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What are the health outcomes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study
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    What constitutes informed consent in the treatment of childhood gender dysphoria?: some comments on the Trans20 study
    • Roberto D'Angelo, Psychiatrist Institute of Contemporary Psychoanalysis, Los Angeles
    • Other Contributors:
      • Juan C d'Abrera, Consultant psychiatrist
      • George Halasz, Adjunct senior lecturer, psychiatrist
      • Philip Morris, Psychiatrist
      • Shirley Prager, Psychiatrist
      • Ron Spielman, Psychiatrist and Psychoanalyst

    We wish to express concerns about the Trans20 longitudinal cohort study of transgender and gender diverse (TGD) youth from Melbourne’s Royal Children’s Hospital Gender Service (RCHGS) presented in the BMJ (Tollit et al BMJ Open 2019:9).

    While we agree with the authors that in regard to the management of TGD youth there is ‘’urgent need for more evidence to ensure optimal medical and psychosocial interventionsi”, we have grave reservations about the ethical underpinnings and methodology of the study as described.

    The Trans20 study aims to “document the natural history of gender diversity presenting in children”. It is not clear to us how the methodological design could allow observation of the ‘natural’ history of TGD youth when it intervenes in the developmental trajectories of all 600 expected participants. Given that a vast majority of young people who commence puberty blockers proceed to cross-sex hormonesii, it may well be the case that early intervention ‘locks’ a child into a persistent gender incongruence, closing them off to future choices in identity. We already do possess good data on the ‘natural history’ of gender confusion which shows that a majority of children desist at puberty and return to a gender identity congruent with their natal sexiii. Is this fact presented to concerned families?

    The RCHGS adopts an exclusively gender-affirming model of care, offering psychosocial and biological interventions to children as young as 3. Although...

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    Conflict of Interest:
    None declared.