Yesterday, working in a colleague's clinic, I saw a transgender patient (male to female) who came in for a refill of his estrogen and testing for sexually transmitted infections, which he said he did every six months "just in case." As I asked and discussed with the patient issues such as risk factors for sexually transmitted disease, existence of new signs or symptoms, length of time on estrogen and if a specialist oversaw this medication, if the patient understood the possible risks (such as breast cancer, even in a "natal male") of taking estrogen, it became clear that the patient did not understand these issues, and even seemed to believe that what constituted a vagina for him was exactly the same as the vagina of a "natal female." I later found out that this patient has a congenital condition (genetic) that, among other traits, impairs his cognitive abilities. This scenario reminded me of the several transgender patients I have seen previously who had poorly-treated schizophrenia, who were actively delusional and thereby cognitively impaired but were none the less given transgender reassignment treatments. Then, as today, I wonder how it is possible for a person, a patient, to give informed consent to undergo something as risky and irreversible (not to mention inappropriate) as transgender reassignment treatment. I was told, about the schizophrenic patients, that treating the gender dysphoria would help settle the schizophrenia, that the schizophrenic symptoms were exacerbated by the gender dysphoria, or, alternatively, that once a patient was less distressed about gender, he or she would be more amenable to being treated for schizophrenia.
Or, perhaps, the standard for informed consent for transgender treatment is less rigourous than other conditions, transgender treatment has a lower bar for cognitive ability, as though, I am hypothesizing, one's sense of gender and possible dysphoria with that gender, is so fundamental that cognition is secondary in the consideration to usher the patient into the world of transgender treatment.
The patients I am thinking of above are adults. What about children, and their cognitive ability to give informed consent? We already know children's brains are not cognitively mature until well past adolescence (there is much literature; here is one article). Again, and now with children, is the claim of gender dysphoria considered of such a primal nature that considerations of cognitive ability are secondary to decisions to give transgender treatment?
Indeed, at the local clinic that specializes in (adult) transgender treatment, their definition of informed consent is:
“When a person gives “Informed Consent,” it means that the individual possesses the cognitive ability to make an informed and independent decision about their health care and are choosing to do so without coercion.
The individual understands both the benefits and potential risks of the choice they are making and is able to anticipate how that choice may impact them now and in the future. In other words, the individual has the capacity and all of the information needed to make a completely informed decision.”
The words sound right, but when parsed, are solipsistic (why does that word keep cropping up when attempting to assess transgender theory?). It is not specified how it is judged that an individual has the cognitive ability to make such decisions. Is it sufficient for the patient to say "yes" when asked if he or she understands?
More so at the local children's hospital transgender clinic, where the consent forms are worded in the first person, but go on at a length which I have great difficulty believing a child could understand.
It appears we have a situation of trying to medicalize, and then legalize, a condition which is simultaneously being declared a matter of identity politics: I am because I say I am, so give me what I say I want, even if I cannot understand to a degree required to give informed consent for any other medical or legal situation.
I truly expect more of my physician colleagues.
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