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.
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- 1. Clayton A, D'Angelo R, Clarke P. Parental consent and the treatment of transgender youth: the impact of Re Imogen [letter]. Med J Aust 2022; 217: 167.
- 2. Kelly F, Giordano S, Telfer MM, Pang KC. Parental consent and the treatment of transgender youth: the impact of Re Imogen. Med J Aust 2022; 216: 219‐221. https://www.mja.com.au/journal/2022/216/5/parental‐consent‐and‐treatment‐transgender‐youth‐impact‐re‐imogen.
- 3. Chew D, Anderson J, Williams K, et al. Hormonal treatment in young people with gender dysphoria: a systematic review. Pediatrics 2018; 141: e20173742.
- 4. Tollit MA, Pace CC, Telfer M, et al. What are the health outcomes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study. BMJ Open 2019; 9: e032151.
- 5. National Institute for Health and Care Excellence. Evidence review: gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. NICE, 2020. https://web.archive.org/web/20220414202655/https://arms.nice.org.uk/resources/hub/1070905/attachment (viewed June 2022).
- 6. National Institute for Health and Care Excellence. Evidence review: gender‐affirming hormones for children and adolescents with gender dysphoria. NICE, 2020. https://web.archive.org/web/20220215111922/https://arms.nice.org.uk/resources/hub/1070871/attachment (viewed June 2022).
- 7. Kuper LE, Stewart S, Preston S, et al. Body dissatisfaction and mental health outcomes of youth on gender‐affirming hormone therapy. Pediatrics 2020; 145: e20193006.
- 8. van der Miesen AIR, Steensma TD, de Vries ALC, et al. Psychological functioning in transgender adolescents before and after gender‐affirmative care compared with cisgender general population peers. J Adolesc Health 2020; 66: 699‐704.
- 9. de Vries AL, Steensma TD, Doreleijers TA, Cohen‐Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow‐up study. J Sex Med 2011; 8: 2276‐2283.
- 10. Rafferty J. Ensuring comprehensive care and support for transgender and gender‐diverse children and adolescents. Pediatrics 2018; 142: e20182162.
- 11. Hembree WC, Cohen‐Kettenis PT, Gooren L, et al. Endocrine treatment of gender‐dysphoric/gender‐incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017; 102: 3869‐3903.
- 12. World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender nonconforming people; version 7. WPATH, 2011. https://www.wpath.org/publications/soc (viewed June 2022).
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.
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.