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Helping Transgender Adolescents Make Informed Decisions About Their Reproductive Care
Danielle is a 15-year-old transgender female who is about to begin hormone therapy. Her parents would like her to explore gamete cryopreservation – sperm freezing – as a means of preserving her fertility, which could be impaired by the hormone treatments. Danielle would prefer not to, remarking, “If I change my mind later, I’ll just adopt.” Parent-child-doctor conversations such as this one are becoming increasingly common as more adolescents identify as transgender and seek transitional treatment, which, data suggests, has significant long-term benefits to their psychological well-being. The conversations raise ethical questions about the decision-making capacity of adolescent minors, informed consent, and how to determine the best interest of the patient.
The complexities of decision-making concerning fertility and the use of cross-sex hormones by transgender adolescents is explored is an article in Clinical Practice in Pediatric Psychology co-authored by Elizabeth Dietz, a Hastings Center research assistant and project manager. Another author, Gwendolyn Quinn, was a Hastings Center visiting scholar.
Based on the literature on decision-making capabilities of adolescents, the authors write that their “understanding of near-term consequences is generally better developed than that of long-term risk.” The authors also note that fertility preservation often involves heightened attention to aspects of gender that may accentuate the distress caused by gender dysphoria.
The article concludes that Danielle’s physician should engage in a constructive conversation that allows Danielle to make an informed decision. Such a conversation is particularly challenging in cases such as Danielle’s, where the parents and patient disagree about fertility preservation. Ideally, this conversation should include a discussion of future family-making options, including cost. “As with most medical decision making, the goal is not to convince Danielle in one director or another but to provide her and her parents with all the necessary information to make an informed choice,” the authors conclude, “including perhaps the notion that people at ate 15 often feel differently at ages 25 and 35.”
More information about the ethical questions surrounding the care and well-being of transgender youth, as well as other LGBT individuals can be found in a Hastings Center Report special report, LGBT Bioethics: Visibility, Disparities, and Dialogue.