arrangement with clinicians at remote
sites if required. In practice, very close
collaboration is required between
psychiatrists, endocrinologists and
gynaecologists, with regular case conferencing
and clinical group meetings
to discuss management, establish and
audit process, and review new literature.
Consultation with legal counsel
and clinical ethicists is also required.
Providing treatment to suspend the
development of normal puberty may
present an ethical dilemma for some
physicians. Due to the complexity of
treatment, we have established a
stringent process of assessment and
management within a clinical service
for children with GID, and details can
be found at http://www.rch.org.au/
outpatient/directory/index.cfm?fuseaction=home.full&id=127.
The response of clinicians to children
with gender dysphoria has been
varied, with some specialist practitioners
who are willing to provide
medical care encountering unclear
referral and management pathways.
We support the establishment of specialised,
formal paediatric GID services
within tertiary paediatric centres
elsewhere in Australia, according to
similar protocols and guidelines.
The experience of growing up in a
body which feels alien is difficult and
confusing. Profound GID represents a
mental health crisis in childhood,
with implications for problematic psychosocial
and relationship development
throughout life. Our experience
is consistent with reports from international
centres — that children and
adolescents with GID suffer with a
great burden of morbidity, and are
deserving of optimal medical care.
However, in view of the significance
of hormonal treatment and the still
emerging evidence base, rigorous
assessment and follow-up is essential,
along with the stringent auditing and
publication of outcomes.
Competing