Letters
Sexual health Child health
Volume 217 - Issue 3

Parental consent and the treatment of transgender youth: the impact of Re Imogen

Authors:  Alison Clayton, Roberto D’Angelo and Patrick Clarke

Med J Aust 2022; 217 (3): 167-167. || doi: 10.5694/mja2.51643
Published online: 1 August 2022
Download PDF (141 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: We read with interest the article by Kelly and colleagues,1 In our opinion, the authors’ statement “Access to timely gender‐affirming care is associated with improved mental health outcomes and overall wellbeing” is not well supported by the two citations provided.

The first citation is a systematic review by Rew and colleagues.2 A critique of this review was recently published.3 Rew et al, in response, clarified that they did not make any causal statements about puberty blockers and reported improved mental health outcomes, but believe their findings warrant more rigorous longitudinal studies.4

Kelly and colleagues’ second citation is a systematic review by Mahfouda et al.5 This review concluded there is only scarce and preliminary evidence that hormonal and surgical gender‐affirming treatments in adolescents are associated with mental health benefit and improved quality of life. The available evidence was described as having multiple methodological limitations and being at medium to high risk of bias. The authors called for further urgent research to clarify long term outcomes on psychological functioning and safety.

Importantly, two recent systematic reviews by the United Kingdom’s National Institute for Health and Care Excellence found that the results of the studies investigating the benefits or adverse effects of puberty blockers and gender‐affirming hormones are of very low certainty and, as the studies themselves may not be reliable, any identified changes could be due to confounding, bias or chance.6,7 The recently published interim report of the UK’s Cass Review also noted that there are different views on the benefits versus harms of early social transition and more information about outcomes is required.8

In conclusion, the literature does not support there being a robust evidence base for the gender‐affirming social, medical and surgical interventions for children and adolescents. Rather, the literature highlights the scarce and low quality evidence and the urgent need for more high quality evidence.

In any consideration of the processes of informed consent and/or court consent it would seem imperative that there is acknowledgement of the uncertain evidence base underpinning these interventions. Thus, it is of concern that Kelly and colleagues fail to do this.

 

Authors

  • Alison Clayton1
  • Roberto D’Angelo2
  • Patrick Clarke3
  • 1. University of Melbourne, Melbourne, VIC
  • 2. Institute of Contemporary Psychoanalysis, Los Angeles, CA, USA
  • 3. University of Adelaide, Adelaide, SA

Correspondence: alclayton@student.unimelb.edu.au

Competing interests

Alison Clayton and Patrick Clarke are affiliated with the Society for Evidence‐based Gender Medicine (SEGM). Roberto D'Angelo is a clinical and academic advisor to SEGM.

References

Linked content

  • MJA Perspective: Parental consent and the treatment of transgender youth: the impact of Re Imogen

  • MJA Letter: In reply

View this article on Wiley Online Library