Paper short abstract:

In 2017 informed consent was codified as a legitimate protocol for hormone commencement for Victorian trans patients. Examining trans patient and clinician experiences in this era, I ask what ‘consent’ means among historically coercive medical systems, used to constrain patient gender.

Paper long abstract:

Unprecedented visibility of ‘trans’ during the 2010s was paralleled by medical treatment and public policy attempts to reconcile ideas of ‘trans’ with ideas of ‘patient.’ When I sought hormones in Victoria in late 2017 at the age of 20, I had contradictory experiences with practitioners: paternalistic, condescending, respectful and deferential. At the time, I was not aware of the seismic impact of ‘informed consent’ within trans medicine. ‘Informed consent' is the ethical principle that a patient can decide to undergo a medical treatment/s, provided the patient has sufficient information regarding the benefits and risks of treatment, and adequate capacity over mental faculties in considering treatment.

Since the 1960s trans healthcare has involved compulsory psychiatric or psychological assessment prior to treatments such as hormones. Abnormal experiences of gender are construed as fundamentally pathological, insensible, and irrational, thus, in need of curtailment by medicine. In 2017 ‘informed consent’ was explicitly codified as a protocol for the initiation of cross-sex hormones for trans people. What are trans experiences of navigating, negotiating, and enacting informed consent? To address this question, I re-examined my own experiences in the clinic, compiled a history of trans health, and interviewed eight trans patients and clinicians about their experiences during the late 2010s.

In its totality, this article finds trans young people embrace uncertain and elastic visions of selfhood, contrary to medicine’s preferential treatment of the (imagined) rational, articulate, and coherent patient. Moreover, I suggest that informed consent is an essential but contradictory way of conceptualizing trans patients.