The Fiction of Prior Knowledge: Rethinking Informed Consent in Adolescent Gender-Affirming Medical Care

Current debates on adolescent gender-affirming care often revolve around questions of decision-making capacity and informed consent. Rather than asking whether adolescents are capable of providing informed consent, this article takes a different starting point by examining the assumptions embedded in the medico-legal model of informed consent itself and how these play out in clinical practice. Drawing on qualitative interviews with transgender youth and clinicians in the Netherlands, as well as observations of multidisciplinary team meetings, we analyze the tensions that arise concerning informed consent and the clinical realities of adolescent gender-affirming care. We show that informed consent becomes entangled with diagnostic assessment, treatment indication, and the evaluation of readiness, resulting in a form of normative overburdening that exceeds its conventional medico-legal function. We argue that this overburdening reflects a deeper misalignment between the medico-legal model of informed consent and the processual character of gender becoming. We conceptualize this misalignment along three interrelated dimensions: ontological, epistemic, and temporal. Together, these reveal how informed consent comes to depend on forms of subjectivity, knowledge, and temporal certainty that cannot be fully established in the context of this care practice. Instead of treating this as a problem of adolescents’ decision-making capacity or of gender-affirming care itself, we call for rethinking informed consent under conditions in which subjectivity, knowledge, and futures remain inherently in the making.