> Concerns about making irreversible changes to children’s bodies, and the impossibility of gaining their informed consent for this, have been at the heart of controversy over transgender medicine. In America 23 states have now restricted or banned such care for minors, even though almost all medical associations in America support it—an issue the Supreme Court has been asked to rule on. Much less focus has been on whether adult patients with psychiatric disorders can give informed consent for such procedures. On that matter the files are especially revealing.
> In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (DID), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view DID primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling.