Parental consent and the treatment of transgender youth: the impact of Re ImogenIn reply: We thank Clayton and colleagues 1 for their letter on our recent Perspective article. 2 We certainly agree with the authors that more rigorous longitudinal studies and more high quality evidence are desirable, but this is hardly a novel observation. Indeed, we ourselves have made this point on multiple occasions and have commenced a longitudinal study known as Trans20 to help address this concern. 3,4 Notwithstanding this agreement, some of the other comments made by Clayton and colleagues deserve further examination.