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Hormone replacement therapy: informed consent without assessment?
  1. Toni C Saad1,
  2. Bruce Philip Blackshaw2,
  3. Daniel Rodger3
  1. 1 Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
  2. 2 Department of Philosophy, University of Birmingham, Birmingham, UK
  3. 3 Allied Health Sciences, London South Bank University School of Health and Social Care, London, UK
  1. Correspondence to Toni C Saad, University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK ; ToniSaad{at}


Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy (HRT) is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT.

  • informed consent
  • sexuality/gender
  • abortion

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  • Contributors Each of the others has contributed substantially to the planning and writing of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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