Can kids really consent to transgender procedures?

ENGLAND’S National Health Service on March 12 confirmed it would no longer routinely prescribe puberty blockers for children with gender dysphoria. But many doctors have no qualms about such protocols. Files leaked from the World Professional Association for Transgender Health and published on March 4 revealed member doctors encouraging one another to prescribe transgender interventions to patients as young as 9—including hormones and surgeries—even as some doctors expressed uncertainty. Currently, U.S. gender clinics rely on WPATH’s pro-transgender guidelines for treating kids.

What was in the leaked files? Online forum discussion threads showed doctors and other WPATH members agreeing transgender procedures were important and shouldn’t be denied to minors or the mentally ill. But some asked whether such patients had the mental capacity to understand the risks and long-term consequences of cross-sex hormones and surgery.

Did the WPATH doctors admit transgender procedures are harmful? They openly discussed complications faced by their patients, including genital pain, vaginal atrophy, sexual dysfunction, infertility, and cancer.

Did they obtain informed consent from young patients? All claim they did. But among the leaked files is an 82-minute video of a WPATH virtual meeting where doctors admitted their difficulties defining and obtaining informed consent from minors. Dr. Daniel Metzger, a pediatric endocrinologist at BC Children’s Hospital in Vancouver, British Columbia, told participants that many kids know little about the organs they’re asking to modify: “It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall.”

Do these kids know what they’re getting themselves into? Many don’t. Doctors in the online discussion forum, for example, couldn’t agree whether a 13-year-old girl who showed signs of an eating disorder and wanted a prescription for testosterone was capable of giving informed consent.

What about their parents? Another WPATH member, University of Minnesota psychologist Dianne Berg, said during the virtual meeting, “What really disturbs me is when the parents can’t tell me what they need to know about a medical intervention that apparently they signed off for.”

What’s ethically required for medical informed consent? The American Medical Association says doctors should assess whether a patient can make an “independent, voluntary decision” and inform him about the diagnosis, treatment options, and risks in a way the patient can understand.

Do harmed children have any legal recourse? Some former patients say they regret irreversible procedures like double mastectomies that they agreed to as teens. Now adults, they have lawsuits pending against their doctors, surgeons, and therapists.