Transgender and gender diverse youth need high-quality medical care just as other teenagers

The Endocrine Society and a coalition of LGBTQ+ youth and reproductive health organizations argued in a joint submission to the High Court of England and Wales that transgender teenagers should be able to give informed consent to treatment the same way teenagers with other medical conditions can.

The coalition submitted a written intervention as part of the appeal of Bell v Tavistock and Portman NHS Health Foundation, a case where the High Court ruled in December 2020 that adolescents younger than age 16 are not competent to give consent to treatment to delay puberty. The ruling threatens to block transgender and gender diverse teenagers from accessing the medical care they need.

"The current system forces transgender and gender diverse teenagers to operate under a different set of rules from other adolescents when they seek medical care," said Sabine Hannema, M.D., Ph.D., a paediatric endocrinologist at Amsterdam UMC in the Netherlands, a co-author of the Society's Clinical Practice Guideline on Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons and a co-author of the World Professional Association for Transgender Health statement responding to the Bell v Tavistock ruling.

Gender-affirming care for transgender and gender diverse teens in the context of a multidisciplinary approach is widely accepted as standard practice among major medical associations worldwide. Delaying puberty and providing teens with access to gender-affirming hormone therapy, when administered by a trained professional following a thorough assessment, improves psychological functioning and is potentially life-saving."

Sabine Hannema, M.D., Ph.D., Pediatric Endocrinologist at Amsterdam UMC in the Netherlands

A June 2020 study published in the Journal of Adolescent Health found that transgender and gender diverse youth who had started treatment to delay puberty had lower suicidality and improved psychological functioning, comparable to the general population, while those who had not yet begun treatment were found to have higher psychological problem scores and increased rates of suicidality.

Major international medical organizations--including the Endocrine Society, the World Professional Association for Transgender Health, the European Society of Endocrinology, the European Society for Pediatric Endocrinology, and the Pediatric Endocrine Society--agree on the appropriate care for transgender people. Scientific studies support the concept that biological factors, in addition to environmental ones, contribute to the development of gender identity.

Prior to puberty, transgender children are encouraged to explore their gender identity. A mental health professional can provide support in this process. After transgender and gender diverse minors start puberty, prescribing hormones to delay puberty is the recommended strategy after careful screening, if it is desired by the patient and if diagnostic and treatment criteria are met. This treatment, which delays puberty in a reversible manner, gives adolescents more time to explore their options.

Treatment to delay puberty is "only prescribed to children who suffer strong and persistent (gender dysphoria) with the purpose of avoiding the predictable and intense distress of puberty," the interveners wrote in the written submission to the court. "As a result, withholding treatment is not a neutral option. Children denied (hormones to delay puberty) become bystanders as their bodies change in ways that they know to be irreversible; they develop an Adam's apple, their voice drops, their hips widen, knowing that these features will affect how they see themselves and are seen by others for the rest of their lives."

The interveners in the case include Gendered Intelligence, a community interest group for trans youth, and youth sexual health organization Brook, as well as the Endocrine Society. The intervention is supported by the Good Law Project's Legal Defence Fund for Transgender Lives.

"Health care providers have prescribed treatment to delay puberty for youth experiencing early puberty for decades without issue or public outcry. Transgender and gender diverse adolescents deserve the same access to medical care," said Joshua Safer, M.D., of the Mount Sinai Center for Transgender Medicine and Surgery and Icahn School of Medicine at Mount Sinai in New York, N.Y. Safer is a co-author of the Society's Clinical Practice Guideline on Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons as well as the Society's transgender medicine position statement.

"The High Court's decision, if it is allowed to stand, would set a harmful precedent preventing physicians from providing transgender and gender diverse youth with high-quality medical care," Safer said.