Children’s hospital gender clinics offering contentious hormone drugs for troubled teenagers who declare themselves “born in the wrong body” face an audit and review of their treatment approach.
The Australian Health Ministers’ Advisory Council, which brings together the top health officials across the nation and today discusses the gender clinic controversy for the first time, has requested states and territories to carry out the audit and review, and report back by July 17.
Federal Health Minister Greg Hunt asked the council to look at “strong and balanced counselling and safeguards” for under-18s seeking treatment, the over-representation of autistic teenagers in gender clinics, and a new more cautious approach to hormonal treatment of gender non-conforming minors adopted in Britain.
There is global concern about a puzzling surge in teenagers, chiefly girls, identifying as trans and seeking medical treatment. Many have multiple issues including mental illness, awkward same-sex attraction, autism, and family trauma. Social contagion of trans identity via online platforms and peer groups is suspected by some clinicians.
On Thursday more than 70 health and medical practitioners signed a letter to Mr Hunt calling for urgent inquiry into psychotherapy and other cautious alternatives to the hormonal and surgical treatments of the “gender affirming” approach promoted by the clinics.
The letter warns health ministers they are “medico-legally vulnerable” under the High Court’s strict 1992 Rogers v Whitaker ruling on negligence because the gender affirming approach is “experimental” and known side-effects of these treatments have been “withheld”. Side-effects include infertility, reduced sexual pleasure, low bone density, metabolic syndrome and cardiovascular issues.
On Tuesday Mr Hunt’s spokesman said the Federal Government would “continue to ensure these matters are expressly and clearly addressed by the state and territory bodies that have constitutional, administrative and clinical responsibility and control”.
One of Australia’s most distinguished medical scientists T.J “Jack” Martin, an emeritus professor of medicine at the University of Melbourne and still an active researcher at the St Vincent’s Institute, was among the signatories.
He said the gender affirming treatment regime involving puberty blocker drugs, opposite-sex hormones and surgery was “really an uncontrolled experiment”, and there was no evidence it was superior to non-invasive alternatives.
“In order to justify (the medical treatment) proposed you need to have fairly substantial evidence, and there’s certainly not substantial evidence supporting the affirmation approach,” he told The Australian.
The largest gender clinic, at the Royal Children’s Hospital in Melbourne, said in an open letter last year its treatment for gender dysphoria — distress over feeling “born in the wrong body” — was based on “the best available medical evidence” and followed “strict clinical governance standards”. RCH refuses to engage with critics, saying it maintains “a dignified silence”.
Affirmative model treatments are promoted as “lifesaving” but even some advocates admit the evidence is short-term, low quality and patchy.
On Monday, a law reform review of Tasmania’s new system allowing trans people to change their birth sex recommended that the right of children under-16 to consent to trans surgery without mandatory counselling should be enshrined in statute. Under-18 trans mastectomy is thought to be rare in Australia but there is no public data.
By May 31, the birth sex of 13 children under 16 had been changed in Tasmania, according to the state Department of Justice. The rationale for the new system, which also applies in Victoria and allows birth sex to be changed once a year, is that the previous requirement for sex-reassignment was inhumane.
From today #trans Victorians can now apply for a birth certificate that reflects their true gender.
No medical treatment
A simple process that allows trans & non-binary adults and young people the dignity and respect of recognition as who they are.
It’s a good day! pic.twitter.com/CX8X4Oe1SB
— Anna Brown OAM (@AnnaEquality) April 30, 2020
Citing human rights, the Tasmanian Law Reform Institute’s new report says children under 16 should be entitled to go ahead with trans surgery if a medical practitioner is satisfied they are competent to consent, and rejects compulsory pre-operative counselling as “an unnecessary imposition”.
The affirmation model regards children as young as three years of age as “expert” in their “gender identity” regardless of whether or not it is at odds with their biological sex, frames medical treatment as a human right, and resists some safeguards as “medical gatekeeping”.
The Australian Psychological Society’s submission to the law reform institute argued against mandatory pre-operative counselling for under-16s, and said a proposed requirement for sign-off by two independent medical practitioners might be too restrictive because of a lack of specialists and a “bottleneck” in the supply of medical services for trans youth.
The peak LGBTQ organisation Equality Australia, which like the Australian Human Rights Commission campaigns for self-identified trans status, also supported legislative backing for under-16 access to trans surgery, pointing out parents sometimes would not go along with it because they rejected their child’s “gender identity”.
An investigation by the BBC’s flagship Newsnight program this month revealed clinicians at the government-run Tavistock “gender affirming” youth clinic in London had told an internal inquiry they were concerned the medical treatments might be doing lifelong harm.
“Maybe we are medicating gay kids, maybe we are medicating kids with autism … and if we are, we’re doing bad things to these vulnerable kids,” one staffer at the GIDS clinic said.
Newsnight reported: “As well as seeing young people struggling with their sexuality, staff say some parents appeared to prefer their children to be transgender and straight, rather than gay.
“In one example, a GIDS clinician describes a young person who had come out as a lesbian and faced homophobic bullying, ‘within the family and quite openly in school’.
“Suddenly the young person changed their mind and they started identifying as trans.”
Lesbians are prominent among the emerging group of young adult “detransitioners”, who regret irreversible hormone treatment and mastectomy, and say trans identity was a mistake.
The Australian put questions about the risks faced by potentially gay or lesbian children in gender clinics to Equality Australia, the human rights commission and RCH clinic director Michelle Telfer as president of the gender clinicians’ and trans lobby group AusPATH.
EA did not reply, and the commission refused to comment. RCH also did not answer a request for comment, and there was no response from Dr Telfer.
The UK-based LGB Alliance, which says establishment LGBT groups have ignored the conflict of rights set up by self-declared trans identity, said it opposed “all surgery and medicalisation of kids suffering from gender dysphoria” on the grounds that minors could not give informed consent.
“It has been shown that young people sometimes misidentify as ‘trans’ for reasons of internalised homophobia and other factors,” said alliance co-founder Bev Jackson.
“This applies especially to girls, who often realise later that they are lesbian.”
Justine Kreher, from the US-based LGBT group Gender Health Query, said: “There are now too many stories of female teenagers meeting full (diagnostic) criteria for gender dysphoria, even for a few years, and then completely outgrowing it, for LGBT organizations like Equality Australia to pretend this is not a serious risk to lesbian and bisexual teens.”
“GHQ has sent Equality Australia, and most LGBT organisations in English-speaking countries, examples of these stories and transition regret among mostly lesbian and bisexual women.”
A new book by American journalist Abigail Shrier — Irreversible Damage: The Transgender Craze Seducing Our Daughters — argues “many of the girls now being cornered into a trans identity might, in an earlier era, have come out as gay”.
She quotes gay writer Julia D. Robertson: “You’ve got a situation where young lesbians are being pressured if they don’t give into this new idea of what it is to be a lesbian”.
Shrier: “That ‘new idea’ is that lesbians do not exist: girls with more masculine presentations are ‘really’ boys. Some adolescents today do identify as lesbian, but it’s hard to miss that this identity has considerably less cachet than being trans.
“Riley (a 16-year-old who began identifying as a boy at 13) told me that fifteen students in her British all-girls’ school of five hundred have come out as transgender. ‘How many girls are lesbian?’ I asked her. She thought about it for a moment, and I watched her be surprised by the answer: ‘None,’ she said.”
The book from Regnery Publishing is available on June 30. Amazon has reportedly suspended the advertising campaign for the book on the grounds that content “infers or claims to diagnose, treat, or question sexual orientation”.
Unbelievable.@AbigailShrier 's book, Irreversible Damage, is getting blocked by Amazon. I hope @WSJ will pay attention. Nobody understands the sort of censorship we are living under. What we don't know will hurt us. https://t.co/hr8fSDekDk
— EZ (@ZaneEmma) June 21, 2020
Almost 20,000 people have signed an Australian teenager’s change.org petition asking Mr Hunt for Medicare funding of “top” and “bottom” trans surgery — mastectomy and genital reconstruction — with the line “Feeling like yourself shouldn’t cost an arm and a leg”.
Comments by signatories include “Everyone deserves a chance to be whoever they want to be”, “Trans lives matter! Equal healthcare for all Australians, it is life or death for some trans people and affordability shouldn’t be a factor” and “Proud trans mum of a teenager with Asperger’s. I want my daughter to be able to medically transition when she wants to rather than when I can afford to.”