Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults

Area of Science:

• Pediatric Endocrinology
• Adolescent Medicine
• Bioethics

Background:

• An unprecedented rise in gender transition requests among children and adolescents has been observed in Western countries.
• Current social, medical, and surgical interventions for gender transition are supported by very low-quality evidence.
• The experiences of detransitioners highlight significant risks associated with these interventions, including the potential medicalization of transient adolescent identities.

Purpose of the Study:

• To critically evaluate the evidence base for gender-affirmative care in minors.
• To examine the ethical considerations and limitations of the informed consent process in pediatric gender transition.
• To differentiate between beliefs and established facts regarding gender-affirmative care.

Main Methods:

• Review of existing literature on gender-affirmative care and its outcomes.
• Analysis of the quality of evidence supporting medical and surgical interventions.
• Discussion of the components and limitations of the informed consent process.
• Examination of data related to suicide rates and limitations of foundational studies (e.g., Dutch studies).

Main Results:

• The evidence supporting gender-affirmative interventions remains of very low quality.
• The informed consent process is often compromised by professional assumptions, inadequate initial evaluations, and incomplete information sharing.
• Limitations exist in the foundational Dutch studies used to guide interventions.
• Data on suicide rates require careful interpretation within the context of these limitations.

Conclusions:

• Gender-affirmative care for minors is based on weak evidence, necessitating a re-evaluation of current practices.
• Ethical management requires a rigorous informed consent process that accurately conveys benefits, risks, and alternatives.
• Professionals must distinguish between established facts and beliefs to ensure appropriate patient and parental guidance.
• Despite improvements in informed consent, significant uncertainties persist in certain clinical scenarios.