This chapter introduces the book by providing some background and context to the medico-legal nexus for treatment of trans youth with gender dysphoria in Australia, England and Wales. The guiding research questions for the book are outlined, followed by the structure of chapters. The chapter descriptions are interwoven with the relevant methods employed to examine the law in the relevant jurisdictions. Lastly, the scope and limitations of the book are noted to guide future researchers in this area.

This chapter presents an overview of the medical literature to outline what is known about gender dysphoria in childhood and adolescence. This chapter begins with a discussion of terminology commonly used in literature on gender diversity, as well as the preferred terms within this book. Second, literature on the medicalisation of gender diversity is reviewed to contextualise the relationship between gender and the medical establishment. Third, the diagnoses that may be given to trans children and adolescents that present to a medical professional for treatment are reviewed alongside critical commentary. Fourth, the research on gender variance in children and adolescents is reviewed broadly. Key themes identified in the literature include: prevalence; determinants of gender diversity; the natural history of gender dysphoria; and co-occurring conditions of trans youth. This area of research has advanced significantly in recent years. However, it is also in constant flux and answers to key questions are unsettled. This review of the medical literature provides context for treatment recommendations for children and adolescents discussed in Chapter 3.

In this chapter, the medical literature on treatment for trans youth is utilised as an evaluative lens through which to consider the soundness of the law in Australia, and in England and Wales. The historic and current legal frameworks are assessed with reference to the state of medical knowledge to identify points in time where the law was and was not congruent with medicine. The medico-legal analysis focuses predominantly on an assessment of congruency of law with medicine across three key themes: (1) the nature and purpose of treatment; (2) the effects of treatment; and (3) the risks and consequences of a wrong decision being made about treatment. While historically, findings in the case law have been incongruent with the medical literature, the current legal framework is significantly more congruent than in the past in Australia. The position in the England and Wales decision analysed is broadly incongruent with respect to current medical knowledge though it is noted to no longer be authoritative.

This chapter examines the Australian law governing consent to medical treatment for trans adolescents. This is contextualised first, by critically examining the general principles in respect of consent to medical treatment by and for young people in Australia. The actors involved in consent processes, young people, their parents and courts, are outlined with respect to the scope and limitations on their power. Notably, this includes discussion of the landmark decision of the High Court in Marion’s Case, alongside further cases that developed and applied the legal principles from that case. Significantly, the chapter presents an account of the key Australian case law relating to the treatment of gender dysphoria in adolescence. It will be shown that, while some legal barriers have been removed by case law, those that remain are troubling. It is argued that the Australian case law in this area is incoherent, inconsistent and ultimately fails to achieve its aims to safeguard the health and wellbeing of trans young people and their right to exercise bodily autonomy.

This chapter concludes the book by charting a path forward for law reform. Suggestions for reform of the significantly more burdensome legal framework in Australia, as opposed to England and Wales, are presented. Throughout this book is a plea for the law to support, rather than impede, trans young people’s gender expression and bodily autonomy.

This chapter presents an overview of the current state of medical knowledge for treatment of children and adolescents with gender dysphoria. The chapter begins with an overview of the literature on how gender dysphoria is treated in childhood and adolescence, respectively. Medical treatment of relevance for pubertal youth is the primary focus. Next, the research on outcomes of medical treatment for trans youth is reviewed. The review is organised by reference to the staged treatment protocol: stage 1 – puberty blockers; stage 2 – gender affirming hormones; and stage 3 – surgery. Both physical and psychosocial effects of treatment are outlined. Lastly, to contrast, research is reviewed to determine what the likely outcomes are for trans youth if they do not receive medical treatment in adolescence. The review of medical knowledge surrounding the treatment of gender dysphoria reveals that there is substantial, and building, consensus around the appropriate treatment to be offered to trans youth in adolescence. It finds that while there may be a limited evidence base regarding long-term treatment outcomes, this is rapidly growing and supportive of treatment prior to adulthood.

This chapter examines the law in England and Wales governing consent to medical treatment for trans children and adolescents. First, the general legal principles governing consent to children’s medical treatment in England and Wales are detailed. In doing so, the various avenues to consent for children’s medical treatment in England and Wales are laid out. Second, it will be seen that, historically, there has been limited guidance from case law on the situation of trans young people; however, this was altered with the landmark 2020 decision of the High Court in Bell v Tavistock and Portman NHS Trust and subsequent appeal. Key changes to the law in respect of trans youth’s ability to seek medical treatment as a result of these judgements are analysed. Finally, the law is synthesised as to what represent the current legal principles applicable to trans youth seeking medical treatment in England in Wales.

In this chapter, comparative analysis is employed to juxtapose the law in Australia with that in England and Wales. What is compared is both the presence or absence of relevant legislation and case law, its conceptual and operational nature and scope and the possible resulting outcomes of any differences. The similarities between the two jurisdictions include the actors involved in consent processes for young people and the aim of this area of law, the best interests of the child. Major points of difference include: the statutory age of medical decision-making; whether treatment for gender dysphoria is considered ‘special’; Gillick competence and concurrent consent powers; and the law regarding disputes and the need for dual parental consent.