A concept designated as clinically significant distress or impairment related to a strong desire to be of another gender, which may include a desire to change primary and/or secondary sex characteristics. Not all transgender or gender diverse people experience dysphoria.
Gillick competent:
The legal test is used to determine if a child is capable of giving consent when he or she “achieves a sufficient understanding and intelligence to enable the child to understand fully what is proposed”. This is referred to as ‘Gillick competent’ or a ‘mature minor’.
Is an application to the Court mandatory?
Whether mandatory or not, once an application is made and if a child is found to be Gillick competent, can he/she make his/her own decisions about their treatment?
If so, what order, if any, should be made in respect of the issue of Gillick competence?
If a child’s consent is not sufficient and the Court is required to make an order that is in the child’s best interests, should that order grant the child “parental responsibility” to make his/her own decision or should an order authorising treatment be made?
Gender Dysphoria is a term that describes the distress experienced by a person due to incongruence between their gender identity and their gender assigned at birth. The description of Gender Dysphoria in the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM-5 Fifth Edition is in two parts. Part A sets out six manifestations of marked incongruence, two of which must be present for at least six months. Part B requires the incongruence to be associated with clinically significant distress or impairment in social, occupational or other important areas of functioning.
The Australian Standards provide that the optimal model of care for trans and gender diverse adolescents who present to services involves a coordinated, multidiscipline team approach. This may include clinicians with experience in the disciplines of child and adolescent psychiatry, paediatrics, adolescent medicine, paediatric endocrinology, clinical psychology, gynaecology, andrology, fertility services, speech therapy, general practice and nursing.
Gender dysphoria treatment
The Australian Standards describe stage 1 Gender dysphoria treatment as ‘puberty suppression’ which typically relieves distress for trans adolescents by halting progression of physical changes such as breast growth in trans males and voice deepening in trans females.
In Australia, gonadotrophin-releasing hormone analogues are available in subcutaneous and intramuscular injectable preparations. The Australian Standards claim that the effects of puberty suppression is reversible whilst acknowledging both that the main concern relates to the impact upon bone mineral density and that the long term impact on bone mineralization is currently unknown.
The Australian Standards describe stage 2 treatment as gender-affirming hormone treatment using oestrogen and testosterone and notes some of the effects of this medication are irreversible (such as breast growth), whilst others are unknown (such as decreased sperm production).
The Australian Standards provide guidelines for surgical interventions for trans and gender diverse adolescents. In its guidelines to health professionals, the Australian Standards make an incorrect assertion about the current state of the law. The Australian Standards state, “current law allows adolescent’s clinicians to determine their capacity to provide informed consent for treatment. Court authorization prior to commencement of hormone treatment is no longer required”. The guidelines say that informed consent from parents/legal guardians should be obtained in relation to puberty in relation to the commencement of gender-affirming hormone treatment. The Australian Standards say although obtaining consent from parents/guardians for commencement of hormone treatment is ideal, parental consent is not required when the adolescent is considered to be competent to provide informed consent. The effect is that the Australian Standards incorrectly state the current law in relation to the need for the consent of parents/guardians to stage 2 treatment. The statements in the Australian Standards do not accurately reflect current Full Court authority in circumstances where there is a dispute about treatment.
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