RT Journal Article SR Electronic T1 Reply to ‘Hormone replacement therapy: informed consent without assessment?’ JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP medethics-2019-105628 DO 10.1136/medethics-2019-105628 A1 Florence Ashley YR 2019 UL http://jme.bmj.com/content/early/2019/07/16/medethics-2019-105628.abstract AB In a previous article, I argued that assessment requirements for transgender hormone replacement therapy (HRT) are unethical and dehumanising. A recent response published by the Journal of Medical Ethics criticises this proposal. In this reply, I advance that their response misunderstood core parts of my argument and fails to provide independent support for assessment requirements. Though transition-related care may have similarities with cosmetic surgeries, this does not suffice to establish a need for assessments, and nor do the high rates of depression and anxiety justify assessments, especially given the protective role HRT plays towards mental well-being.