Approximately half of transgender or gender diverse youth identify as gender non-binary (not entirely/exclusively male or female). Some clinicians have reported that some non-binary youth request ongoing puberty suppression to prevent development of secondary sex characteristics. These requests are controversial, as puberty suppression for transgender or gender diverse youth has typically only been discussed as the first of a two-stage hormonal treatment pathway, rather than standalone treatment. Ethical issues associated with puberty suppression for non-binary youth remain under-explored. This study aimed to explore how Australian clinicians working with transgender or gender diverse youth navigate these complexities and view and make decisions about puberty suppression for non-binary youth.
Semi-structured interviews were conducted with clinicians. Inductive content analysis was used to identify content categories from the data. While clinicians expressed concerns about the potential physical, cognitive and psychosocial harms of blocking puberty long-term, many were also concerned that asking non-binary youth to choose a puberty could also cause psychosocial harm. Given the current lack of evidence and professional guidance, clinicians could benefit from evidence-based ethical guidelines for making these complex decisions. Such guidelines could support clinicians and improve decision-making and outcomes for patients and families.
Acknowledgements: This project is funded by a University of Melbourne Early Career Researcher Grant awarded to Dr Lauren Notini. Dr Notini wishes to acknowledge the participants, and her collaborators: Dr Ken Pang, A/Prof Michelle Telfer, Prof Julian Savulescu, Prof Lynn Gillam, Dr Rosalind McDougall, Mr Brian Earp, Prof Anthony Penington, A/Prof Michelle Taylor-Sands and Ms Paula O’Brien.