Pediatrics. 2020 Jan 23. pii: e20191606. doi: 10.1542/peds.2019-1606. [Epub ahead of print]

Long-term Puberty Suppression for a Nonbinary Teenager.

Pang KC1,2,3,4, Notini L1,5, McDougall R6, Gillam L6,7, Savulescu J1,8, Wilkinson D8, Clark BA9, Olson-Kennedy J10, Telfer MM1,2, Lantos JD11.

Author information

1

Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

2

Department of Adolescent Medicine and.

3

Departments of Paediatrics and.

4

Psychiatry.

5

Melbourne Law School, and.

6

School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

7

Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.

8

Uehiro Centre for Practical Bioethics, Oxford University, Oxford, United Kingdom.

9

The University of British Columbia, Vancouver, Canada.

10

University of Southern California, Los Angeles, California; and.

11

Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri jlantos@cmh.edu.

Abstract

Many transgender and gender-diverse people have a gender identity that does not conform to the binary categories of male or female; they have a nonbinary gender. Some nonbinary individuals are most comfortable with an androgynous gender expression. For those who have not yet fully progressed through puberty, puberty suppression with gonadotrophin-releasing hormone agonists can support an androgynous appearance. Although such treatment is shown to ameliorate the gender dysphoria and serious mental health issues commonly seen in transgender and gender-diverse young people, long-term use of puberty-suppressing medications carries physical health risks and raises various ethical dilemmas. In this Ethics Rounds, we analyze a case that raised issues about prolonged pubertal suppression for a patient with a nonbinary gender.