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Treatment for gender dysphoria in children: the new legal, ethical and clinical landscape

Gender dysphoria is a serious condition in which a child’s subjectively felt identity and gender are not congruent with her or his biological sex, causing clinically significant distress or impairment in social functioning or other important areas of functioning. Over the past 10 years, the Family Court of Australia has received an increasing number of applications seeking authorisation for the commencement of hormone therapy to treat children diagnosed with gender dysphoria.111

Treatment of children with gender dysphoria is given in two stages. Stage 1 treatment involves the provision of puberty blocking medication, and stage 2 comprises cross-sex hormone treatment. Until very recently, courts considered both stages of treatment together and regarded them at law as a form of special medical procedure, which can only be lawfully performed with court approval. In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to stage 1 treatment. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. A Gillick-competent child is one who is found to possess sufficient understanding and intelligence to enable her or him to understand fully what is proposed.12 Medical…