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Young transgender people are able to decide about puberty blockers

Young transgender people are able to decide together with their parents on a reversible intervention with puberty blockers. These are the results of a study by LUMC Curium and Amsterdam UMC of 74 young people undergoing treatment. Ninety percent of the young people studied proved able to make an informed decision. The results have been published in Pediatrics.

Researchers Lieke Vrouenraets and Martine de Vries from the LUMC conducted research together with Annelou de Vries, Anna van der Miesen (both from Amsterdam UMC) and Irma Hein (Levvel) into whether young transgender people can give informed consent to puberty-blocking treatment. They looked at whether these young people were competent to reach a decision on whether to start puberty blockers once they’d been through a thorough diagnosis pathway. This is a topical issue around the world, but has been the subject of little scientific research.

Careful joint decision

‘Young transgender people often make a drastic medical decision at a young age. This study shows that they are able to give informed consent to this decision at a young age. This can help advance the treatment standards, both nationally and internationally,’ says Vrouenraets. 

Pros and cons

The study was of 74 young people aged between 10 and 18 who were being treated at a gender clinic. They often already felt distress about their biological sex, what is known as gender dysphoria, from a young age, which can cause stress and low mood at the onset of puberty. Puberty suppression with medication is reversible, but alongside suppressing puberty, these drugs also have a negative effect on, for instance, bone development, growth and fertility. The young people must be aware of this. 

Puberty blockers give time to think

Puberty blockers delay the development at puberty of secondary sexual characteristics such as breast growth in trans boys and beard growth and a deeper voice in trans girls. It therefore gives these young people time to think about whether they want to go through with the transition, while their body stops developing any further into the sex that they don’t want. If the young person stops taking the puberty blockers, the puberty of their birth sex will resume. Puberty blockers therefore create time to think before making decisions about irreversible interventions, such as gender affirming hormones or surgery. The idea is that young people can make these decisions at a later stage. 

Informed consent

Informed consent is an important term in medicine. Someone can give informed consent if they understand the information about the condition and its treatment, can reason about the consequences and can thus reach an informed decision about the treatment. This was researched in two ways in this study. First, on the basis of the informed consent form that young people and their parents went through, as is usual after the diagnosis pathway. Second, on the basis of a structured interview of the young people with questions on all aspects of the capacity to give informed consent. These studies showed that 90% of the young people were able to give informed consent.

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