In reply: We thank Clayton and colleagues1 for their letter on our recent Perspective article.2 We certainly agree with the authors that more rigorous longitudinal studies and more high quality evidence are desirable, but this is hardly a novel observation. Indeed, we ourselves have made this point on multiple occasions and have commenced a longitudinal study known as Trans20 to help address this concern.3,4 Notwithstanding this agreement, some of the other comments made by Clayton and colleagues deserve further examination.
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Ken Pang is supported by the Royal Children's Hospital Foundation and the Hugh DT Williamson Foundation, neither of which had any role in the planning, writing or publication of this article.
Ken Pang is a member of the World Professional Association for Transgender Health as well as the Australian Professional Association for Trans Health, and is also a member of the editorial board of the journal, Transgender Health.