Free to be who you weren't

Conversion therapy redux; surgery that never happens; Switzerland says No; Oz inquiry news; trans India on the US dime; Chile's gender docs 'persecuted'; Canada's woke paediatrics; US hospitals warned

Photo by Markus Winkler on Unsplash

GCN in brief

Trans away the gay

United Kingdom | Former UK MP Chris Davies delivered a sharp dissent from a gender ideology motion at the Liberal Democrat party conference in Harrogate last weekend. “Conversion therapy was used to try and persuade gays and lesbians that they were really straight,” Mr Davies said.

“Now, conversion therapy, too often, means persuading young people—still thinking through their sexuality—that they are trans and maybe they will feel happier with life-changing chemical or surgical treatment. How can it be right to actively encourage people to feel uncomfortable in the bodies with which they were born and in which biologically they will live all their lives?” The motion—“Free to be who you are”—was passed, in defiance of the caution urged by England’s 2020-24 Cass review.

Surgery on the sly

America | A new analysis from the Manhattan Institute suggests that at least 7,000 girls under the age of 18 had mastectomies or breast reductions as part of medicalised gender change in the US between 2017 and 2023. “Between 50 and 179 of these girls were only 12 and a half years old or younger at the time of procedure,” institute fellow Leor Sapir says. “The US is one of the only countries offering these procedures to minors.”

Yet gender clinicians and activists have claimed over the years that trans surgery is rarely or never performed on minors. The institute’s figures come from a health insurance database covering about 90 per cent of US claims. It does not include California’s biggest insurer, Kaiser Permanente, which is being sued by detransitioner Chloe Cole, who had a trans mastectomy at the age of 15.

Operating in the dark

International | The evidence from most studies of the psychological and physical outcomes of trans mastectomy in females aged under 26 and diagnosed with gender dysphoria is of “low to very low certainty,” according to the first systematic review and meta-analysis of its kind. However, some of the studies under review provided “high certainty” evidence for the outcomes of death, necrosis, and excessive scarring.

“High certainty evidence from prospective cohort studies and, if ethical, randomised controlled trials, are needed to elucidate the short- and long-term effects of mastectomy in individuals with [gender dysphoria] on mental health outcomes,” says the paper published in the journal Plastic and Reconstructive Surgery. The research team included McMaster University’s Professor Gordon Guyatt, a pioneer of evidence-based medicine and the GRADE system for rating the quality of evidence. The systematic review was commissioned by the Society for Evidence-based Gender Medicine.

Red flags

Germany | Coverage of Germany’s new S2k “gender-affirming” treatment guideline in the newspaper Die Welt has highlighted an oddity in the document’s handling of the vexed question of informed consent by minors. The guideline seeks to reassure clinicians that this medico-ethical question has been dealt with in detail—and yet the only source for this suggestion is a lone unpublished legal opinion.

The Zürich-based media outlet NZZ has also run a sceptical report on the contentious new guideline. NZZ quotes Professor Tobias Banaschewski, Director of the Clinic for Child and Adolescent Psychiatry and Psychotherapy in Mannheim, on the claim that puberty blockers offer children a neutral pause for reflection. He said: “If I halt the physical and psychosexual development of a 12-year-old girl, but all of her school friends are developing into 14-, 15-, 16-year-olds, I am not putting the young woman in a more neutral starting position from which she can make a better decision. On the contrary, I can create completely new psychological dilemmas.”

Switzerland is yet to accept the new German-language S2k guideline and has started its own review, according to the Society for Evidence-based Gender Medicine, which has published an analysis of the document.

Piggybacking on HIV

India | India’s first gender clinic has ceased operations in three cities following cuts to the US foreign aid program, USAID, by the Trump administration, the BBC has reported. The Mitr Clinic had been providing “transition-related medical services,” according to a former staffer, but the BBC report focuses on the claimed effect of the US funding freeze on the 6-8 per cent of trans-identifying patients, younger than age 30, being treated for HIV. However, sources told Reuters that antiretroviral medication for HIV would be unaffected by the USAID decision.

There is concern in some poorer countries, such as South Africa, that foreign and domestic public funds (as well as monies from non-government organisations) are being diverted from HIV and other health priorities to “gender-affirming” hormones and surgery.

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Video: US congressman Dan Crenshaw talks to detransitioner Chloe Cole and whistleblower surgeon Eithan Haim

Probe Down Under

Australia | Psychiatrist Ruth Vine has been appointed to lead an independent review of paediatric gender medicine in the state of Queensland. Its focus is the evidence for puberty blockers and cross-sex hormones with gender-distressed minors in the public health system, as well as related issues of ethics, informed consent, governance and the law.

The terms of reference, agreed in consultation with Professor Vine, give her some latitude in her inquiries. Her background is in adult mental health, forensic psychiatry and government health administration, mostly in the state of Victoria, where she served as chief psychiatrist. Victoria was the beachhead for the gender-affirming treatment model in Australia. Anyone at Professor Vine’s level would have been aware of the rise of this rights-driven model and its patronage by Victoria’s centre-left government.

On Thursday her appointment was announced by Queensland’s (centre-right) Health Minister Tim Nicholls, who said she would bring a “truly independent mind” to the review. Professor Vine’s final report is due by November 30, although there is provision for more time if needed. She is to conduct the review with a panel of unnamed “subject matter experts” from fields such as child and adolescent psychiatry, endocrinology, ethics and law.

The state’s Liberal National Party government has been vindicated in its decision to pause the supply of hormonal treatments for gender-distressed minors, pending the Vine review, according to emeritus professor of law Patrick Parkinson.

He was commenting on news that records kept by a public sexual health clinic in the regional city of Cairns lacked the necessary proof of both parents’ consent in 11 out of 17 cases of hormonal treatment. And at the flagship state-run Queensland Children’s Gender Service, the process for obtaining consent from “estranged parents” was reportedly “determined on a case-by-case basis.” Professor Parkinson said court approval for treatment was required when parents disagreed. “If the level of record-keeping and legal compliance was this poor in the files analysed, in what other ways might the quality of medical practice fall below minimum standards?” he said.

Gender medicine lobby the Australian Professional Association for Trans Health has reportedly raised almost $100,000 to fund puberty blockers from the private sector for Queensland minors who cannot get subsidised blockers because of the freeze on new treatment in public health. At full price, these drugs cost almost $3,000 a year.

In a column last weekend for Queensland’s Courier-Mail newspaper, journalist Des Houghton said: “Transgender activists have legally sidestepped Deputy Premier Jarrod Bleijie’s ban on puberty blockers in an embarrassing setback for the [government of state premier David Crisafulli].”

Mr Houghton said it “beggars belief” that the state-run gender service was still open. And he said international expert opinion sided with the whistleblower psychiatrist, Dr Jillian Spencer, yet she was still up against her employer, the government agency Queensland Health, in an industrial tribunal.

When Dr Spencer first went public in 2023 with her concerns about the dangers of paediatric gender medicine, the state was run by a centre-left administration devoted to gender ideology. It was the current, centre-right government that in January imposed a cautionary pause on hormonal treatment of gender-distressed minors.

A cautious guide

Chile | Nicolás Raveau, a detransitioner and former trans activist in Chile, has launched a Spanish-language guide to challenge the abundant resources in his country promoting gender ideology and its medical interventions. The 23-page illustrated guide is intended for families as well as the education and health sectors.

In the introduction, the guide says: “Many are not aware of it, but today in Chile there is a regulation that allows those over 14 years of age to demand to be called by another name (for example, Mía instead of Miguel) and to change their school uniform without the authorisation of their parents … Even more seriously, parents are sidelined from the decision of whether or not [their children should] undergo endocrinological treatments to block pubertal development. Children and adolescents need time and alternatives. Better-developed public health guidelines such as those in Finland, England and Sweden are adaptable to our country.”

Earlier this month the Medical College of Chile denounced what it called “the persecution of doctors who treat transgender people”—doctors it said were “carrying out their work based on scientific evidence and professional ethics.” In November, a group of opposition MPs filed a complaint with the Regional Prosecutor’s Office of Valparaíso to investigate and punish “sex change” surgeries on minors in the public health system nationwide, the media outlet BíoBío reported.

That complaint cites the ground-breaking coverage of Chilean journalist Sabine Drysdale as well as an acknowledgement by the Ministry of Health of “sex reassignment” surgeries undertaken at public hospitals from 2001 to 2022. Citing the “low number” of surgeries and privacy concerns, the ministry refused to release details following an application under transparency law cited in Mr Raveau’s research.

The complaint to the prosecutor also reprises last August’s testimony before a parliamentary committee by Health Minister Ximena Aguilera, who said there had been 42 cases of gender-affirming surgery (“cirugías asociadas a reafirmación sexo genérica”) from 2009 to 2019, most of them in private hospitals, and all patients being aged 17.

Beyond a child’s comprehension

Canada | Lawyers for Alberta have defended in court the province’s legislation restricting puberty blockers and cross-sex hormones to gender-distressed patients aged 16 and older. Activist groups and families of trans-identifying minors aged 6-12 had told Court of King’s Bench Justice Allison Kuntz that the bill was the only one of its kind in the country and involved an unconstitutional denial of healthcare on the basis of gender identity.

However, Alberta’s lawyer David Madsen said the law’s purpose was to protect “the safety and long-term choice of children and youth from a risky and experimental medical intervention, for which there is little evidence of benefit and evidence of significant harm in some cases.”

He related the adult detransition story of Kellie-Lynn Pirie. “Her comment was ‘boy, if I didn’t know as an adult that this was the right path for me, how’s a young child supposed to know that that’s the right path for them?’” Alberta’s bill, which would also ban trans surgery on minors, has received royal assent but has not yet been proclaimed. This made a constitutional challenge premature, Alberta argued. Justice Kuntz has reserved her decision.

In a separate Canadian case, Indigenous transwoman Lois Cardinal has filed a statement of claim against Alberta, a Montreal hospital and health professionals over surgery to create a neo-vagina in 2009, when she was aged 21, journalist Amy Hamm reports in the National Post newspaper.

In claims yet to be tested in the Court of King’s Bench of Alberta, Ms Cardinal alleges a lack of proper consent, post-operative sterilisation and “constant vaginal pain.” She also claims she “was not informed about how the surgery would affect her identity within the First Nations Community, and ability to practise and pass on Néhiyawak cultural traditions.”

A new paper in a journal of the Canadian Paediatric Society uncritically promotes the gender-affirming treatment model with misplaced fears of youth suicide attempts and fails to mention England’s 2024 Cass report or a recent Canadian systematic review confirming the weakness of the evidence base, according to an article in the National Post.

One of the paper’s “clinical vignettes” presented to Canadian paediatricians introduces 12-year-old Jackson, who “was assigned female at birth but describes identifying as a boy, using he/him pronouns, and engaging in stereotypically masculine activities since age 9. Jackson notes chest tissue development and recent monthly vaginal bleeding that are causing significant distress and gender dysphoria, impacting his mental health. He describes wanting to stop menstruating and wanting a referral to a gender-specific medical clinic for ongoing medical treatment.”

Offshore loophole

United Kingdom | Doctors in Spain, working for the online clinic GenderGP, are reportedly prescribing hormonal treatment for gender-distressed minors in the UK, where puberty blockers have been restricted to a proposed clinical trial and the availability of cross-sex hormones has come under a new court challenge. Some of the prescriptions written by the Spanish doctors are sent electronically to a UK pharmacy for the minor to collect, while others are posted to the minor’s home to be taken to a pharmacy of choice, according to The Daily Mail.

The news report cites last year’s English court case involving a 15-year-old autistic girl given a potentially lethal dose of testosterone; the prescription was written for GenderGP by a Barcelona-registered doctor with a postal address in Bucharest. This offshore practice is legal, The Mail says, because after Brexit, “prescriptions issued by foreign medics in the European Economic Area are permitted for UK use as long as the doctor is qualified to issue the drug in their home country.”

Detransitioner Keira Bell, a former patient at the Tavistock gender clinic, has launched a judicial review in the High Court arguing it was “irrational” and therefore unlawful for UK Health Secretary Wes Streeting not to ban harmful cross-sex hormones for minors following the 2024 Cass report.

The NHS had ended routine use of puberty blockers and advised its gender clinics to take “extreme caution” before prescribing cross-sex hormones to a minor. In an Australian webinar last year Dr Cass had a warning for distressed girls considering testosterone: taking this powerful hormone will make it hard—in some ways harder than mastectomy—to pass as a woman if they end up regretting medicalised gender change and detransition.

Change of guard

America | US hospitals have been issued an official warning about any involvement in the “chemical and surgical mutilation” of gender-distressed children. The warning of possible regulatory action—consistent with President Trump’s January 28 executive order seeking to restrict medicalised gender change for patients under age 19—was sent earlier this month by a federal government agency, the Centers for Medicare & Medicaid Services (CMS).

The CMS letter says: “The US is now an outlier in the treatment of gender dysphoria in children. The UK, Sweden, and Finland have recently issued restrictions on the medical interventions for children, including the use of puberty blockers and hormone treatments, and now recommend exploratory psychotherapy as a first line of treatment and reserve hormonal interventions only for exceptional cases.” The letter to hospitals also cites England’s Cass report and its associated systematic reviews showing the evidence base for youth gender clinics to be very weak and uncertain.

The US Department of Health and Human Services has also rescinded Biden-era policy which sought to mandate insurance coverage for gender medicine under the Affordable Care Act, and plans to issue new guidance “protecting whistleblowers who take action related to ensuring compliance” with the Trump executive order.