If someone is tempted to see the provision of this clinical care as risky or dangerous, we must remember how risky life was for transgender youth before the establishment of child gender identity services. Many would buy hormones from friends or on the street, because remaining without medical treatment is simply not an option for many. Injecting hormones without medical supervision at unregulated dosages exposed them to serious health risks.
Facing discrimination in the work environment and not being able to access healthcare services, trans people found that sex work was often the only way to raise money for treatment. Violence, trauma, HIV, sexually transmitted infection and entanglement in the justice system were all too common.
Denying healthcare to gender-diverse youth is not being cautious: it is leaving them without recourse. Those who question whether adolescents can give consent to treatment must remember they do not consent to their developing bodies either.
While many gender non-conforming children do not transition, others find pubertal development distressing or unbearable. Trans boys may not tolerate breast development and binding is painful and harmful; they often experience the appearance of menarche as humiliating. Trans girls may not tolerate the growth of facial and bodily hair, the masculinisation of their bodies, the spontaneous erections that come with puberty, the deepening of their voices.
These experiences might cause psychological disintegration and are a well-known risk for these young people. Suicide attempts are very high in this group, even in those with supportive families, and evidence shows that suicide attempts are reduced significantly when clinical care is provided.
Omitting treatment at the right time is neither a “cautious” nor a neutral choice: it means exposure to predictable, serious and preventable risk. Limiting the clinicians’ rights to provide treatment is forcing them to violate their duties towards their patients, and is to deny gender minorities the fundamental human right to identity and to health.
The biggest threat to the health of gender diverse people is not the provision of medical care – thinking that it is borders on absurd. As the World Health Organisation, the Council of Europe and the UN have repeatedly stressed, the biggest threat to the health of gender diverse people is the barriers to medical care.
In Australia those barriers are high. Only Melbourne has a fairly well resourced gender service for young people, and it can barely meet demand. In most areas in the country, young people do not have any access to gender care. In NSW, there is one small regional service doing their best and a tiny clinic at Westmead Children’s Hospital in Sydney with a huge wait list.
Growing numbers of referrals are not the sign of a problem but a sign of success. It is to be welcomed that young people feel safe enough to express how they feel and we should take pride in the fact that young people can access medications more safely than ever and that these are prescribed by specialists who can offer quality assurance and follow-up. We should be careful not to do anything to prejudice that safety.
Simona Giordano is a professor of bioethics at the Centre for Social Ethics and Policy at the University of Manchester Law School.