Cass Down Under

Centre-right politics in Australia is alert to the message of paediatrician Hilary Cass, who is about to make a virtual visit to the country

Photo by Joey Csunyo on Unsplash

Members of the centre-right Liberal Party in Australia’s most populous state have endorsed a motion urging a ban on medicalised gender change for minors.

The motion, passed at Saturday’s state council meeting of the party’s New South Wales (NSW) division, calls on “the federal and state governments to ban chemical (drug) and surgical gender dysphoria treatment for minors due to the inability of a child to provide informed consent to these types of procedures.”

The motion is not binding on the parliamentary Liberal Party, which is in opposition, but the overwhelming support shown by members and delegates on Saturday sends a signal to the leadership ahead of a vote on legislation that would allow minors easier access to puberty blockers and cross-sex hormones.

The NSW Equality Legislation Amendment (LGBTIQA+) Bill 2023, a private Bill introduced by independent member Alex Greenwich, would allow gender-distressed minors aged 16-17 to authorise their own irreversible hormone treatment, with risks including sterilisation and sexual dysfunction. The Bill would also permit doctors in some circumstances to give children younger than 16 puberty blockers without the knowledge or consent of parents¹.

Under centre-left Labor premier Chris Minns, the state of NSW continues the expansion in supply of puberty blockers and cross-sex hormones begun by the previous Liberal health minister Brad Hazzard.

Last month, the Liberal opposition leader in Western Australia, Libby Mettam, announced a policy to prohibit medical gender transition for children under 16, should she be elected to govern.

“In light of the recent publication of the Cass review in the UK, a WA Liberal Government would ban the use of puberty blockers, cross-sex hormone treatments and surgical intervention for children under the age of 16 for the purpose of gender transition,” Ms Mettam said.

“We would also initiate a comprehensive review to examine the suitability of these interventions for treating gender incongruent children to ensure the treatment of young people and children with gender dysphoria is safe in the long and short term.

“This policy is consistent with recent restrictions on medical interventions for treatment of gender incongruent children in Finland, Norway, Sweden, Italy, the UK, and the US.”

England’s Cass report²—which deplored the “remarkably weak evidence” for youth gender medicine and confirmed the experimental status of puberty blockers—was cited in support of Saturday’s motion at the state council meeting of the NSW Liberals.

The motion, put up by the Coffs Harbour branch of the party, was carried by a show of hands, according to a person at the meeting, who estimated that perhaps a dozen of the 500-plus members and delegates in the room voted against the motion.

Upper house member Jacqui Munro, who describes herself as “the NSW Liberal Party’s first LGBTQI+³ woman parliamentarian”, reportedly spoke against the motion as contrary to a family’s right to choose healthcare for children.

Cass webinar

Dr Cass, the former president of the Royal College of Paediatrics and Child Health who led England’s 2020-24 review of youth dysphoria care, has agreed to take part in a webinar on the relevance of her report to Australia.

The July 2 webinar will be moderated by Professor Philip Morris, president of the National Association of Practising Psychiatrists (NAPP), which in 2019 became the first Australian medical society to call for an inquiry into paediatric gender medicine.

The NAPP takes a cautious approach to managing gender dysphoria, stating: “Individualised psycho-social interventions (e.g. psychoeducation, individual therapy, school-home liaison and family therapy) should be first-line treatments for young people with gender dysphoria/incongruence.”

Outlining her policy, Western Australia’s Liberal leader, Ms Mettam, said: “Appropriate, compassionate, comprehensive, and accessible psychotherapeutic support will be the first priority of a WA Liberal Government in treating young people with gender dysphoria.”

She said a ban on hormonal and surgical interventions was urgently needed, given the rise in patient numbers at the Perth Children’s Hospital gender clinic and international concern about harm to vulnerable young people.

“When experts are telling us the potential permanent side effects of these treatments can include infertility, sexual dysfunction, obesity, heart and liver disease, blood clots and atrophy of the genitals, we need to investigate,” Ms Mettam said.

“In the meantime, we should be more cautious and careful when it comes to using these treatments on our children, that’s why a ban first to allow for a comprehensive review is the right approach.”

Last September, Canada’s opposition Conservative Party adopted a resolution to prohibit medicalised gender change for minors. Delegates at the party’s national convention in Quebec City passed the resolution with a Yes vote of 69 per cent.

The resolution says—

“A Conservative government will protect children by prohibiting life-altering medicinal or surgical interventions to treat gender confusion or dysphoria, and encourage positive mental and physical health support for all Canadians suffering from gender dysphoria and related mental health challenges.”

In August last year, the national committee of America’s Republican Party passed a resolution stating that children have a fundamental right to be protected from medicalised gender change and should be encouraged to “love and accept their bodies.”

The resolution endorsed at the summer meeting of the Republican National Committee in Milwaukee claims that “sex-trait modification procedures”—puberty blockers, cross-sex hormones and transgender surgery—are “permanent, risky, and experimental,” with potential harms including infertility, low bone density and heart disease.

Last week, South Carolina became the 25th American state to restrict or prohibit medicalised gender change for minors.

GCN has sought comment from the NSW Liberal Party and Ms Munro

1. The Bill does not specify particular treatments, but Mr Greenwich’s second reading speech says: “The prospect of experiencing a puberty that does not align with one’s gender can be highly distressing. Strong evidence from over at least a decade shows that gender-affirming medical care can reduce depression and suicidal ideation in young trans people [This claim is contradicted by the Cass report and multiple systematic reviews of the evidence—GCN]. But without support from both parents, children can only access gender-affirming medical care through the courts. Although the courts generally approve requests, courts are difficult to access for young people, who end up missing out on the care they need. The Bill would legislate Gillick competence [This is a common law test of capacity to give informed consent—GCN] by clarifying in the Children and Young Persons (Care and Protection) Act 1998 that a young person who is 16 or over is able to make a decision about their own medical and dental treatment as validly and effectively as an adult. Children under 16 will need a parent’s consent, or their treating medical practitioner would need to ensure that they are capable of understanding the nature, consequences and risks of the treatment and that the treatment is in the child's best interest.”

2. The Cass report, established by England’s National Health Service, has had a degree of bipartisan support in the UK.

3. In her first parliamentary speech, Ms Munro said: “It is an enormous honour to be elected as the NSW Liberal Party’s first openly LGBTQI+ woman in parliament, and its youngest in the Legislative Council. I was not selected for these attributes, and although they should be unremarkable, and while I do not like identity politics, these unchangeable parts of myself mean I can provide a new perspective in this place.” She praised the stoicism of her late mother, saying: “Today I call myself somewhat of an adherent of the stoic philosophy, espoused by Epictetus, Seneca and Marcus Aurelius, to maintain a healthy mind and perspective amidst the cut and thrust of politics.”