{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T21:40:32Z","timestamp":1758750032424,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2019,6,13]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/medethics-2019-105611","type":"journal-article","created":{"date-parts":[[2019,6,22]],"date-time":"2019-06-22T17:15:15Z","timestamp":1561223715000},"page":"824-825","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Hormone replacement therapy: informed consent without assessment?"],"prefix":"10.1136","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9831-1784","authenticated-orcid":false,"given":"Toni C","family":"Saad","sequence":"first","affiliation":[{"name":"Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9115-582X","authenticated-orcid":false,"given":"Bruce Philip","family":"Blackshaw","sequence":"additional","affiliation":[{"name":"Department of Philosophy, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Rodger","sequence":"additional","affiliation":[{"name":"Allied Health Sciences, London South Bank University School of Health and Social Care, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,22]]},"reference":[{"key":"2025092414271652000_45.12.824.1","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2018-105293"},{"key":"2025092414271652000_45.12.824.2","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2011.700873"},{"key":"2025092414271652000_45.12.824.3","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1080\/14681994.2014.954993","article-title":"Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?","volume":"29","author":"Bouman","year":"2014","journal-title":"Sexual and Relationship Therapy"},{"key":"2025092414271652000_45.12.824.4","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X12469532"},{"key":"2025092414271652000_45.12.824.5","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3109\/09540261.2015.1115753","article-title":"Mental health and gender dysphoria: A review of the literature","volume":"28","author":"Dhejne","year":"2016","journal-title":"Int Rev Psychiatry"},{"key":"2025092414271652000_45.12.824.6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.3109\/09540261.2015.1073143","article-title":"Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature","volume":"28","author":"Marshall","year":"2016","journal-title":"Int Rev Psychiatry"},{"key":"2025092414271652000_45.12.824.7","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S0140-6736(16)00684-X","article-title":"Global health burden and needs of transgender populations: a review","volume":"388","author":"Reisner","year":"2016","journal-title":"The Lancet"},{"key":"2025092414271652000_45.12.824.8","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1001\/journalofethics.2016.18.11.sect1-1611","article-title":"Informed consent in the medical care of transgender and gender-nonconforming patients","volume":"18","author":"Cavanaugh","year":"2016","journal-title":"AMA J Ethics"}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/medethics-2019-105611","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T21:27:25Z","timestamp":1758749245000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/medethics-2019-105611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,22]]},"references-count":8,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12,3]]},"published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1136\/medethics-2019-105611"],"URL":"https:\/\/doi.org\/10.1136\/medethics-2019-105611","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"type":"print","value":"0306-6800"},{"type":"electronic","value":"1473-4257"}],"subject":[],"published":{"date-parts":[[2019,6,22]]}}}