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I find it important to reply to her letter titled “The current gender-affirming care model in BC is unvalidated and outdated.”
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.” 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. 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. While appealing for evidence-based care, these letters promote interventions that are not based in evidence and that delay affirming care. In the Premise 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
This letter was submitted in response to “The current gender-affirming care model in BC is unvalidated and outdated” and “Informed consent for gender-questioning youth seeking gender-affirmative care is a complex issue.”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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