Letter
LGBTQI+ health Child health
Volume 217 - Issue 3

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

Authors:  Ken C Pang, Fiona Kelly and Simona Giordano

Med J Aust 2022; 217 (3): 168-168. || doi: 10.5694/mja2.51640
Published online: 1 August 2022

In reply

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In reply: We thank Clayton and colleagues1 for their letter on our recent Perspective article.2 We certainly agree with the authors that more rigorous longitudinal studies and more high quality evidence are desirable, but this is hardly a novel observation. Indeed, we ourselves have made this point on multiple occasions and have commenced a longitudinal study known as Trans20 to help address this concern.3,4 Notwithstanding this agreement, some of the other comments made by Clayton and colleagues deserve further examination.

First, the authors imply that we were making causal inferences in noting previous reports describing access to gender‐affirming care and improved mental health outcomes and wellbeing. However, this is not the case. We were careful to describe such findings as associations, which should of course not be confused as evidence of causation.

Second, the authors point to two systematic reviews in this area which were conducted by the National Institute for Health and Care Excellence (NICE) in the United Kingdom.5,6 While these reviews have garnered substantial attention, their flaws must be noted. For instance, in one of the largest prospective studies reported to date, Kuper and colleagues7 followed 148 transgender youth and observed significant improvements in body dissatisfaction, depression and anxiety following hormonal treatment. Interestingly, NICE discounted these results, concluding that “no statistical analysis was reported” despite the article describing the relevant Cohen's d effect sizes, confidence intervals and P values. As another example, NICE failed to review a seminal article by van der Miesen et al8 even though it was published within their review time frame. These authors found that transgender adolescents receiving puberty suppression therapy (n = 178) not only had fewer emotional and behavioural problems than a comparison group of newly referred transgender adolescents (n = 272), but also had similar or fewer problems than same‐age cisgender peers from the general population (n = 651), a stunning observation given the poor mental health typically observed in transgender youth.8

Finally, it is important to highlight the inherent limitations on the quality of evidence available in this field, since performing randomised controlled trials of hormonal interventions for transgender adolescents presents both practical and ethical concerns.9 As such, the evidence base is likely to never be as robust as some other areas of medicine. However, it is important that we not use this to discount, discredit or deny clinical care for which there is expert consensus and endorsement by leading organisations, such as the American Academy of Pediatrics,10 the Endocrine Society,11 and the World Professional Association for Transgender Health.12

 

Authors

  • Ken C Pang1
  • Fiona Kelly2
  • Simona Giordano3
  • 1. Murdoch Children's Research Institute, Melbourne, VIC
  • 2. La Trobe University, Melbourne, VIC
  • 3. University of Manchester, Manchester, UK

Correspondence: ken.pang@mcri.edu.au

Competing interests

Ken Pang is a member of the World Professional Association for Transgender Health as well as the Australian Professional Association for Trans Health, and is also a member of the editorial board of the journal, Transgender Health.

Acknowledgements

Ken Pang is supported by the Royal Children's Hospital Foundation and the Hugh DT Williamson Foundation, neither of which had any role in the planning, writing or publication of this article.

References

Linked content

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

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

View this article on Wiley Online Library