A Gender Dysphoria diagnosis involves a conflict between a person's physical gender and the gender with which they identify. This can cause a person distress including anxiety, depression and self-harm.
Children with a Gender Dysphoria diagnosis may wish to access medical treatment. This can consist of 3 stages:
- Stage 1: or 'puberty blocking treatment', is therapeutic and, when used for a limited time (3-4 years), its effects are reversible.
- Stage 2: or "gender affirming hormone treatment", involves the use of either estrogen to feminise the body or the testosterone to masculinise the body. Some side effects are irreversible.
- Stage 3: or treatment that is surgical in nature.
Until recently, children could not commence stage 2 or stage 3 treatment unless Court authorisation was obtained.
Re: Kelvin[2017]FamCAFC:
In this recent case, the Family Court decided that Court authorisation is no longer required for stage 2 hormonal treatment for children with Gender Dysphoria where there is no dispute between parents, medical practitioners and the child, and where the treatment administered is in accordance with published best practice guidelines.
The child "Kelvin" was assigned female at birth in 2000. Kelvin experienced all aspects of the Gender Dysphoria diagnostic criteria from age 9. In year 8 Kelvin transitioned socially as a transgender person. Kelvin had not undergone stage 1 treatment, and his experience of female puberty caused him significant distress. He suffered anxiety, depression and self-harm. Stage 2 treatment was necessary for Kelvin's psychological health and overall wellbeing. At age 16 Kelvin's father commenced Family Court proceedings seeking authorisation for stage 2 medical treatment.
Ultimately the Court decided that it is no longer mandatory to apply to the Family Court before commencing treatment in circumstances where:
- Stage 2 treatment of a child for Gender Dysphoria is proposed;
- The child consents to the treatment;
- The treating medical practitioners agree that the child is competent to give that consent; and
- The parents of the child do not object to the treatment.
The decision means that the significant distress, financial costs and delay in medical treatment historically experienced by families having to apply to the Family Court for permission have now been removed.
The decision reflects the evolution of medical knowledge since previous cases. It is now understood that the therapeutic benefits of stage 2 treatment outweigh the risks and consequences involved in the irreversible nature of the treatment. The decision places emphasis on the need for proper medical assessment in determining treatment to be appropriate for the child.
It remains unclear whether the Court will take the same approach if the decision to undergo stage 2 treatment rests with a guardian or relative (rather than a parent). Court authorisation will still be required where a child is under the care of a state government department or where there is a dispute between the child, parents and medical practitioners about the treatment.
Re: Matthew[2018]FamCA161(16 March 2018):
In this case the Family Court decided that young transgender people no longer need to apply to Court to access stage 3 treatment.
The evidence was that the proposed treatment would significantly reduce the psychological pain and distress Matthew felt as a result of the incongruence between the physical appearance of his breasts and his presentation as a male.
The Court held that stage 3 treatment was therapeutic because it would be administered for the purpose of treating a psychiatric condition.
In this case there was no controversy or disagreement about the proposed treatment between medical professionals or between the parents, child and medical professionals. It follows that where controversy does exist, the conflict must be resolved by application to the Family Court before treatment can commence.
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