All treatment decisions involve the tacit decision to treat or to withhold treatment. Although often not expressed, the “not to treat” side of the analysis of risks versus benefits is quite important and should be explored in patients with gender identity dysphoria (GID) and its variants. The availability of somatic treatments as accepted interventions for the overall management of GID raises a number of bioethical issues. The medical literature rarely is as rife with affect as when this issue is discussed by those who oppose the application of surgical treatments as part of the treatment plan for gender transmutation.
