Footnotes

• Twitter @briandavidearp, @juliansavulescu

• Contributors LN is the main author of this article, wrote the first draft, revised subsequent drafts based on feedback received from coauthors and prepared and submitted the manuscript for publication. All coauthors (BDE, LG, JS, MT and KCP) commented on the paper and made revisions. All authors contributed substantially to the content and arguments of the paper, and have approved the final version of this response.

• Funding JS was supported by the Wellcome Trust (WT203132/Z/16/Z and WT104848/Z/14/Z). LN is the recipient of an Early Career Researcher Grant awarded by the University of Melbourne (project title: ‘The ethics of ongoing puberty suppression for gender non-binary youth’).

• Competing interests None declared.

• Patient consent for publication Not required.

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

• ↵For an example of such a critique, see Ashley.8

• ↵Wren also highlights the importance of sex hormones for brain maturation, functioning and behavior, raising concerns about the potential cognitive effects of ongoing puberty suppression, and echoes our call for more research in this area.4

• ↵As evidenced by Phoenix’s breast bud development.

• ↵Acknowledging the lack of methodologically rigorous data regarding the impact of puberty suppression on cognitive development.

• ↵This is a key lesson learned from other contexts, such as the surgical assignment of sex in intersex conditions.