Methods: Review of research data, established standards of care and practice guidelines, and clinical observations.Results: Differences and similarities are noted and discussed in several realms: genderrelated experiences prior to receiving hormonal treatment; the relationship between the physical changes and psychological experiences that accompany the introduction of testosterone or suppression of testosterone with replacement with estrogen; the intrapersonal and interpersonal implications of the treatment; considerations of fertility preservation for future family building; the role of the family in the decision-making process prior to starting a course of hormone therapy; and the capacity of youth to make informed decisions about these partially irreversible medical interventions.Discussion: Medical providers who offer gender-affirming hormonal care to youth should work with the family and allied professionals to assure that the youth's gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in. Conclusion:The cohort of youth who come to medical providers after completing puberty, and request gender-affirming hormones in the form of increases or reductions in T have a great deal in common, and also extensive variation among them. K E Y W O R D Sgender affirmative model, gender-affirming hormones, gender expansive, TGE youth, transgender INTRODUCTIONFrom its Greek derivations, the word "andrology" literally translates to "the study of man." Historically, that meant those individuals born

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“…Another is to rely on the “mature minor doctrine,” assuming that the child understands fully the treatment and its risks, none of which are to be serious in nature. And, finally, physicians can assert that parental disagreement with GAT for their child violates the Harm Principle and enjoin the state to intervene (Dubin et al 2019). This all implies that the harm of not allowing transition greatly outweighs the harm of affirming the child.…”

Section: Box 4: Contextual Features—implications For Individuals Fami...mentioning

confidence: 99%

The Bioethical Dilemma of Gender-Affirming Therapy in Children and Adolescents

Robles

2021

Linacre Q

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Since the establishment of the first transgender clinic in the United States in 2007, over sixty clinics associated with children’s hospitals have opened across the nation and are seeing very young children and adolescents with a diagnosis of gender dysphoria (GD). Once known as gender identity disorder, GD has been redefined by the latest version of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition ( DSM-5) not as a mental illness but as the distress experienced by individuals related to their biological sex. The widely accepted practice of gender-affirming therapy (GAT) to treat a vulnerable population despite the associated health risks, the lack of supportive scientific evidence for the pharmacological and surgical interventions, along with the unqualified claim that these interventions will decrease the rate of suicide in these individuals presents a significant bioethical dilemma. The growing trend of GD not only impacts the individuals diagnosed but also society, culture, and the integrity of the profession of medicine. This article utilizes the five-box method, an ethical decision-making framework, to address the implications of the proposed treatment. Once applied, it becomes clear that the hormonal and surgical approaches used are not scientifically or ethically justified. The patient’s autonomy and preferences should be respected, yet constrained, if there exists a considerable risk to the well-being of the individual without proven benefits. The quality of life of those receiving this treatment has not been shown to be significantly improved long term, and the mental, physical, and spiritual health of individuals with GD is not thoroughly addressed in these clinics. The important social and contextual factors, on both microcosmic and macrocosmic scales, are minimized in favor of promoting an ideology. Ultimately, Catholic moral teaching reveals that this widely recommended treatment violates the body–soul union, disregards the principle of totality and integrity, and debases the dignity of humanity. Summary: This article examines GAT, the paradigm used in treating individuals identifying as transgender, through the lens of an EDMF. Each stage of this widely proposed treatment - social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery - poses harms and risks that are not fully disclosed to minors and families, creating a bioethical dilemma. Dialogue utilizing science and reasoning must be encouraged to assist individuals who experience a gender identity that rejects their biological sex. This approach would also contribute to the well-being of society.

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Medically assisted gender affirmation: when children and parents disagree

Cited by 25 publications

References 42 publications

Transsexuality: Legal and ethical challenges

Transsexuality: Legal and ethical challenges

Take the T out, put the T in: Gender‐affirming hormones in youth

The Bioethical Dilemma of Gender-Affirming Therapy in Children and Adolescents

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