The ethics of puberty blocking treatment for adolescents under the age of 16 diagnosed with Gender Dysphoria

Gender Dysphoria (GD) refers to ‘incongruence’ between an individual’s gender identity and their biological sex accompanied by significant psychological distress. Adolescents as young as 12 with GD are currently offered puberty-blocking medical treatment (PBT) to temporarily stop the pubertal development of the sexed body which does not ‘correspond’ with gender identity, aiming to ease psychological suffering. Acknowledging that there may be adolescents with GD who do not continue to express gender incongruence and/or experience resolution of dysphoria, PBT is purported to give adolescents time to explore their gender identity without unwanted pubertal development but also allowing for resumption if treatment is stopped. My research aims to evaluate the ethics of managing GD in adolescents under the age of 16 with PBT.  

I found that the bioethics debate is polarised and focused on two issues – the status of scientific evidence in support of PBT as best treatment, and the capacity of young adolescents to consent to treatment given the potential harms. However, the debate fails to address the ethical significance of the gender norms that are encoded in the diagnosis and management of GD. I drew on Judith Butler’s theory of gender performativity and recognition to undertake a feminist ethical analysis of the diagnosis of GD and its management with PBT. I argue that the diagnosis and treatment of GD lack a coherent theoretical framework and are based on norms that reinforce the gender binary. Medicine provides recognition to the transgender adolescent as a medical subject founded on the concept of ‘misalignment’ of gender identity with sexed body, which medicine can correct– an outcome which forecloses alternative embodiments of gender. I suggest that Butler’s ethics of recognition can guide the development of a new model of care for transgender youth in which diverse gendered futures can be imagined.