Ethical Considerations of GnRHa Treatment and Consent Process

Pubertal suppression for transgender youth presents multiple ethically complex issues. In this chapter, we discuss the roles of beneficence, nonmaleficence, autonomy, and informed consent and assent in pubertal suppression of transgender youth. The unknown long-term impact of gonadotropin-releasing hormone (GnRH) agonists makes providing fully informed consent and assent challenging and undermines the meaningful exercise of patient and/or family autonomy. The uncertainty also limits medical professionals’ ability to balance beneficence and nonmaleficence in counseling patients and families. Despite the limited data about the positive psychological impact of GnRH agonists alone, we endorse the use of GnRH agonists as a vital component of the protocol for treatment of gender dysphoria. Additionally, we call for more research on the long-term effects of GnRH agonists as well as gender-affirming hormones. Only such evidence will permit medical professionals to act in a beneficent manner and enable patients and families to adequately exercise autonomous decision-making.