17-year-old Autistic son has started taking hormones without our knowledge or consent

[VeryWorriedMother]

Ok, so this isn't really a feminist topic but I need some help. This will be long, sorry.

My 17-year-old son was diagnosed with ASD last year. He is also gifted, and has struggled with fitting in and making friends. He has very black and white thinking, and thinks that his way is the only right way. He has struggled for many years with his executive functioning and emotional intelligence - he has difficulty planning and completing tasks, and regularly loses his temper. It has been the focus of our lives for a long time. After a very long struggle we finally convinced him to agree to therapy, in the hopes that it would help with his ups and downs, and in figuring out what his autism diagnosis means for him.

He has been on antidepressants for a couple of years, and increased the dose last year. A few weeks ago he asked for an appointment with our GP for another dose increase. DH took him to the appointment but stayed in the waiting room to allow him to speak with the doctor privately. DS went back for a follow up two days ago, and that night I received a notification from my pharmacy saying that his prescriptions were ready: Cyproterone Acetate (a testosterone suppressant) and Estradiol. I was absolutely shocked.

This has come out of absolutely nowhere. He refuses to speak to us about it and, being in Canada, doctors are allowed to prescribe hormones to children if they feel that they fully understand it, without parental consent.

There is no way my son understands the long-term ramifications of this. He has Autism, ffs, and hyperfixation, and he can't even manage to plan a school project, never mind consider the fact that he will be growing irreversible breasts!

He has never, ever talked about wanting to be a girl. Yes, he feels uncomfortable in his body, but, again, he has autism and he's 17! What 17-year-old DOESN'T feel uncomfortable in their body?! I am worried that he is just jumping on the trans bandwagon here, just because he feels different due to his autism. There is a very worrying correlation between Autistic teens and gender dysphoria.

I am so, so angry that our doctor, whom I trusted, has allowed him to do this so quickly. No thinking time, nothing.

DS has heard me voice appreciation for JK Rowling fighting for women's rights, and is under the impression that we are transphobic, so he has completely shut down. I am prepared to support him, but I very strongly disagree with giving children hormones, and so quickly. I don't know what to do.

Thank you if you have read this far.

Where has this idea come from? I would probably be having a look at his internet history and seeing who he is in contact with. I think before you tackle the issue you need to understand where the initial idea or interest in transitioning came from.

Tte advice to swap medication is insane, incredibly dangerous and potentially criminal.

And a kid who is independent enough to go to the GP and get meds themselves will obviously notice.

Agree with this - get your son off the internet and out into the real world, if at all possible.

So, I have a 21 y/o Ds (no gender confusion) who is on meds for heart issues. Needs help ordering prescriptions, organising & reminder to take due to dx ASD & under ADHD. Local NHS extremely resistant to parental help. I also have an 18 y/o ASD Dd who is certain she is really a boy & very keen to go down meds/surgery route. GP very keen to support this. College (she withdrew as overwhelmed) very keen to support (a tutor actually told her 'not to worry about incontinence risks as you'll be who you were meant to be - to a kid who is semiverbal & carries a plushie around)
OP, I don't mean to 'jump on' your thread but I'm keen to also read the links. I do hope you gind a way of helping your son see that this isn't 'The Answer' to feeling different.

Remember that there are men who use the internet to look for 'eggs to crack'.

a tutor actually told her 'not to worry about incontinence risks as you'll be who you were meant to be'

JHC.

I'm so sorry. That's wicked. And the absolute naivety of someone who has no idea at all of what it's like to live with incontinence. No amount of 'being yourself' is going to wipe out the hell of it. Wicked. These ruddy people with massive egos and more self righteousness than brain cells.

So, DS picked up the prescription himself. We have to be extremely cautious with how we behave with him right now because he has form for making very rash decisions. Once I turned off the modem and he was so angry he left the house in the middle of the night. This is not a child who should be responsible for irreversible actions on his body.

Thank you for all of the support. It is terrifying what is happening to our children right now with all this. I never ever thought I'd be dealing with this.

I'm sorry to hear this.

Yes, it's absolutely infuriating. Our children are being failed.

But keep going! One step at a time.

💐

I have a child with AuDHD.

we have been through similar.

I would advise digging in for the long run.

my dd reacts extremely emotionally to any attempt to logic or reason with her about any of this and we no longer discuss it.

extremely emotionally.

this is unlikely to be something you can reason with them about or present evidence about.

personally I just focused on keeping her alive (anxiety and self harm were also major issues) and everything else was secondary.

can report she is still alive.

I think all you can do is look to support from people who have gone through this scenario. The laws of your country have to be abided to, I think a fair few people are going to miss you are in Canada.

I have only ever known one person whose child is trans, also a lad with ASD but he was a fair bit older when he started hormones at about 20. His Mothers only worry was that he would not be able to Father children but apparently he was just going to adopt. She was not gender critical.

@VeryWorriedMother there's a Substack here you might find useful.

https://maiapoet.substack.com/p/my-kid-came-out-as-trans-now-what?utm_source=post-email-title&publication_id=2848083&post_id=166127062&utm_campaign=email-post-title&isFreemail=true&r=l6otf&triedRedirect=true

The situation is different depending on which Province you are in. I know a bit about the law in Ontario; if you are a different province then the details are quite different.

If person is capable they make their own healthcare decisions. That is a clinical judgement made by the Health Care Provider offering the treatment. You can be capable for the purposes of some decisions and not others. There are no upper or lower age limits or requirements. Capable means "able to understand the information that is relevant to making a decision about the treatment, admission, confining or personal assistance service, as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision." Note only the "ability to" is required; whether the patient actually understands or not, is not part of the test.

If a patient is not capable then there is a descending list of alternative decision makers. Starting with a court-appointed Guardian of the Person, then the holder of a Power of Attorney for Personal Care, then someone appointed by the Consent and Capacity Board, then a spouse or common-law partner, then parents and children, siblings, other relatives, and finally the Public Guardian and Trustee.

If you think a Health Care Provider's finding that someone is capable is wrong and the person is actually incapable, you can make an application to the Consent and Capacity Board:
https://www.ccboard.on.ca/scripts/english/index.asp

With regard to what a Health Care Provider can share with you: only what the (capable) patient permits them to. But a responsible HCP should encourage a patient to allow them to share some of the details, to enable that person to be supported, even if not the full details.

If you are in Ontario, you are welcome to DM me for some more information. If you're in another province the details will be different and I can't be of much help.

I was thinking about this today at work. My suggestion about swapping meds for vitamins last night, was not the best and maybe the unfortunate product of being tired/having a tough time recently with our DS. But now with the benefit of some sleep, maybe a better alternative would be to say that if he wants you to help with appointments and prescriptions going forward, then you need to sit down and talk through the medical evidence together? Can he draw something up to show he has all the facts and has done a proper grown up risk assessment? Like "BRAN" Benefits Risks Alternatives Nothing. Because you wouldn't be doing your job as a mum if you didn't check he was fully informed and keeping healthy into the future. Ask for a copy and then maybe to build in talking points into the future, agree a monthly monitoring of height, weight, BP pulse etc and some numerical scales on mood etc. which he could decide on. Good luck

I have just PM'd you.

That "vitamin" thing is an incredibly dangerous thing to do to anyone you care about because there are plenty of prescription drugs and over the counter medicines that should not be mixed with anti depressants (not to mention alcohol) plus if he then knowingly took anti depressants on top of the vitamins they could overdose.

Please don't ever do this to anyone.

Lastly I don't know what the situation is in Canada but have you considered discussing Living Power of Attorney with him when he turns 18. I've been discussing this with my DS because he can hardly make his own breakfast so has no chance of running his own affairs in the short term. We have of course been talking about doing this in partnership rather than me taking full control because he can't - I think that is called Deputyship in the UK.

In Ontario a Power of Attorney for Personal Care is only taken into account if the person is deemed incapable. Since the OP already occupies the highest (occupied) rung of the ladder of alternative decision makers, it would have no effect. If her son is incapable she (and the father, together) automatically become the decision makers for healthcare decisions. At that time they "stand in the shoes" of the patient and are entitled jointly to all medical information relevant to the decision. Both parents must agree with any healthcare decisions; if there is a dispute and agreement cannot be reached the healthcare provider must apply to the Public Guardian and Trustee to make the decision. Obviously healthcare providers bend over backwards to get the parents to agree before taking such a step.

If the child is capable then he can appoint any other person (at least 16 years old and must consent to be appointed) as his Attorney for Personal Care. That would remove any parental authority over his healthcare if he were to become incapable at a later time as the Attorney for Personal Care is on a higher rung of alternative decision makers than any relatives. Any interested party (including parents or other relatives) can appeal to the Consent and Capacity Board if they believe the Attorney is not acting in the best interests of the grantor. The CCB can appoint someone (including a parent) as a substitute decision maker, which would then overrule the holder of the PoA.

However, this is all irrelevant if the person concerned is deemed capable. In that case they make their own healthcare decisions and cannot be overruled just because someone else thinks they making a bad choice. Even if the CCB (or a Judge) thinks it's a wrong or bad choice. In Ontario people are free to make bad choices.

As long as someone is "capable of understanding the reasonably foreseeable consequences" of their choice, nobody can overrule them.

Sorry - I made a mistake. A person appointed by the CCB doesn't overrule the holder of a POA - the holder of the POA is on a higher rung. But the CCB can order the Attorney for Personal care to make a different decision if they judge them not to be acting in the best interests of the grantor. Minor point, but it's best to be correct.

On the subject of consent, this information may be helpful:

https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians#informed%20consent

Another approach is to ask for an appointment with the doctor and explain the background to your concerns that your son is not capable of informed consent. You could put some weight on the doctor's responsibility to make sure the patient is properly informed of the consequences of treatment for the consent to be valid.

The doctor can't discuss the treatment but it's fine for you to explain your concerns.

An appeal to the CCB is really a nuclear option: you are standing in front of a tribunal and saying in front of them that you want their rights to healthcare autonomy to be stripped from them. It could be quite a hand grenade in family relationships.

What are his plans for when he leaves school? If you make your stance clear - that you love him but humans can’t change sex and you think this is a mistake - can you co-exist with him as he grows breasts and cosplays femininity?

Bayswater parent group mentioned above is good but it is UK-based. If you are in Canada, try Our Duty. Genspect is also very good.

Genspect Family and Friends survey has a page summarising side effects - see Part 3a here: GenspectFamilyFriendsSurveyQuestions_EN.pdf

You should be able to contact your GP with your concerns about the possible risk of misdiagnosis, medical negligence and medical harm. You can ask if the prescription was based on self-reported observations and self-diagnosis only or a comprehensive, holistic assessment by a multidisciplinary team using multiple sources of information (i.e. school, family etc). In addition, was family medical history well understood and taken into account, particularly any history of conditions such as diabetes, thrombosis, cardiovascular problems?

You could also ask whether Cass review recommendations were considered. Hilary Cass review advises that patients under 25 are still at a vulnerable stage in their journey due to their psychological, social and physical aspects of adolescence not complete. These young people should not be rushed into changing gender, but should receive unhurried, holistic, therapeutic support. If they're not following Cass report - why not?

In general, you can try to approach it in the same way as you would approach any other case of suspected medical negligence or medical malpractice - with caution, asking for an explanation / second opinion, taking time to understand. In conversations with your son, you could say that for something that has such serious lifelong implications, it is more important to do it right, than to do it quickly. For you to support him, you have to know that the diagnosis is accurate and the treatment is effective, but at the moment you have doubts because the diagnosis is inconsistent with your own observations and everything you've known about him for so many years.

Best wishes.

Thank you from me also for that excellent post. Good to see such a positive practical approach. And those are things parents could say to many young people and many doctors.

I didn't realise the Genspect questionnaire would have so much medical research infomation attached (in the informed consent section) Much of it not good news. 😢

Does anyone have the thread (or the article it referenced) about the Scottish family who managed to successfully challenge their older child’s medical provider about hormones? The family put together a huge dossier of the familial medical history (which of course the child had not been asked for) all of which contra-indicated medical transition.

If you believe he doesn’t have capacity to understand, is there a mechanism in Canada to allow you to be responsible for his healthcare? Here it would be the court of protection granting you deputyship. Here at least doctors would have declare that didn’t have capacity to understand medical decisions, which is what you are expressing op. First step is to speak to your gp/family doctor who may refuse to discuss your child but should listen to your concerns from your perspective, you can also stress that they are under 18. The doctor will also be able to direct you to resources to assist with the consent side of things in your jurisdiction.

Found it! @VeryWorriedMother, this thread may have some resources for you. It’s a Scottish case, so some things won’t be directly relevant, but I think there are things that might be helpful. Also I think the mum in question participated in the thread, so she might also have useful advice.

www.mumsnet.com/talk/womens_rights/5355146-gender-clinic-backs-off-after-family-successfully-challenges-direct-contact-with-adult-daughter