Transgender male teens may want to physically change their appearance more in line with how they feel. Being born female but identifying as male can be incredibly difficult. It is a time where they need their parent’s support and the support of their medical practitioner to make good decisions.
So how do you help your teenager determine if gender affirming surgery is right for them if they are under 18?
Deciding whether to undergo ‘top’ surgery
Making the decision to support your teenager having top surgery to affirm their gender is a huge decision. It will affect the rest of their life. Surgery is permanent, so you want to make sure it is really what your child needs and wants.
For teenage gender transition, the surgical requirements for under 18s include:
- Usually being older that than 16 for top surgery, with consideration given if younger
- At least a 12 month history of diagnosed gender incongruence.
- Be physically and mentally healthy, or if there are issues they should be managed well.
- Having the ability to make a decision based on all the facts.
Some specialist plastic surgeons will complete surgery on teens under 16 years old in special circumstances. For example, where there is no dispute between the teen, their doctors and parents about whether the teenager:
- Has been diagnosed with gender dysphoria by an appropriately qualified psychiatrist or psychologist, and meet the WPATH 7 criteria, and
- Has Gillick competence, and
- Needs the procedure as part of their treatment, and delay is deemed to be of unacceptable risk to their health.
If there is a dispute of any kind, then it is mandatory to apply to the Family Court of Australia for a judgement before surgery can take place.
Identifying gender dysphoria
Your teen may have gender dysphoria if he:
- Tells you he is not sure about his gender or does not identify as a female.
- Wants you to refer to him as him, they or other non-female terms, and changes their name to a male one.
- Starts dressing in a more male manner.
- Expresses distress at the development and appearance of breasts, and may start hiding their chests, with binding, taping or loose clothing.
- Asks you about changing their physical characteristics such as taking medication to become more male or wanting surgery to remove their breasts.
- Is anxious in social situations, particularly with being “mis-gendered”.
- Becomes physically and socially less active, such as not wanting to join in activities that are gender specific, or activities where their body may be more exposed, such as swimming.
- Starts physically harming himself.
- Does not want to go to school or wants to change the type of school uniform he wants to wear.
- Starts feeling hopeless about the future in regard to his body or experiences discrimination or bullying because of his gender or body.
What is Gillick competence?
Gillick competence is important where a teenager under the age of 18 wants to have top surgery to physically alter his appearance. There is no hard and fast rule about who has Gillick competence, the assessment is case by case.
Normally children only acquire the ability to consent to medical procedures once they reach 18. But when a teen has Gillick competence, it allows them to withhold consent or consent to a medical procedure without the consent of their parents.
So what does this mean?
Where a child has the intelligence to understand the situation, Gillick competence allows the child to make a medical decision on their own behalf despite their parents’ decisions. This protects children from parents making decisions that are irreversible so it gives the child the power to make the decision about medical procedures and treatment.
In Australia, children under 18 (and 16 in South Australia) can consent to medical procedures if their medical practitioners consider them competent. If they do not believe the child is competent, then the parents usually need to give consent. But there are some procedures where the doctor’s assessment of a child’s competence is not enough and a court has to decide.
Assessing Gillick competence
Gillick competency is usually determined by the child’s treating GP, psychiatrist or psychologist. Assessing a child’s competence takes into account a number of factors. These can be their age, maturity, education, how independent they are, their intelligence and ability to express what they want.
And, by understanding and intelligence, this means whether the child has an in depth understanding of the treatment, what it means, what is involved and if there are alternatives.
So if a teen has Gillick competence, they can consent to top surgery. There is no need to apply to the court if there is no dispute over the teen’s competence to make a decision. But if their competence is under dispute, or their doctors or parents disagree, or there is no consent from the parent or a doctor, then a court will make the decision.
At Pure Aesthetics, our experienced specialist plastic surgeons can give you all the information your need about top surgery for your male teenager. Your initial consultation will take around 45 minutes. Dr Steve Merten will answer all your questions so make sure you write them down so you do not forget to ask anything. He will also spend time discussing your desired outcome, go through any potential complications to the surgery and the costs.
Contact us today to book an initial consultation for your teenager.