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The mature minor doctrine and gender diverse youth

Transgender hormone blockers, hormones, and surgery are generally only available to minors whose parents or legal guardians give consent in consultation with the minor and medical experts.

In some cases, these mature minors may be able to give medical consent for puberty suppressing drugs as part of a harm reduction model of care. In some cases, a mature minor may even be able to make medical decisions that go against the wishes of their parent or guardian.

The legal doctrine is similar to providing minors vaccinations, drugs for contraception, or treatment for sexually transmitted infections without knowledge or consent of a parent or guardian. Some key points from Dubin:

Importantly, the mature minor doctrine is an ethical principle, and its applicability does not necessarily grant legality to a decision-making process. The law’s recognition is both limited and patchwork. Within the USA, 34 states have no legal exceptions in place for mature minors and only 14 states permit mature minors to consent to general medical treatment.

Ultimately, allowing transgender minors to consent to gender-affirming treatment, that is, over-riding parental consent, should be sought only when all other avenues to try to bring caretakers around have failed or if approaching them poses a clear and present risk to the minor’s well-being. The discussion of such approaches is outside the scope of this paper. The avenues discussed previously should be considered only after attempts to reconcile parent–child disagreement with psychosocial intervention have been thoroughly pursued.

Although guidance is not law, the capacity of a transgender minor should be strongly advocated for in a matter consistent with a provider’s general treatment of adolescents in any other medical decision-making settings such as STI services and contraception. The clinician should consider the decision to pursue hormone therapy or surgery in relation to current guidelines, risks to the individual patient and the child’s decision-making capacity.

Dubin (2020)


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