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I find it important to reply to her letter titled “The current gender-affirming care model in BC is unvalidated and outdated.”[1]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This letter was submitted in response to “The current gender-affirming care model in BC is unvalidated and outdated” [10] and “Informed consent for gender-questioning youth seeking gender-affirmative care is a complex issue.” [11]
Read the guest editors’ response in “Guest editors reply to Drs Sinai, Regenstreif, and Leising.” [12]
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [13]. |
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 Sinai J. The current gender-affirming care model in BC is unvalidated and outdated.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.
Links
[1] https://bcmj.org/cover/september-2022
[2] https://bcmj.org/author/julie-leising-md-frcpc
[3] https://bcmj.org/node/9257
[4] https://bcmj.org/sites/default/files/BCMJ_Vol64_No7-letters_2.pdf
[5] https://bcmj.org/print/letters/closer-look-evidence-gender-affirming-care
[6] https://bcmj.org/printmail/letters/closer-look-evidence-gender-affirming-care
[7] http://www.facebook.com/share.php?u=https://bcmj.org/print/letters/closer-look-evidence-gender-affirming-care&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton
[8] https://twitter.com/intent/tweet?text=A closer look at the evidence for gender-affirming care&url=https://bcmj.org/print/letters/closer-look-evidence-gender-affirming-care&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton
[9] https://bcmj.org/javascript%3A%3B
[10] https://bcmj.org/letters/current-gender-affirming-care-model-bc-unvalidated-and-outdated
[11] https://bcmj.org/letters/informed-consent-gender-questioning-youth-seeking-gender-affirmative-care-complex-issue
[12] https://bcmj.org/letters/guest-editors-reply-drs-sinai-regenstreif-and-leising
[13] http://creativecommons.org/licenses/by-nc-nd/4.0/
[14] https://bcmj.org/modal_forms/nojs/webform/176
[15] https://bcmj.org/%3Finline%3Dtrue%23citationpop