Informed consent becomes really interesting and really important when you're looking at adolescents, and children, but for sure adolescents in a different way than it does with adults. And so where the field has kind of gone, which I think is a great movement for adults, is to go towards an informed consent. As long as it's actual informed consent, which I think a lot of what happens isn't really informed consent. Because we're not really giving the people the information that they really need. So if you're actually really doing it from consent I think it's a great model for adults. I have some concerns about, and this goes along with that, that we maybe shouldn't be doing everything that we do with adults without adolescents. That I think my worry is that we need to do a much better job with adolescents and parents around informed consent, and that there should be kind of more done with that process, when you're looking at adolescence and parents, then maybe when you're looking at adults. Because adolescence are in a developmental stage where they don't tend to be thinking about any of this stuff. And they don't have to think about any of this stuff until they identify somewhere as trans, and then all of a sudden they're kind of having to do this developmental process that isn't something that they would typically have to do. And so I think trying to, you have to do informed consent in a more broad way and you just have to do it differently than you do it with adults, I think, to really do a good job of it with adolescents. And one of the places that, in adolescent care, that we haven't been very good in terms of informed consent is around issues of fertility and really helping parents and teens understand kind of the implications for fertility. And I think that's especially, again, difficult with adolescents because adolescents aren't in a place where they're thinking about their fertility. It's not part of their developmental, what they need to be doing developmentally. And so you're kind of sticking in these huge topics that are really life important topics into a developmental process that isn't typical for an adolescent. So how do we do that in a way that's well done, is one of the things that we're trying to work on. The other thing is that adolescents, and just the developmental nature of adolescents, is they don't really think in the future. So I had one adolescent I was working with, we were talking about bone health and some of the ways that puberty suppression can influence bone health, and the adolescence said I don't need my bones. All I do is sit around and play video games. And I kind of thought, well, that's a little extreme. But it's an interesting way of thinking about who cares in the future if I'm 60 and I have osteoporosis, which we don't even really know about the long-term impacts of this stuff into adulthood, but you're just not in that developmental place to be thinking about that. And so how do we help parents think about it with them and how do we have those conversations. So at least we've done our due diligence in those areas of brain development, bone health and fertility. We've had adolescents coming to us that are on medical intervention, on puberty suppression, and they have not had a discussion about any of those things that we listed. Like the pediatric endocrinologist just didn't do it. Or if they did, they didn't do it well enough for the kid to have absorbed it.
