Assessing the decisional capacity and readiness of trans adolescents for gender-affirming hormones: a survey of Australian clinical practices

Background Clinicians who provide gender-affirming care for trans adolescents assess whether the young person is ready and capable of deciding about starting gender affirming hormones and other medical treatments. To date, there have been no comprehensive formal surveys of these clinical practices.Objectives This study aims to: i) clarify the processes, tools, and criteria Australian clinicians use when assessing the decisional capacity and readiness of trans adolescents seeking gender-affirming hormones, and ii) identify supports that may help clinicians with these assessments.Methods Australian clinicians who, in the preceding year, had conducted assessments for trans adolescents seeking hormones were invited to fill out an online survey covering: (i) clinical experience and scope of work, (ii) assessment processes, (iii) collaboration and support systems, (iv) tools and materials, and (v) important elements of decisional capacity and readiness for hormones.Results 41 clinicians responded to the survey. Overall, clinicians reported that they conduct thorough, multi-session assessments of readiness and decisional capacity for hormones which consider the young person and their family’s individual circumstances. Factors considered include psychosocial factors, parental support, and mental and physical health needs. 45% of clinicians used an age-agnostic individualized developmental approach in line with clinical guidelines. Some clinicians limited access to hormones to adolescents aged 16 and above for medicolegal reasons. About half of clinicians expressed a desire for more collaboration, such as secondary consultations and peer discussion. Half of clinicians also wished for better tools and materials, including information resources and decision aids for young people, as well as standardized, evidence-based tools and report templates for assessing decisional capacity.Conclusions Current practices in conducting assessments of trans adolescents seeking hormones are comprehensive and well-considered. Nonetheless, clinicians could be better supported in these assessments by facilitating access to clinical collaboration and developing relevant tools and materials to aid both the young person and clinician.