A closer look at the evidence for gender-affirming care

Issue: BCMJ, vol. 64, No. 7, September 2022, Page 287 Letters
By: Julie Leising, MD, FRCPC

Like Dr Joanne Sinai, I believe that transgender and gender-nonconforming (TGNC) youth deserve compassionate and evidence-based care. For this reason, I find it important to reply to her letter titled “The current gender-affirming care model in BC is unvalidated and outdated.”[1]

Since I drafted this reply, Dr Sinai co-authored a second Letter to the Editor with Dr Leonora Regenstreif, titled “Informed consent for gender-questioning youth seeking gender-affirmative care is a complex issue.”[2] Both letters promote the idea that TGNC youth are being treated in a way that is potentially harmful in the long term. I find this insinuation to be problematic. Drs Sinai and Regenstreif imply that care providers are failing to comprehensively assess a youth’s capacity to consent to medical interventions and provide appropriate information to obtain informed consent, despite findings that 89% to 93% of youth age 10–18 have been found capable of providing medical decision-making competency for gender-affirming care based on clinical assessment and validated tools, respectively.[3] They present a limited and biased selection of the evidence and disregard the existing literature that indicates potential harm to TGNC youth when affirming care is delayed or denied.[4] While appealing for evidence-based care, these letters promote interventions that are not based in evidence and that delay affirming care. In the Premise[5] published in this issue, I summarize the available evidence and respond in two parts, the first looking at the evidence for our current model of gender-affirming care, and the second discussing specific interventions and outcomes.
—Julie Leising, MD, FRCPC
Vancouver

This letter was submitted in response to “The current gender-affirming care model in BC is unvalidated and outdated” and “Informed consent for gender-questioning youth seeking gender-affirmative care is a complex issue.”

Read the guest editors’ response in “Guest editors reply to Drs Sinai, Regenstreif, and Leising.”

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References

1.    Sinai J. The current gender-affirming care model in BC is unvalidated and outdated. BCMJ 2022;64:106.

2.    Sinai J, Regenstreif L. Informed consent for gender-questioning youth seeking gender-affirmative care is a complex issue. BCMJ 2022;64:286-287.

3.    Vrouenraets LJJJ, de Vries ALC, de Vries MC, et al. Assessing medical decision-making competence in transgender youth. Pediatrics 2021;148:e2020049643.

4.    Sorbara JC, Chiniara LN, Thompson S, Palmert MR. Mental health and timing of gender-affirming care. Pediatrics 2020;146:e20193600.

5.    Leising J. Gender-affirming care for youth—separating evidence from controversy. BCMJ 2022;64:314-316,319.

Julie Leising, MD, FRCPC. A closer look at the evidence for gender-affirming care. BCMJ, Vol. 64, No. 7, September, 2022, Page(s) 287 - Letters.


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