Intended for healthcare professionals

Letters Gender dysphoria

Gender dysphoria: a question of informed consent

BMJ 2019; 367 doi: (Published 04 December 2019) Cite this as: BMJ 2019;367:l6442
  1. Julie Maxwell, community paediatrician1,
  2. Katherine Clyde, consultant psychiatrist2,
  3. Lucy Griffin, consultant psychiatrist3
  1. 1Basingstoke and North Hampshire Hospital, Basingstoke RG24 9NA, UK
  2. 2Southern Health NHS Foundation Trust, Hampshire, UK
  3. 3The Priory Hospital Bristol, Bristol, UK
  1. julie.maxwell1{at}

We welcome discussion around the treatment of children with gender dysphoria, particularly the concerns that have been raised regarding the puberty blockers study.1 Although the Health Research Authority’s investigation concluded that researchers did not veer from research norms, we are left with important questions over their use.

Gender dysphoric children and teens are experiencing a crisis of identity. Young people generally struggle to think about the long term consequences of life choices. Unsurprisingly, questions are asked about the ability of these young people to make decisions with informed consent. This is especially true of interventions with unknown long term outcomes.2

Gonadotrophin releasing hormone (GnRH) agonists are generally given under the premise that they provide “breathing space” for a child or teen to explore their identity without the distress caused by pubertal changes.3 It is becoming clear, however, that once started on GnRH agonists to block puberty almost all children go on to receive cross sex hormones.4 The information given to parents and children that GnRH agonists are completely reversible might therefore be construed as misleading.

Concern around informed consent is reinforced by the increasing number of young adults wanting to “detransition.”5 These young adults have undergone varying degrees of social, medical, and surgical transition before realising that they no longer identify as the opposite sex and want to accept and reconcile with their natal sex. They cite untreated mental health problems and awareness of same sex attraction as reasons to transition. Studies show over-representation of major mental disorders, bullying, and same sex attraction in adolescent gender clinic populations.67

Children deserve detailed psychosocial assessment, treatment of comorbid conditions, and evidence based treatments. We need urgent debate so that these vulnerable children can get the help and support that they need.



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