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Letter to a Doctor Advocating for a Young Person

To Whom It May Concern,

[member name, date of birth, and address]

We are writing to advocate for the above named person, who is receiving gender affirming healthcare with the advice of our service.

We were deeply disappointed to hear that you are opposing the above named person’s decision to receive gender affirming healthcare. It is our judgement that this will severely impact the person’s mental health and violates the key principles of medical ethics.

Transgender (trans) people comprise a vulnerable group in society who are systematically disadvantaged by prejudice, discrimination, and threats to their basic rights. Due to these challenges, trans adolescents suffer significantly worse outcomes regarding mental health and social wellbeing than their cisgender peers. Access to gender affirming healthcare is a crucial part of alleviating these health disparities and enabling trans adolescents to flourish. Unfortunately, access to gender affirming healthcare for trans adolescents is being restricted in the United Kingdom, with severe consequences for trans adolescents and their families.

The provision of gender affirming healthcare is supported by international professional organisations such as the World Professional Association for Transgender Health, the Endocrine Society, and University of California San Francisco, whose evidence-based guidelines are based on robust peer-reviewed research [1–3]. Such research has shown that gender affirming healthcare can be lifesaving and that it results in significant improvements in the mental health and social wellbeing of transgender youth. Moreover, the withholding of gender affirming healthcare has been shown to cause very serious harms, including increased risks of depression, anxiety, and suicide [4–14].

Gender is an aspect of one’s identity that falls within the sphere of one’s autonomy and right to self-determination [15–17]. The provision of gender affirming healthcare respects the rights of young people to attain their embodiment goals and determine their own futures. Accordingly, gender reassignment is a protected characteristic under the Equality Act 2010. Trans adolescents are not being pressured into transitioning by doctors or by their parents. The decision regarding gender affirming healthcare is a complex decision that involves assessing the wishes and interests of the young person, the psychological development of the person, and the capacity of the person to give informed consent. Furthermore, research evidence indicates that the decisions made by trans adolescents about their own healthcare are well considered and demonstrate the appropriate understandings and capacities required for informed consent [18].

There is a clear indication for the above named person to access gender affirming healthcare. The above named person has a confirmed diagnosis of Gender Incongruence according to the criteria set by the 11th revision of the International Classification of Diseases. Not only is such treatment likely to be beneficial for the young person’s health and wellbeing, but withholding such treatment would very likely result in serious deterioration of the person’s psychological health. Furthermore, the above named person has demonstrated the relevant understanding and capacity to give informed consent to the treatment, and so opposing this informed decision would amount to a violation of the person’s autonomy.

It is our view that opposing the above named person’s decision to receive gender affirming healthcare places the person at risk of harm in the following ways:

  1. Opposing the person’s gender affirming healthcare is violating the person’s autonomy and right to self-determination, especially given that the person has demonstrated the relevant understanding and capacity to consent to medical treatment under legally recognised standards;
  2. Opposing the person’s gender affirming healthcare violates the ethical principle of nonmaleficence by putting the person’s mental health and social wellbeing at serious risk, as there is substantial research evidence indicating that restricting gender affirming healthcare leads to increased risks of depression, anxiety, and suicide in trans adolescents;
  3. Opposing the person’s gender affirming healthcare violates the ethical principle of beneficence by preventing the person from receiving the benefits that such treatment could bring regarding mental health and social wellbeing, which have been demonstrated by numerous research studies;
  4. Opposing the person’s gender affirming healthcare violates the person’s right to privacy, as well as the right to private and family life;
  5. Opposing the person’s gender affirming healthcare potentially amounts to prejudiced and discriminatory treatment that fails to respect gender identity as a protected characteristic and contributes to the severe health disparities suffered by trans people.

Yours sincerely,



International guidelines for gender affirming healthcare

  1. Centre of Excellence for Transgender Health (2016). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people, 2nd edition, edited by Deutsch, M. B. University of California San Francisco.
  2. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline”. Journal of Clinical Endocrinology and Metabolism, 102: 3869–3903.
  3. World Professional Association for Transgender Health (2022a). “Standards of care for the health of transgender and gender diverse people, version 8”. International Journal of Transgender Health, 23: S1–S259.

Research studies on gender affirming healthcare in transgender adolescents

  1. Allen, L. R., Watson, L. B., Egan, A. M., and Moser, C. N. (2019). “Well-being and suicidality among transgender youth after gender-affirming hormones”. Clinical Practice in Pediatric Psychology, 7: 302–311.
  2. Bungener, S. L., de Vries, A. L. C., Popma, A., and Steensma, T. D. (2020). “Sexual experiences of young transgender persons during and after gender-affirmative treatment”. Pediatrics, 146: e20191411.
  3. de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). “Young adult psychological outcome after puberty suppression and gender reassignment”. Pediatrics, 134: 696–704.
  4. Chen, D., Berona, J., Chan, Y. M., Ehrensaft, D., Garofalo, R., Hidalgo, M. A., Rosenthal, S. M., Tishelman, A. C., and Olson-Kennedy, J. (2023). “Psychosocial functioning in transgender youth after 2 Years of hormones”. New England Journal of Medicine, 388: 240–250.
  5. Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., and Nelson, E. E. (2021). “Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys”. Psychoneuroendocrinology, 132: e105358.
  6. Green, A. E., DeChants, J. P., Price, M. N., and Davis, C. K. (2022). “Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth”. Journal of Adolescent Health, 70: 643–649.
  7. Kuper, L. E., Stewart, S., Preston, S., Lau, M., and Lopez, X. (2020). “Body dissatisfaction and mental health outcomes of youth on gender affirming hormone therapy”. Pediatrics, 145: e20193006.
  8. Rew, L., Young, C. C., Monge, M., and Bogucka, R. (2021). “Review: Puberty blockers for transgender and gender diverse youth—A critical review of the literature”. Child and Adolescent Mental Health, 26: 3–14.
  9. Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., and Ahrens, K. (2022). “Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care”. JAMA Network Open, 5: e220978.
  10. Turban, J. L., King, D., Carswell, J. M., and Keuroghlian, A. S. (2020). “Pubertal suppression for transgender youth and risk of suicidal ideation”. Pediatrics, 145: e20191725.
  11. van der Miesen, A., Steensma, T. D., de Vries, A., Bos, H., and Popma, A. (2020). “Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers”. Journal of Adolescent Health, 66: 699–704.

Autonomy, consent, and the principles of medical ethics

  1. Maung, H. H. (2024). “Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis”. Journal of Bioethical inquiry.
  2. Ashley, F. (2022). “Adolescent medical transition is ethical: An analogy with reproductive health”. Kennedy Institute of Ethics Journal, 32: 127–171.
  3. Beauchamp, T. L. and Childress, J. F. (1979). Principles of biomedical ethics. New York: Oxford University Press.
  4. Clark, B. A., and A. Virani, A. (2021). “‘This wasn’t a split-second decision’: An empirical ethical analysis of transgender youth capacity, rights, and authority to consent to hormone therapy”. Journal of Bioethical Inquiry, 18: 151–164.
Updated on February 7, 2024

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