Monday, 23 June 2014

Family Court allows 17 year old to have testosterone for gender dysphoria

A 17 year old biological girl has been allowed to have testosterone, after a Family Court judge determined that the teenager, called Spencer, was competent to decide to have treatment, to change her irreversibly to male.

Justice Johns in the Family Court case of Re Spencer stated:

"The making of a declaration such as is sought by the applicant carries with it a heavy weight of responsibility. A declaration as sought will open the door to a new phase in Spencer’s life; the pathway to the physical transition to his affirmed gender will begin. I am satisfied......that the power “to make orders relating to the welfare of the children” includes the power to make a declaration such as is sought by the applicant. Further, I am satisfied that it is in Spencer’s best interests that I make that declaration. The evidence before me from his treating doctors and his mother indicates that to do otherwise would gravely compromise Spencer’s health and wellbeing."


One of the first questions that her Honour had to consider was whether Spencer was mature enough to make the decision for himself. This is called the Gillick competent test. Justice Johns had this to say about the proposed treatment:

"Of all the medical treatments that might arise, treatment for something as personal and essential as the perception of one’s gender and sexuality would be the very exemplar of when the rights of the Gillick competent child should be given full effect."

Therefore, if Spencer were found to be Gillick competent, then that was that- treatment could be carried out without further interference. The evidence that Spencer was Gillick competent was overwhelming:

 His psychiatrist stated:
[Spencer] certainly agrees to undertake treatment...he has been seeking treatment for over the period of the last year. He has been consistent and insistent in his request to receive testosterone treatment.
I believe that [Spencer] is able to make an informed decision about undertaking treatment with testosterone.
Although he had previously been experiencing significant depression and feeling anxious and unsettled in social situations, I believe that he does have an age-appropriate mature understanding of the treatment required.
I have been asked to consider whether [Spencer] meets the criteria for decision-making in respect of his own health which would be consistent with the ‘Gillick competent’ criteria. I understand that this requires that the young person have a high level of maturity and insight such that they are able to make their own decision in relation to such matters as medical treatment ...
I believe that [Spencer] does have the insight and maturity to understand the nature of the treatment with testosterone as proposed. He is aware of the perceived positive changes that will result with his bodily development: that his muscle bulk will increase, that his voice will change and that he will have a masculine pattern of body hair. He is aware that his bone density will increase. He is aware that commencing testosterone will not of itself reduce the size of his breasts, and he would like to seek surgery at some time in the future to do so.
I believe that he is aware that testosterone treatment will affect the development of his ovaries and that he will not produce ova (eggs) from his ovaries whilst on testosterone treatment.
...[Spencer] has done a lot of research using the web, some resources provided by his mother and discussions with myself and medical staff at the hospital, into the nature of gender identity disorder and the hormonal and other treatments available. I believe he does understand the effect of commencing Zolidex treatment and testosterone treatment and the respective potential benefits and risks.
...He is aware that there are some risks associated with testosterone treatment including a remote possibility of liver damage and the effect upon his reproductive capacity. He has been able to discuss at an earlier stage the possibility of harvesting ova later and should he wish to have a child using his own genetic material. ... I believe [Spencer] does express a very clear and consistent opinion that he wishes to commence testosterone treatment, understanding that this is not an absolutely irreversible course of action. He has been unwavering in his request for testosterone treatment over recent times. [Spencer] acknowledges that other people may have changed their mind about transgender treatment and expressed regret but that he cannot conceive that this would happen to him.

Another psychiatrist stated about Spencer:

[Spencer] appears to be of average intelligence. [Spencer] is able to demonstrate full understanding of the nature of the treatment, including side effects and limitations and is actively requesting the treatment. In my opinion [Spencer] is Gillick competent and is capable of making an informed decision about the treatment. He understands that the stage two treatment is only partially reversible and that changes like deep voice and facial and body hair will persist should he stop the treatment. I believe [Spencer] has also been given opportunity to discuss fertility with the appropriate specialist.... [Spencer] is capable of making an informed decision.




Spencer's paediatrician stated:

[Spencer] is very well-informed with regards to his treatment options and even before seeing myself at the hospital he had done much of his own research into the available options for masculinisation using testosterone. [Spencer] has been the driving force for commencement of assessment and treatment and initiated contact with medical staff. He is very keen to commence testosterone treatment as soon as possible.

[Spencer] is Gillick competent to make the decisions regarding commencement of stage two [testosterone] treatment. This has been demonstrated during our consultations where [Spencer] has engaged in sophisticated discussion around the issues of his gender identification, fertility preservation and the long term consequences of treatment both in terms of physical and psychological health and wellbeing. [Spencer] is aware that one of the options for transitioning is to do so socially without utilising hormonal treatment. [Spencer] expresses that this will not be tolerable for him as the incongruence between his gender identity and his physical appearance causes significant distress. He is an intelligent young man about to complete his VCE and has been particularly resourceful in gaining knowledge of hormonal options and their physiological effects. He understands the benefits and possible side effects of treatment including the possibility of regret in the context of irreversible physical changes from testosterone treatment.

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