New standards for transgender children

Tuesday, 26 June, 2018

New standards for transgender children

Individualised care and supportive, gender-affirming management are emphasised in new Australian standards of care and treatment guidelines for transgender and gender diverse children and teenagers.

According a position statement summary published in the Medical Journal of Australia, international guidelines for the treatment of transgender and gender diverse (TGD) children and adolescents exist but there are, according to the statement’s authors “particular challenges in providing TGD health care in Australia … [including] cultural and linguistic diversity, and vast geographical distances creating barriers to treatment access for people living in rural and regional locations”.

Lead author of the summary is Associate Professor Michelle Telfer, Director of the Royal Children’s Hospital Gender Service in Melbourne and acting President of the Australian and New Zealand Professional Association for Transgender Health.

“With increasing visibility and social acceptance of gender diversity in Australia, more TGD children and adolescents are presenting to community and specialist health care services,” Telfer and colleagues wrote.

“It has been estimated that about 1.2% of Australian adolescents identify as transgender, and it is therefore likely that referrals to health care professionals will continue to rise in the foreseeable future. In response to the sharp rise in demand for medical services for TGD children and adolescents, multidisciplinary services have been created and expanded throughout Australia.

“Given this rapid change, there is a clear need for the development of clinical guidelines to assist in the provision of optimal and consistent care, improve access and equity to such care, and facilitate research.”

Written in consultation with transgender health clinicians, TGD children and their families, the guidelines recommend:

  • individualising care: “decision making should be driven by the child or adolescent wherever possible; this applies to options regarding not only medical intervention but also social transition”;
  • using respectful and affirming language: “understanding and using a person’s preferred name and pronouns is vital”;
  • avoiding causing harm: “the withholding of gender affirming treatment potentially [exacerbates] distress and [increases] the risk of self-harm or suicide;
  • considering socio-cultural factors: “additional barriers to treatment access may exist for Indigenous TGD Australians and those belonging to religious or cultural groups whose beliefs and values may be at odds with a gender affirming approach”;
  • considering legal requirements: “current law allows the adolescent’s clinicians to determine their capacity to provide informed consent for treatment; court authorisation before commencement of hormone treatment is no longer required”.

Other recommendations are specific to either pre-pubertal children or adolescents (after onset of puberty).

“Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved,” Telfer and colleagues concluded.

Image credit: © Hermes Furian

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