219 A judge, acting as a decision-maker, should give substantial weight to the child’s
best interests, which results in a heavy burden cast on the actor seeking to displace a child’s best
interests to justify their approach using legitimate, compelling reasons.
Treatment options that the advisory council can offer will be based on established best
practices. “Refusing timely medical interventions for adolescents might prolong gender dysphoria
and contribute to an appearance that could provoke abuse and stigmatization.”
221 Due to the
youth’s level of psychiatric distress and its strong association with the level of gender-related
abuse, it is not a neutral option for youth to have puberty suppression and hormonal therapy
222 It is no longer considered ethical for treatment to aim at changing a youth’s gender
expression and identity to become more congruent with their sex assigned at birth.
A youth may be eligible for puberty suppressing hormones as soon as that youth starts
going through puberty, where early use may avert negative social and emotional consequences of
gender dysphoria more effectively than their later use would.
224 Extensive exploration of
psychological, familial, and social issues should be undertaken before considering any physical
225 Intervention with puberty-suppressing hormones, which may continue for a few
years, is justified by two goals: giving youth time to explore their gender nonconformity and other
issues and facilitating transition by preventing development of sex characteristics that are difficult
or impossible to reverse.
226 The value of using hormone blockers lies in the time bought for youth
without an overwhelming fear of their body progressing past puberty – within months of stopping
the use of hormone blockers, youth return to genetic puberty.
The Standards of Care developed by World Professional Association for Transgender
In order for adolescents to receive puberty-suppressing hormones, the follow
minimum criteria must be met:
1) The adolescent has demonstrated a long-lasting and intense pattern of gender
nonconformity or gender dysphoria (whether suppressed or expressed);
2) Gender dysphoria emerged or worsened with the onset of puberty;
3) Any coexisting psychological, medical, or social problems that could interfere with
treatment (e.g., that may compromise treatment adherence) have been addressed,
such that the adolescent’s situation and functioning are stable enough to start
4) The adolescent has given informed consent and, particularly when the adolescent
has not reached the age of medical consent, the parents or other caretakers or
guardians have consented to the treatment and are involved in supporting the
adolescent through the treatment process.