Levine, S. B., Abbruzzese, E., & Mason, J. W. (2022).
Journal of Sex & Marital Therapy, 48(7), 706–727.
Abstract
In less than a decade, the western world has witnessed an unprecedented rise in the numbers of children and adolescents seeking gender transition. Despite the precedent of years of gender-affirmative care, the social, medical and surgical interventions are still based on very low-quality evidence. The many risks of these interventions, including medicalizing a temporary adolescent identity, have come into a clearer focus through an awareness of detransitioners. The risks of gender-affirmative care are ethically managed through a properly conducted informed consent process. Its elements—deliberate sharing of the hoped-for benefits, known risks and long-term outcomes, and alternative treatments—must be delivered in a manner that promotes comprehension. The process is limited by: erroneous professional assumptions; poor quality of the initial evaluations; and inaccurate and incomplete information shared with patients and their parents. We discuss data on suicide and present the limitations of the Dutch studies that have been the basis for interventions. Beliefs about gender-affirmative care need to be separated from the established facts. A proper informed consent process can both prepare parents and patients for the difficult choices that they must make and can ease professionals’ ethical tensions. Even when properly accomplished, however, some clinical circumstances exist that remain quite uncertain.
Here are some thoughts:
The article critiques the prevailing standards for obtaining informed consent in the context of gender-affirming medical interventions for minors and young adults. It argues that current practices often fail to adequately ensure that patients—and in many cases, their guardians—fully understand the long-term risks, uncertainties, and implications of puberty blockers, cross-sex hormones, and surgeries. The authors contend that the developmental immaturity of children and adolescents, combined with social pressures and sometimes incomplete psychological evaluations, undermines the ethical validity of consent. They advocate for a more cautious, evidence-informed, and ethically rigorous approach that prioritizes psychological exploration and long-term outcomes over immediate affirmation and medical intervention.