Early diagnosis

Six doctors quick to detect the risks of youth gender medicine

Photo by Sharon McCutcheon on Unsplash

There were doctors who saw the risks early on.

In October 2019, The Australian reported the start of a landmark legal campaign against the U.K. Tavistock gender clinic. Back then, who would have predicted that the Tavistock, the world’s biggest youth gender clinic, would be shut down?

The month before the Tavistock litigation campaign began, a handful of Australian doctors came together to support Dr John Whitehall, a professor of paediatrics, who was urging an independent public inquiry into children’s hospital gender clinics across Australia’s states.

They launched an online petition aimed at Australian doctors.

In three and a half days, before an activist spam attack forced the petition to be shut down, it attracted 260 signatures, including 20 professors or associate professors, 14 paediatricians, 20 psychiatrists (among them 9 child psychiatrists), and other doctors “with a shared concern about the epidemic of childhood gender dysphoria and the lack of scientific basis for its current treatment”.

Some of these medical practitioners took up the opportunity to write about their concerns over the exponential increase in minors undergoing medicalised gender change with hormonal and sometimes surgical interventions. (These doctors requested anonymity; good faith critiques of gender medicine can lead to activist abuse, harassment, and even threats to livelihood. This misleads the public about the true state of medical opinion.)

Below are lightly edited extracts from this hitherto unpublished commentary by six Australian doctors in September 2019.

Paediatrician

“One of the main issues that concerns me is that people are making life-changing decisions about their bodies before their brains and cognitive function have fully matured.  We know that the frontal lobe matures around the age of 25 years. The frontal lobe is where much of our complex decision-making takes place, and so [young people] are supported to make these irreversible body decisions before they are fully mature. This is why I have major concerns, and wonder what will be happening when the brain does mature in many of these [former patients] who have had irreversible body changes.  

“Just because it can be done, does not mean it should be done — and the consequences are life-long.  But it also raises the Catch-22 issue that if you wait till later (after age 25), [this intervention] cannot be done with the same outcomes.”

Psychiatrist

“Transgender medical treatments of children and adolescents are experimental treatments lacking a scientific basis and having possibly irreversible short-term and long-term adverse effects.

“There appears to be an absence of thorough diagnosis, including differential diagnoses, and of sufficient opportunity for appropriate psychiatric treatments of children and adolescents. 

“There appears to have been a shrewd strategy to bypass the usual scrutiny of new medical and surgical treatments by [Australian regulatory agencies] the National Health and Medical Research Council, the Therapeutic Goods Administration, and the specialist medical colleges. 

“The Australian Health Practitioner Regulation Agency delegates the formulation of standards and guidelines to the medical specialist colleges, which have failed in their duty to properly evaluate the evidence for these treatments. 

“There has also been an abdication of responsibility by paediatricians, paediatric endocrinologists and paediatric surgeons. They appear to have relied on the opinion and recommendations of psychiatrists without at least thinking through their own ethical position and the scientific basis of their treatments. They may have also relied on guidelines that did not have the endorsement of the NHMRC. 

“There is an element of psychological blackmail involved — ‘If you don’t endorse this treatment, the patient will suicide’.

“Internationally, there have been examples of medical practitioners whose careers were placed under threat as a result of external pressures from activists. This is no excuse, but not everyone is heroic and willing to stand up to the activists and be vulnerable to their attacks. 

“At a minimum, any proposed treatment should have been presented as an experimental trial and subjected to approval by a properly constituted ethics committee. This has not happened in Australia.”

Psychiatric registrar

“There are many examples in society where we have got things so very wrong — the ‘stolen generation’ [the removal of Indigenous children], sleep therapy in psychiatry that has now been banned, the notion of repressed memories and more recently the support for E-cigarettes. 

“This highlights how vulnerable we are, regardless of our education status, to easily believing the unfounded convictions of others. I see a similar pattern occurring in transgenderism. I fear for these [young] people that they will live with both physical and psychological scars from medical intervention, and that we as doctors are failing them by not standing by evidence-based medicine.”

General practitioner

“I am concerned that Australian adolescents are unnecessarily being placed on life-long, life-altering hormonal treatments, while their primary mental illnesses and psychosocial problems are being wilfully ignored by ideologically motivated doctors.  I am concerned that the repercussions of these treatments may be calamitous, as they fail to bring relief, provoke avoidable social stigma and ruin the prospects of [these young people] having a biological family.

“We are putting a generation of young Australians through a dramatic experiment based on radical gender ideologies with a lack of medical restraint.”

Emeritus professor of medicine

“I am not passing judgment on any adult who chooses to have their gender reassigned.

“My concern is that unproven medical technology is being deployed in children/adolescents who are not in a position to understand the long-term implications of what is being done to them. Their parents, who will be heavily emotionally engaged, are scarcely in a better position to give meaningful consent.

“This treatment involves potent hormones, hormone blockers [and sometimes] surgery, and is not innocuous. Many doctors and ethicists would regard this as unproven or experimental treatment. Under these circumstances, the validity of informed consent from both child and parents could be challenged, and probably will be challenged in court by some children who grow up and regret being transitioned.

“Another issue concerns the explosion of a spectrum of disorders in adolescents including autism spectrum disorder, eating disorders, behavioural disorders, mental health problems and gender dysphoria. These disorders often seem to be interrelated and were relatively uncommon several decades ago. It is likely that children/adolescents who present with gender dysphoria will also exhibit features of other disorders on that list.

“It seems that there is a tendency to latch onto gender dysphoria and treat that ‘because we can’, rather than looking at the whole person in their family, social and cultural setting.”

Child and adolescent psychiatrist

“Children with gender dysphoria typically have a lot of comorbidity. Some of them have trauma backgrounds (post-traumatic stress disorder or similar). A proportion of them have autism spectrum disorder. Some have systemic issues, such as dysfunction in the family system. There are complex interplays between all these factors. 

“The proponents of transgender affirmation treatments state that the psychiatric morbidity [of these patients] is related to their gender dysphoria and associated stigma. I don't know how they can say this. It is negligently simplistic. After all, when these [young] people transition, they continue to carry their morbidity. 

“Phenomenologically similar conditions such as body dysmorphic disorder (BDD) and eating disorder (ED) also have a lot of comorbidity. The treatment for BDD and ED is to accept that the comorbidity is contributing to the BDD and ED. Therapists manage the comorbidity together with the dysmorphia. Especially with ED, therapists provide a lot of very assertive treatments, despite the dysphoria that the patients have about their bodies.

“There are no robust studies, to my knowledge, comparing the [“gender-affirming”] and transitioning treatments for gender dysphoria, with the treatments for BDD and ED, which may involve —

• Validating the patient's distress about their dysphoria about their bodies

• In children and adolescents, involvement of the family in all phases of assessment and treatment

• Use of cognitive behavioural therapy or other psychotherapies to address the body dysphoria

• Use of family therapy to address systemic issues

• Assessment and treatment of comorbidity

• Manage medical sequelae [for example, after-effects or complications of an ED]

“Unless there is robust evidence to say otherwise, involvement of family in the treatment of gender dysphoria is essential. Failure to involve family is negligent and flies against all established practice in child and adolescent psychiatry.

“In transitioning treatments, there is not enough follow-up and study of those who wish to detransition — and end up detransitioning.”