'Happy day'
An Australian mother shares news that the gender clinic has found a surgeon to perform a double mastectomy on her 15-year-old daughter
A 15-year-old girl who identifies as a boy has reportedly been given a referral for a double mastectomy by the Royal Children’s Hospital (RCH) Melbourne in Australia’s state of Victoria.
In December, Victoria’s Health Minister Mary-Anne Thomas gave a written assurance to upper house member Moira Deeming that, “The Royal Children’s Hospital DOES NOT provide or refer children to surgical treatment.”
RCH operates the country’s most influential “gender-affirming” clinic. Mrs Deeming, a campaigner for women and girls, had asked the minister a series of questions on notice about the clinic, including details of any referrals for gender-affirming procedures.
Earlier this month, a parent on a transgender support site reported that there were surgeons in Melbourne willing to perform under-16 “top surgery”—a double mastectomy for a girl who rejects her birth sex—if RCH provided a referral.
“Luka Hein had both breasts removed as a 16-year-old in Nebraska. Chloe Cole, in California, was a year younger when she had her double mastectomy. She had been on testosterone and puberty-blocking drugs since 13, also after a sexual assault.”—The Economist, news article, 5 April 2023
‘Who is in charge?’
Mrs Deeming, who has been pilloried by state government figures for raising concerns about gender medicalisation, highlighted the contradiction between the mother’s report of a referral and the Minister’s denial.
“Is this wilful ignorance? Is it negligence? Is it incompetence? Do these referrals have the tacit consent of the Health Minister?”, Mrs Deeming asked yesterday.
“Who’s in charge—is it the Health Minister or the zealots at the Royal Children’s Hospital? Who’s going to take responsibility for the surgery that is happening on minors in this state?”
Mrs Deeming said Victorians she spoke to were very worried about hormonal and surgical interventions for vulnerable children but felt silenced by “the chilling effect” associated with Victoria’s punitive “anti-conversion” laws which entrench the medicalised “gender-affirming” treatment model.
“They’re extremely concerned that any other non-invasive pathway towards alleviating gender distress might be belittled or ignored or not prioritised,” she said.
She said the minister could not escape responsibility for gender non-conforming children being medicalised in Victoria, whether in the private or the public sector.
“But if gender surgery is a legitimate, evidence-based treatment, why would you not have it at the Royal Children’s Hospital?,” Mrs Deeming asked.
“The fact is, the Health Minister knows, and we all know, that it is an ideological, harmful intervention based on scant, low-quality evidence, and there are going to be lawsuits coming down the pipeline.
“The Victorian government cannot avoid responsibility for this scandal.”
Mrs Deeming put out a call for healthcare whistleblowers to contact her.
“We need people who are employed in these hospitals to come forward. I have parliamentary privilege and I’m willing to use it for the sake of helping children and to protect whistleblowers. But we need more evidence.”
“All my hatred of being a woman was just focused on my chest, on my breasts.”—Melbourne detransitioner Mel Jefferies, who had a history of depression, sexual assault and confusion about her sexuality, and underwent a double mastectomy at 26 that left her scarred physically and emotionally, 7NEWS Spotlight program “De-Transitioning”, September 2023
Breast rejection
Gender clinicians claim that trans-identifying girls suffer gender dysphoria because their breasts are at odds with their inner sense of a male “gender identity.”
Clinicians and activists promote double mastectomy—reportedly costing $4,000-$18,000 in out-of-pocket expenses—as a masculinisation of the chest supposed to improve mental health and reduce suicide risk. However, a recent landmark study suggests that gender-affirming hormones or surgery do not reduce suicide risk.
And a 2021 review by Australian researcher and psychiatrist Alison Clayton concluded that the evidence for “masculinising chest surgery” as a treatment for gender dysphoric youth is minimal and of low quality, meaning it is an experimental intervention demanding proper ethical oversight. Dr Clayton likened the practice of trans mastectomy to past medical scandals, including lobotomies once justified as cutting out the “worry centre” of the mentally ill.
Dr Clayton argued that, despite reassurances by gender clinicians, rates of treatment regret and detransition are “largely unknown”. As more detransitioners emerge internationally, some young women given mastectomies have had children and spoken of their regret at being unable to breastfeed.
Video: American detransitioner Daisy Strongin on reclaiming her reproductive sex, Independent Women’s Forum, 2022
Regret: Daisy Strongin’s anguish upon not being able to breastfeed her daughter; she had top surgery at age 20, tweet, 13 February 2024
Misinfo
The claim that a public children’s hospital has referred a 15-year-old for a trans mastectomy will surprise many Australians because of persistent misinformation that gender surgery for under-18s is not allowed or so rare as to be a non-issue. There is no good public data.
The crowd-funding site gofundme.com lists 323 appeals for top surgery in Melbourne; their profiles often do not state an age, but many seem younger than 25, meaning their brains are still immature.
Earlier this month, the Melbourne mother of an RCH patient made an excited post to a support group for parents of trans-identifying children—
“Happy day today. Just been informed there’s a surgeon that our gender clinic recommended here in Melbourne that will do top surgery on my 15-year-old son. This will be a massive breakthrough for his mental health as he will now be able to wear t-shirts like his friends and not constantly get asked why do you wear hoodies in the summer. And he will be able to go swimming.”
Another group member asked: “Have you had support through the gender service at RCH? I keep getting told these kids can’t get top surgery until they’re 18 [in Victoria.]”
The mother replied: “We have been with the gender clinic for two years now. There are some surgeons who will do [the surgery] with a referral from the clinic, which we have. This surgeon was referred to me from our doctor at the clinic… [The] minimum age in [Victoria] with some surgeons is 16, but this particular surgeon will do it at 15 under special circumstances and back-up support from the specialists, which we have.”
Another group member said—
“It’s always been known that there have been NO surgeons who will operate on people under 18 in Victoria. People talk about it all the time in this group. It’s strange given Victoria has been ahead in so many other areas. So, the news that you have found a surgeon in Victoria who will operate on someone under 18 is huge news. Which is why I asked whether you could share the surgeon’s name for those of us in the current process of looking interstate.”
Still another member said: “My 12 yo is wanting this already.”
Other parents said there were surgeons willing to operate on under-17 patients in the states of New South Wales and Queensland.
Gender dysphoria treatment standards issued by RCH—promoted as “Australian standards of care” and used by children’s hospitals across the country—advise that “chest reconstructive surgery (also known as top surgery) may be appropriate in the care of trans males during adolescence.”
The document, which is controversial and based on low-quality evidence, suggests that trans mastectomy is “regularly performed” internationally from age 16.
‘Big news’: Australian parents in search of double mastectomy for their teenage girls
‘Chest reconstruction’
RCH has sent mixed messages on underage surgery since July 2019 when paediatrician Michelle Telfer, founding director of the hospital’s gender clinic, gave evidence to a royal commission into mental health that “many” of her recent female referrals wanted what she called “chest reconstructive surgery.”
This surgery—double mastectomy—was “an integral part of the transition process for trans males,” Dr Telfer said.
She said her hospital had the expertise to offer double mastectomies to its gender patients but lacked the necessary money.
“There are also no private surgical services available for (trans) adolescents under 18 in Victoria, leaving them with no option but to seek chest reconstructive surgery interstate or overseas,” she said.
In support of her case for mastectomy funds, Dr Telfer cited an American study in which girls as young as 13 had undergone this surgery.
She also spoke of “a common misconception” about the diagnosis of gender dysphoria, the condition listed in the diagnostic manual known as DSM-5 and cited in December 2019 by RCH as justifying treatment.
At the royal commission, on 17 July 2019, the following exchange took place—
Counsel assisting Lisa Nichols QC, drawing on Dr Telfer’s witness statement: “Is there a misconception in some parts that the role of the mental health clinician is to diagnose gender dysphoria?”
Dr Telfer: “Yeah, it’s really interesting when we think about mental health clinicians within the context of trans and gender diverse children, because you don’t really need someone to diagnose a person with gender dysphoria, because a trans identity is something that’s so innately personal that really only that young person or adult, depending on what time of their life they’re coming in, only they know how they feel about their gender and whether that’s a problem or not for them.”
Critics of the gender-affirming treatment model argue that it does not operate like any other area of medicine because it substitutes the patient’s subjective feelings for a proper diagnosis.
Chart: The incidence of trans mastectomy among girls aged 12-17 rose 13-fold from January 2013 to July 2020 in the Kaiser Permanente Northern California healthcare system; of the 137 girls followed up more than a year after mastectomy, 55 were younger than 16 when referred for surgery; the median follow-up was 2.1 years, whereas previous studies suggest regret may take 8-10 years to become manifest.
What is the truth?
In May 2021, given a multi-million dollar funding boost, RCH told The Australian newspaper1 that the hospital had “no plans” to spend some of this money on mastectomies for gender clinic patients.
That same month, Dr Telfer told viewers of the ABC Australian Story TV program that, “We don’t provide any surgery [for RCH gender patients]. To access surgery, one has to enter the adult system and that only occurs once someone’s over the age of 18.”
In November of 2021, The Australian asked RCH if the gender clinic referred patients to private surgeons for double mastectomy or other gender-affirming surgery. The hospital said it was “not aware” of any such referrals.
Last week, GCN put the following questions to RCH—
Are RCH gender service staff providing referrals for under-18 patients to private surgeons for mastectomy?
Is this an official RCH policy?
What is the scientific evidence and ethical basis for such referrals? Has RCH had legal advice about the hospital’s exposure to medical negligence actions as a result of these referrals leading to cases of treatment regret and or misdiagnosis?
How many such referrals of RCH gender service patients have been made in the last five years?
Does RCH have systems for long-term follow-up of these patients after their surgery?
Does the RCH gender service provide medical interventions—and refer patients for surgery—on the basis of a patient’s self-diagnosis?
RCH did not reply.
GCN also sought comment from Dr Telfer, who stepped down as gender clinic director in 2022, and from Victoria’s Health Minister. GCN acknowledges that gender-affirming clinicians believe their interventions benefit vulnerable youth.
From 2019 to 2021, I reported on gender clinics for The Australian newspaper.—BL
Thank you for your unrelenting work on this Bernard. Sooner or later RCH and Michelle Telfer will find themselves obliged, probably in a court, to defend their actions.
Hold their feet to the fire, Bernard, Cheers!