Correlates of Medical Decision-Making Capacity for Pubertal Suppression Treatment

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Abstract
Objective: Medical decision-making capacity comprises understanding treatment information, appreciating the context and implications of treatment, and reasoning through risks and benefits before making a clear choice about treatment. The current study examined domains of cognitive, emotional, and executive function as predictors of decision-making capacity for pubertal suppression treatment among transgender and gender diverse (TGD) youth. Methods: A sample of 45 TGD youth [M(SD) age = 11.3 (1.3) years] primarily recruited from a multidisciplinary gender clinic in the Midwestern United States completed the MacArthur Competence Assessment Tool – Treatment (MacCAT-T) and several measures to assess cognitive, emotional, and executive functioning. Regression analyses were conducted to identify cognitive, emotional, and executive functioning predictors of each decision-making capacity domain. Results: At a bivariate level, aspects of cognitive, emotional, and executive functioning were related to each domain of decisional capacity. In regression analyses, higher cognitive functioning (β = 0.77, p < 0.001) predicted a greater ability to appreciate the decision. Higher negative affect predicted a greater ability to appreciate (β = 0.59, p = 0.01) and a lower ability to reason (β = −0.74, p = 0.01) through the decision. No cognitive, emotional, or executive functioning variables were predictive of ability to understand the decision. Conclusions: While cognitive, executive, and emotional functioning were relevant domains to decision-making capacity for pubertal suppression among TGD youth, many of these domains were not strongly predictive of decisional capacity. Cognition and negative affect are relevant correlates to assess and support through the decision-making process. Assessing domains of functioning through behavioral observation, clinical interview, and/or brief screeners may help providers to adapt their approach to counseling TGD youth around pubertal suppression treatment. Implications for Impact Statement: Cognitive, emotional, and executive function were not strongly predictive of transgender and gender diverse (TGD) youth’s capacity to make a decision regarding pubertal suppression treatment, though cognition and negative affect were most relevant. Clinicians supporting TGD youth to make informed medical decisions may benefit from adapting their approach to capitalize on youths’ individual strengths and support or accommodate challenges.
Funding Information
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21 HD087839)

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