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Published on 22 January 2008

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Gender-disordered children “denied drugs”


Gender-disordered children as young as 10 are being denied desperately needed hormonal drugs, leaving them open to bullying, violence and even suicide, a researcher has concluded.

Ethicist Dr Simona Giordano of Manchester University said doctors in the UK were depriving children of relief from “extreme suffering” caused by their condition and forcing their families into seeking help outside the UK.

Dr Giordano, based at the School of Law, said doctors in the USA had reported treating children turned down at UK clinics.

But she said poorer families were unable to afford US medical care.

She also suspected that significant numbers of children were suffering alone and without support, although detailed research was needed to reveal the true extent of the problem.

She said the effect of “hormone ‘blockers” – which suspend puberty – were easily reversible.

However, the effects of other therapies used at later stages – including masculinising and feminising hormones, and surgery – were more difficult to reverse.

Dr Giordano also said controversial guidelines, which advocated not starting treatment until puberty was complete, were still being followed, despite having been withdrawn.

The guidelines were published in 2005 by the British Society for Paediatric Endocrinology and Diabetes.

She commented: “Current evidence on risks and benefits of blockers in children and adolescents does not justify the strong resistance of UK specialists, especially considering the risks of refusal of treatment.

“Children are being exposed to the anguish and terror of growing in a body that is experienced as alien.

“It means they will suffer the ill-effects of having to begin less reversible treatment on a body which is already fully formed.

“That in turn may lead to more invasive surgery, should he or she decide to transition.”

Dr Giordano also argued that children as well as adults were in some cases competent to give consent to hormonal therapy.

She explained: “There is no legal or ethical ground for presuming that a child or adolescent with gender identity disorder cannot be competent to make an informed judgment about this issue.

“This disorder is certainly not a mental illness, as some medics claim.

“Even if it was, UK law says that a person with a mental illness is not necessarily incompetent to make decisions about treatment for his or her condition.

“We have to presume that these people are competent, unless there is evidence of the contrary.

“If it was impossible to give valid consent to treatment whose side-effects are unclear, it would follow that no-one – including adults – could consent to medical research.

“Each case must be evaluated on an individual basis, without assumption that their consent cannot be valid or that treatment cannot be ethical.”

School of Law, University of Manchester

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