Given the increasing prevalence, the perturbation to family life as well as the mind of the child, and the possibility of prolonged therapy, the importance of gender dysphoria now rivals that of anorexia nervosa with its incongruity between bodily reality and mental perception (the body is thin but is imagined to be fat).
Fundamental differences exist, however, between the medical and societal managements of anorexia and gender dysphoria. In anorexia, management seeks to reduce the mindset, not substantiate it. No medical authority would augment weight loss with diet pills and a gastric band. No media would portray anorexia as heroic. No legislature would forbid therapies that did not affirm the delusion. No court would praise the courage of the child in refusing food, and no court would consider being relieved of a protective role. But, with regard to gender dysphoria, these are the kinds of things that are happening.
Decisions of the Family Court of Australia on gender dysphoria.
Most of the fifty-six children went before the court for authorisation to consent to receive cross-sex hormones. In the earliest cases, some sought blockers. Five were authorised for bilateral mastectomy.
In fifteen summaries, including the last one available in 2017, the safety and reversibility of blockers are emphasised. None refers to effects of cross-sex hormones on the structure of the brain.
Of the five authorised to consent to mastectomy, the first was in 2009, involving a sixteen-year-old who had been on blockers for five years and cross-sex hormones for one year. The next was in 2015, a sixteen-year-old on cross-sex hormones for a year. Of those in 2016, one was fifteen and on blockers for nearly two years and cross-sex hormones for eight months; one was seventeen and appears to have had no previous hormonal intervention; and one was fifteen and on blockers for almost one and a half years. The possibility that extended exposure of the brain to blockers and cross-sex hormones might reduce the capacity for informed consent was never discussed.