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We think very carefully about consent in our service. Making sure that young people and parents or carers can give informed consent is an important aspect of our work when young people request a physical intervention for gender dysphoria.
A person’s ability to consent to something depends on them having access to good information tailored to their level of understanding. They need to understand fully what is proposed, grasp the importance of the information and see how it applies to them, and be able to hold onto their understanding of the implications. The degree of insight and understanding that children and young people have is not just a matter of their age but also of their experience and maturity. We also have to try and be sure that their decision was reached without undue influence from others.
For young people of 16 and under, consent to treatment should usually be sought from the child and from one or both parents, except under exceptional circumstances.
For adolescents over 16, if it is concluded that they have sufficient understanding of what is to be offered (this is known as ‘Gillick’ or ‘Fraser’ competence), they may give their own consent to treatment, although under most circumstances, it is good practice to seek parental assent too.
We try to ensure that young person and the family have a good grasp of the available factual information about the interventions they are requesting, including hormone treatments. We also consider the emotional and social issues involved in undertaking treatment. We help them explore the benefits and risks of any requested treatment, and we consider the alternatives to the treatment proposed (including the option of no treatment.) We sometimes seek information from other sources to help us in our assessments. For example, when someone has cognitive difficulties we might want to have a formal assessment of their ability in order that we can modify the assessment in line with their needs.
Information sheets are provided prior to attending the UCLH and LGI endocrinology clinics explaining available physical treatments, and Consent Forms need to be signed prior to any medical intervention.