WHAT IS THE INFORMED CONSENT MODEL?
The informed consent model is a specific approach to gender care in which an adult who understands the risks, benefits, and alternatives of gender-affirming hormones can begin them after a consent conversation with a provider, without a separate mental-health assessment or a referral letter. One point matters most and comes first: this model describes adult care.
Care for young people works differently, involving assessment, a care team, and, in nearly all cases, parental consent. This page explains what the model is, why it exists, and how care for minors differs from it.
The phrase is easy to misunderstand, partly because "informed consent" also names a general principle that applies to all medical care. Separating the general principle from this specific model, and being clear about whom each applies to, is the key to understanding the term.
Terminology note: "Informed consent" refers broadly to a person understanding and agreeing to their care. "The informed consent model" refers to one particular way of delivering adult hormone care. This page keeps the two distinct.
CONTENT NOTE
This is general information, not personal medical advice. Whether this medication is appropriate for a particular young person is a decision for that young person, their family, and their qualified healthcare providers, and in nearly all cases minors cannot receive it without parental consent. If you are in immediate danger, call 911; for support any time, call or text 988.
KEY TAKEAWAYS
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It's an adult care model. The informed consent model describes how some adults access gender-affirming hormones.
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It streamlines adult access. Under this model, an adult can start hormones after a consent conversation, without a separate mental-health assessment or referral letter.
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Youth care is different. Care for minors involves assessment, a multidisciplinary team, and shared decision-making with families.
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Minors need parental consent. In nearly all cases, a young person cannot receive hormones without parental or guardian consent.
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Informed consent still matters for youth. Understanding and agreeing to care is part of good youth care too, as one step within a fuller process.
WHAT THE INFORMED CONSENT MODEL IS
The informed consent model is a specific approach, used in adult care, in which a person can begin gender-affirming hormones after a consent process focused on the risks and benefits, without first undergoing a separate mental-health assessment or obtaining a referral letter.
As described by researchers in PLOS ONE, the informed consent model does not require an assessment of gender identity or gender dysphoria before starting gender-affirming hormones.
The idea is that a transgender or gender-diverse person who understands the risks and benefits can begin treatment without a formal diagnosis or gender assessment.
The same authors note the model emerged as an alternative approach intended to move away from treating being transgender as a disorder and to reduce barriers to care.
As they and others emphasize, this model concerns adult care-seekers.
HOW CARE FOR YOUNG PEOPLE IS DIFFERENT
Care for minors does not follow the adult informed consent model; it involves assessment, a care team, and parental consent. Research describing youth care explains that it typically relies on a multi-step informed consent process and shared decision-making involving young people and their families, rather than a single consent conversation. The contrast is set out below.
Informed consent model (adult care):
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Applies to: Adults over 18
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Before hormones: A consent conversation about risks and benefits; no separate mental-health assessment required
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Who is involved in the deciding: The adult
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Consent: The adult's own informed consent
Care for minors:
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Applies to: Those under 18
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Before hormones: A multi-step assessment, often including a mental-health provider
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Who is involved in the deciding: The young person and their family, together with the care team
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Consent: The young person's agreement plus parental or guardian consent
Sources: PLOS ONE (2023); BMC Medical Ethics (2024); Endocrine Society.
For minors, the Endocrine Society describes hormones being considered only after a multidisciplinary team confirms that gender dysphoria has persisted and that the young person has the capacity to give informed consent, and in nearly all cases parental consent is also required.
For how that assessment actually works, see how trans teens are assessed for care, and for the sequence of steps, the steps of medical transition.
INFORMED CONSENT AS A GENERAL PRINCIPLE
In all of medicine, informed consent means a person understands the risks, benefits, and alternatives of a treatment and voluntarily agrees to it. This general principle applies across health care, including care for young people, where it takes the form of a young person understanding and agreeing to their care alongside their family.
Informed consent in this broad sense is a feature of good care generally, and it is separate from the specific delivery model described across this page.
DECISIONAL CAPACITY
Decisional capacity is a person's ability to understand a treatment's risks, benefits, and alternatives and to make a considered decision, and for young people it is assessed individually as part of care.
The concept describes whether someone can understand what is proposed and arrive at a decision consistent with their own values.
In youth care, capacity is one of the things a care team considers, and the Endocrine Society notes that most adolescents reach the capacity to give informed consent by about age 16.
Even where a young person has that capacity, hormones for a minor still involve parental consent and the fuller assessment process, which is what distinguishes youth care from the adult informed consent model.
WHY THE DISTINCTION MATTERS
Understanding that the informed consent model is an adult model prevents a common misconception: the idea that minors receive hormones simply on request. That is not how youth care works.
For young people, care is staged, assessed, and shared with families, and medical steps for minors require parental consent. The informed consent model is a real and defined approach, but it belongs to the discussion of adult care.
For the overall picture of how young people's care works, see how gender-affirming care works and what gender-affirming care is.