Alpha Methyl Phenylethylamines

Update May 08, 2021: Following a new policy statement from the Karolinska Hospital that went into effect May 2021, this article has been updated to reflect the changes. Update February, 2022: Sweden's National Board of Health and Welfare has followed the Karolinska's lead and issued a national policy update closely mirroring the policy adopted by the Karolinska. You can read more about Sweden's new policy regarding hormonal interventions for gender-dysphoric minors here. The Karolinska Hospital in Sweden recently issued a new policy statement regarding treatment of gender-dysphoric minors. This policy, affecting Karolinska's pediatric gender services at Astrid Lindgren Children's Hospital (ALB), has ended the practice of prescribing puberty blockers and cross-sex hormones to gender-dysphoric patients under the age of 18. This is a watershed moment, with one of world's most renowned hospitals calling the "Dutch Protocol" experimental and discontinuing its routine use outside of research settings. According to the ”Dutch Protocol,” which has gained popularity in recent years, gender-dysphoric minors are treated with puberty blockers at age 12 (and in some interpretations, upon reaching Tanner stage 2 of puberty, which in girls can occur at age 8), and cross-sex hormones at the age of 16. This approach, also known as medical "affirmation," has been endorsed by the WPATH ”Standards of Care 7” guideline. According to Karolinska’s newest policy, which went into effect in May 2021, going forward, hormonal (puberty blocking and cross-sex hormone) interventions for gender-dysphoric minors may only be provided in a research setting approved by Sweden’s ethics review board. The policy states that careful assessment of the patient’s maturity level must be conducted to determine if the patient is capable of providing meaningful informed consent. There is also a requirement that patients and guardians are provided with adequate disclosures of the risks and uncertainties of this treatment pathway. It is not clear whether minors under the age of 16 would be eligible for such trials. The Karolinska Hospital’s new policies echo a growing international concern over the proliferation of medical interventions that have a low certainty of benefits, while carrying a significant potential for medical harm. The latest policy issued by the Karolinska cites the UK NICE evidence review, which found the risk / benefit ratio of hormonal interventions for minors highly uncertain; the 2020 UK judicial review, which highlighted the overarching ethical problems with the practice of medical "affirmation" of minors; as well as Sweden's own Health and Technology Assessment (SBU) evidence review conducted in 2019, which found a lack of evidence for medical treatments, and a lack of explanation for the sharp increase in the numbers of adolescents presenting with gender dysphoria in recent years. In recent months, several countries’ health authorities found that the evidence base is insufficient to justify routine early medical interventions for gender-dysphoric minors. Finland revised its treatment guidelines in June 2020, prioritizing psychological interventions and support over medical interventions, particularly for youth with post-pubertal onset of gender dysphoria (currently the most common presentation). Significant changes are also underway in the UK. Following the 2020 High Court judgement, the NHS (National Health Service) suspended the initiation of hormonal interventions to minors under 16. The ruling is currently under appeal, with a hearing scheduled for June 2021. In North America, the debate about treatments for gender-dysphoric minors has become highly politicized. A number of US states have recently introduced laws banning the use of hormonal interventions in gender-dysphoric minors. In contrast, other states have introduced laws mandating public and private insurance coverage for a wide range of gender-"affirming" medical and surgical interventions for "gender incongruence," regardless of a patient's age or mental health status. In Canada, Bill C-6 goes even further, seeking to criminalize psychological treatment modalities, which represent the primary non-invasive alternative to medical and surgical "affirmation."  As the global awareness of the low quality of evidence of the benefits, and the potential harm of the "affirmative" medical interventions in gender-dysphoric minors grows, non-invasive alternatives for ameliorating the minors' distress, such as the provision of ethical psychological treatments and support, are expected to come into focus. The March (going into effect April 1) and the April (going into effect May 1) policy documents, as obtained by SEGM from the Karolinska Hospital, along with our unofficial translations, are available below.

Australian trans youth seeking medical treatment for gender dysphoria can encounter significant legal barriers to healthcare. Legal requirements for obtaining valid consent to gender-affirming care, first established in 2004, mean that an application to the Family Court is required in many cases before treatment can be provided. The development of Australian law concerning consent for the medical treatment of trans youth has been slow, haphazard, and remains incomplete. The Family Court process has been found to be damaging to trans youth and their families. There is widespread agreement that the law needs reform, even more so since the 2020 decision in Re: Imogen. This article explores the implications of the decision in Re: Imogen for trans youth and their families and raises possible models for reform. It starts by providing the background to Re: Imogen and explaining the current legal position. It then explores why the law needs to be reformed, highlighting the inconsistent approach to competency in Australian law and the harm the current law does to trans youth. Building on critiques of the law in this area, it reviews various options for law reform and suggests an optimal model.

Australia’s courts oversee the treatment for some children experiencing gender dysphoria, but University of Melbourne research asks if there's an alternative.

Do you know when transgender children need to go to court to get treatment? Read the case study of Re Imogen and the rights to gender-affirming treatment!

Family Court settles dispute over hormone therapy for teenager with gender dysphoria.

Abstract. This article outlines the Australian legal position relevant to minors and the commencement of hormone treatment for Gender Dysphoria (GD). It tr

Click on the article title to read more.

Information and referrals for legal issues, document changes, and discrimination.

Abstract. Medical treatment for adolescents with gender dysphoria has attracted considerable attention in recent years, with continuing court involvement i

Australian Professional Association for Trans Health

Europe PMC is an archive of life sciences journal literature.

Europe PMC is an archive of life sciences journal literature.

Family Court of Australia Re: Imogen (No. 6) [2020] FamCA 761 (10 September 2020) Parenting – medical procedures – Gender Dysphoria – where Imogen has been diagnosed with Gender Dysphoria, currently takes puberty suppression medication and wishes to move to stage 2 gender affirming hormone treatment – where the father supports Imogen’s wish – where…

Re Imogen (No 6) [2020] FamCA 761 (on AUSTLII) saw the Court called upon to consider the provision of stage 2 hormone treatment to a minor aged 16 years: Imogen, formerly known as Thomas – bo…

This article outlines and critiques the Australian jurisprudence that has addressed whether minors are able to lawfully consent to gender-affirming hormone treatment, with reference to the landmark decision of Gillick v West Norfolk and Wisbech Area Health Authority. Although the principle of Gillick competency is well recognised in law, the Australian legal developments that apply Gillick to decisions about the commencement of gender-affirming treatment, have taken the principle astray. The approach under Australian law has diverged down a path that does not align with the original reasoning in Gillick, nor its contemporary interpretation. I outline the reasoning in Gillick so that the foundational principles are considered before discussing how Gillick has been interpreted and applied in subsequent cases. I then provide an outline of the key legal developments in Australia relevant to minors and the commencement of hormone treatment for gender dysphoria. I undertake a critique of the Australian law in this field and conclude that there is a need for future judicial determination of how Gillick should be applied, not only in the cases relevant to gender dysphoria, but beyond, so that the position in respect of minors’ decision-making is clarified. This is vitally important because the current approach to this issue has potential implications beyond cases relevant to gender-affirming hormone treatment.

This article outlines and critiques the Australian jurisprudence that has addressed whether minors are able to lawfully consent to gender-affirming hormone treatment, with reference to the landmark decision of Gillick v West Norfolk and Wisbech Area Health Authority. Although the principle of Gillick competency is well recognised in law, the Australian legal developments that apply Gillick to decisions about the commencement of gender-affirming treatment, have taken the principle astray. The approach under Australian law has diverged down a path that does not align with the original reasoning in Gillick, nor its contemporary interpretation. I outline the reasoning in Gillick so that the foundational principles are considered before discussing how Gillick has been interpreted and applied in subsequent cases. I then provide an outline of the key legal developments in Australia relevant to minors and the commencement of hormone treatment for gender dysphoria. I undertake a critique of the Australian law in this field and conclude that there is a need for future judicial determination of how Gillick should be applied, not only in the cases relevant to gender dysphoria, but beyond, so that the position in respect of minors’ decision-making is clarified. This is vitally important because the current approach to this issue has potential implications beyond cases relevant to gender-affirming hormone treatment.

A pathway to better outcomes for transgender youth