Letters
Endocrinology Child health Mental health
Volume 197 - Issue 5

Hormone treatment of gender identity disorder in a cohort of children and adolescents

Authors:  Ann J Conway, Julie C Hamblin and David J Handelsman

Med J Aust 2012; 197 (5): 273. || doi: 10.5694/mja12.10981
Published online: 3 September 2012
To the Editor: In describing 8 years of experience in managing adolescent gender identity disorder (GID) at a paediatric hospital clinic, Hewitt and colleagues highlight a small group of patients who require momentous life-long clinical decisions made in a timely manner.1 However, the rarity of this condition means that experience in any centre is limited. The authors state that authorisation from the Family Court of Australia is ...
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To the Editor: In describing 8 years of experience in managing adolescent gender identity disorder (GID) at a paediatric hospital clinic, Hewitt and colleagues highlight a small group of patients who require momentous life-long clinical decisions made in a timely manner.1 However, the rarity of this condition means that experience in any centre is limited.

The authors state that authorisation from the Family Court of Australia is required to start hormone treatment in patients under 18 years of age. While this is true for adolescents under 16 years or minors lacking the maturity to make an informed decision on their treatment, such costly, stressful and drawn-out procedures are not necessary for all young people aged 16 to 18 years. The principle of Gillick competence — the ability of a young person to make a decision about their own medical treatment based on their intelligence, understanding and maturity — is recognised, including by the courts.2 Decisions by the Family Court in authorising treatment have acknowledged that Gillick competence applies to young people seeking such treatment. When a young person is cared for by a team of specialists (in psychiatry, psychology, andrology, endocrinology, gynaecology) experienced in treating transgender patients, such teams can judge Gillick competence. If this decision is clearly documented, it is not necessary to subject patients and their families to the expense, trauma and stressful delay of a court hearing.

Determining the legal basis of treatment by looking only at Family Court decisions would miss Gillick-competent adolescents aged 16–18 years who have provided valid consent for their treatment, and thereby overlook the clinical expertise of adult centres managing adolescent GID.

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