Heal thyself
Politicians are unlikely to fix the gender clinic scandal unless doctors show them the way
Australia’s medical authorities are blocking a review of the country’s gender clinics by refusing to acknowledge the significance of England’s Cass report or by repeating the fiction that it has no local relevance, according to psychiatrist Andrew Amos.
“Cass specifically evaluated the clinical guidelines used by all of Australia’s public gender services for minors, and they show they’re not fit for purpose,” Dr Amos said last week at a forum with US detransitioner Chloe Cole in Parliament House, Sydney1.
Dr Amos, who regards the gender-affirming treatment approach as a political project alien to the medical model, was referring to a Cass-commissioned evaluation of international gender dysphoria guidelines, including the 2018 “Australian standards of care” issued by the Royal Children’s Hospital (RCH) Melbourne. Those standards, used across the country, scored 19/100 for the rigour of their development and 14/100 for independence; none of the reviewers recommended their use.
“Essentially what that means is that the blueprint for gender medicine for kids in Australia is incompetent, and it’s biased,” Dr Amos said.
He said those against a “desperately needed” review had seized on “cosmetic” differences between the Australian and UK health systems to suggest the Cass report had no implications Down Under, when in truth the gender-affirming treatment model with its puberty blockers and cross-sex hormones was common to both.
Dr Amos, an academic at James Cook University2, highlighted the internationally significant finding of the Cass report that, as he put it, “There was no high-quality evidence that gender-affirming care actually improves kids’ health or mental health.”
“Cass concluded that the rapid increase in gender services in England essentially was only achieved by bypassing the usual safeguards of evidence-based medicine and systematic evaluation of treatment outcomes.
“In England, there was no significant effort to track and monitor detransitioners3. In Australia, we not only don’t properly monitor detransition, the word ‘detransition’ doesn’t appear once in our [RCH Melbourne] guidelines—we just don’t acknowledge it.”
Dr Amos said he expected a local review4 would reach the same conclusions as Dr Cass about the evidence deficit of gender medicine for minors, but he argued that it was necessary in order to inform the Australian public about “what’s been going on”, to engage medical authorities, and tailor recommendations to local conditions where necessary.
“We need political actors and also medical authorities to get involved with this. At the moment, each one is a little bit handing the ball off to the other,” he said.
“I personally think it’s more the fault of the medical authorities, because it would be a very brave politician to say—well, the doctors are telling you one thing, I’m going to go against that.
“I think the medical authorities need to change the situation.”
Dr Amos said medical societies had been subject to “institutional capture.”
“You really only need to get four or five people on to the right committee [of a medical society] and they can make the decisions for an area are of medicine.”
The only response to the Cass report from the Royal Australian & New Zealand College of Psychiatrists5 was a five-paragraph statement rejecting an appeal from a group of members—including Queensland whistleblower Dr Jillian Spencer—for the college to urge an independent review of gender clinics.
Video: At odds with its track record promoting paediatric gender medicine, the US Biden Administration has claimed it does not support surgery for minors. The June 28 statement follows proof that the administration’s No. 2 health official, Dr Rachel Levine, successfully lobbied for the abandonment of minimum ages for surgery in the 8th edition standards of care issued by the World Professional Association for Transgender Health (WPATH). WPATH standards are invoked internationally by gender clinics as a guarantor of effective and safe treatment
“[The Singapore-based online dispensary for puberty blockers and hormones] GenderGP has ditched health advisers in favour of providing transgender people with ‘self-service’ treatment recommendations using an AI algorithm. It means, for example, that a person’s blood test can be analysed by an algorithm, instead of a human health adviser, to provide a treatment recommendation for the patient to take to a doctor.”—interview, The Times, 28 June, 2024
“[GenderGP founder Dr Helen] Webberley said: ‘We fed the algorithms the respected clinical guidelines.’ It removed the ‘human interpretation of protocol’, she added. Webberley joked that she had seen the clinic referred to as ‘GenderGPT’, like the AI tool ChatGPT, but insisted the changes made the service safer. However, the revelation may deepen concern about its transgender care. [GenderGP says it uses the RCH Melbourne clinical guidelines, which Dr Webberley has described as ‘beautiful’.—GCN].”
Kids’ welfare, not culture war
At an Adelaide forum6 last Thursday, independent state politician Frank Pangallo renewed his request for an inquiry into gender care, citing new figures that children as young as age three had been seen by the gender clinic of South Australia’s Women’s and Children’s Hospital.
Under the RCH Melbourne guidelines, the decision to go ahead with “social transition”—a psychological and social intervention affirming an opposite-sex identity and potentially putting the child on the path to medicalisation at puberty—is to be “driven by the child or adolescent wherever possible”. It is a dogma of the gender-affirming model that even very young children are “experts” in their gender identity.
In February, Mr Pangallo’s cross-party campaign for a parliamentary inquiry was rejected7 by state Labor Premier Peter Malinauskas, who dismissed it as a “culture war”.
The premier said he preferred that “any sort of examination of this [gender medicine issue] be done in a methodical, policy-based way based on the science and best available medical advice.”
On Thursday, Mr Pangallo said his proposal was not about a culture war but “about the health, welfare and protection of our most vulnerable children, [a cause] which [the premier] himself has recognised in the creation of a Ministry for Autism.”
“Why are the premier and health minister sanctioning what in effect is a human medical experiment without proper protocols being implemented? It is shocking that these practices that are unproven and have little support in quality evidence [are] being allowed,” Mr Pangallo said.
Video: Australian Senator Claire Chandler reveals a dramatic increase in the number of transgender-identifying females being given taxpayer-subsidised testosterone supposed to be for patients suffering from the male condition of “androgen deficiency due to an established testicular disorder”. Senator Chandler says, “Thousands of young women and girls are being exposed to lifelong consequences and irreversible damage. That’s why it’s so important to collect the evidence that it was all based on a lie.”
One-way help
Detransitioner Chloe Cole, a 19-year-old from California, told Tuesday’s Sydney forum of the stark difference between the encouragement of medicalised gender transition and the solitary burden of detransition.
“My own doctors, when I told them about the complications [from transition], when I asked them about what I could do next, what detransition might look like, even with things as simple as, how do I stop taking hormones?—I had absolutely no help and no support whatsoever,” she said.
“Whereas [with] my transition, I was always given the next step. I was always given a general idea of what that may look like. And now I had to figure it out completely on my own. I didn’t know where to turn.
“But I soon discovered that there was an entire community online of people, young men and women, just like me, who had been through the process of social and medical gender transitions, who came back out of this, with years of their life wasted, with parts of their bodies gone. And in some way, it comforted me knowing that I wasn’t alone in this.”
Her troubles had started before the age of 10. She was “a little bit awkward” with others, artistic, “quite the tomboy” and had some autism-like symptoms.
“My breasts started to develop when I was only about eight or nine years old. I was getting a lot of unwanted attention from my peers and even from the adults around me, and I really wanted to run away from this. I felt I was being looked at almost like I was a woman, when I was still a girl,” she said.
“I really didn’t feel very comfortable in my own skin, especially because I had a fear of people taking advantage of my femininity. I knew many girls growing up who were victims of rape and abuse in their own families, and I was afraid of the same thing happening to me. Eventually, that same fear materialised when I was 13 years old.
“I discovered the transgender community when I was 12 years old, through social media platforms, mainly Instagram. And what really drew me towards it was not only the artwork celebrating transition, but also just how closely knit this community seemed to be.
“It was all these kids who were just like me in a lot of ways. Many were artists, many were a little bit on the nerdy side. Many were growing up as effeminate boys and tomboyish girls who felt like they never had really, truly fit in, and had their struggles with socialising, with making friends.
“It gave me a sense of hope, watching these kids, who I wasn’t too dissimilar from, start to find their identity through this community.”
She came out to her parents as a boy, and they turned to health professionals.
“So, they started sending me to therapy for what they thought, correctly, was a mental health issue.
“What they weren’t expecting, though, was that I would immediately be thrusted on to the path of affirmation and of gender transition.
“They weren’t even allowed in the appointments—in the room—with my psychologist. So, they didn’t have a clue about what was going on, about what was actually being discussed. But they could see I was going to therapy, and I wasn’t getting any better.
“So, they decided to take matters into their own hands, to speak to the doctors themselves. They asked some very reasonable questions like, why do we have to pursue this [medical transition] right now? Why can’t we wait until she’s an adult? She’s just not mature enough—what happens if she ends up regretting this later?
“The doctors told them, well, this is an innate part of your child, this is her gender identity. It’s clear that she knows what she wants. It doesn’t matter how young she is because children understand what their gender identity is from a young age.
“In fact, if you don’t give this to her right now, if you don’t allow her to pursue medical transition like she wants to, it’s very likely that she’s going to start feeling suicidal and eventually take her own life.
“My mom and dad were basically given the ultimatum of having to choose between ‘having a dead daughter or a living, happy, thriving transgender son.’
“The problem was, as distressed as I was, I was never suicidal. I wanted to feel loved. I wanted to feel accepted. I wanted to feel like I had an identity. I never wanted to take my life until I was actually administered these treatments.”
At age 13, she was given the puberty blocker drug Lupron.
“It basically cleared out all the sex hormones in my body at a time [when] I was otherwise perfectly healthy and developing completely normally. I was put into an artificial childhood-onset menopause. I was very lethargic, I was very tired. Emotionally, I was very numb.
“I was experiencing these uncomfortable physical sensations, these hot flashes. I was uncontrollably sweating. I was itchy in my hands and my fingers in my arms. I would experience a tingling-burning sensation.”
She felt there was no going back, that she had to escape the discomfort of puberty suppression by moving forward to the next stage: synthetic testosterone as a cross-sex hormone.
On testosterone, she got her energy back, at first, and experienced “gender euphoria”. She put on muscle and went into high school passing perfectly well as a boy. But it turned out to be a honeymoon period.
“I started to realise more and more just how unnatural this was, just how much pain I was in, trying to fit in every day, trying to act like somebody who I wasn’t. I was living a lie.
“Despite the obvious distress that I was in—that my doctors knew I was in—I was allowed to go through the next, final step of my medical transition. At 15 years old, just after the start of the second year of high school, I was allowed to undergo the surgical removal of my breasts, a radical double mastectomy.
“And this marked a major change in my transition, in my feelings around it. Eventually, my stitches were taken out. And every day, before and after every bath and every shower, and whenever I went swimming, I had to look down at this part of my body, and look at all the scars and the skin grafts, the bruises… I felt like a monster. I felt like part of me had been ripped away.
“The regret came in very soon after. But because I was so far in my transition, because everybody in my life knew me as a boy, as a son, as a grandson, as a brother, I didn’t think that I had a way out. So, I tried to cover up the feeling and think, well, this pain is just a normal part of the post-op process.
“Especially after my 16th birthday, I started to realise adulthood isn’t too far away. I have to start thinking about things like, am I going to get married? Will I have children of my own?
“I was taking a class in psychology and towards the end of course, it was very focused on things like family and children. And it was then that I had this epiphany—I wanted to become a mother one day, I wanted to have children naturally, I wanted to have that experience of getting married, of having a husband, of getting pregnant, of birthing my own children and nursing them.
“But I wasn’t sure if I would ever be able to naturally have children after years of puberty blockers, of being on male hormones. And now after having my breasts taken away from me, I never would have the choice of nursing and nourishing my own children and building that bond.
“That realisation killed me. For weeks, I couldn’t forgive myself. I stopped focusing on my studies. I stayed in my room all day, crying.
“I didn’t know what to call myself anymore, but I didn’t want to be transgender. I didn’t want to further my transition, and every single part of it, I regretted. It was the hardest choice in my life [to detransition], and a choice that no 16-year-old girl or boy should ever have to make for themselves.”
At 17, she decided to go public. She felt she had a duty to other distressed children out there, to try to spare them what she had gone through.
The Sydney forum was organised by Upper House member John Ruddick of the Libertarian Party. Chloe Cole’s tour of Australia was hosted by the Australian Christian Lobby.
Dr Amos also chairs the Queensland Section of Rural Psychiatry within the Royal Australian & New Zealand College of Psychiatrists.
A detransitioner is someone—typically in their late teens or early adulthood—who stops medical transition and re-embraces their birth sex.
There have been multiple calls for federal or state reviews of gender clinics over the last five years.
The college of psychiatry has a tortuous history of trying to resolve deep internal conflicts over its policy on youth gender dysphoria.
The Adelaide forum was hosted by Mr Pangallo and two fellow members of the state Upper House, Heidi Girolamo and Laura Henderson, both from the centre-right Liberal Party.
Members of the centre-left Labor Party were denied a conscience vote on the issue of an inquiry.
I cite the summary line from a recent edition of ‘Current Sexual Health Reports’:
“The evidence base for gender-affirming interventions is sparce and of very low quality. While the evidence of benefits is highly uncertain, the harms to sexual and reproductive functions are certain, and many uncertainties about the long-term health effects exist. As a result, it is hard to ethically justify continuing to use hormones and surgeries as first-line “treatment” for gender dysphoric youth”.
It is nonsensical to suggest that somehow the findings of the Cass report are less appropriate to the Australian model of Affirmative ‘Care’ in the treatment GD in minors.
Medical ethics and the criteria required to satisfy ‘evidence based interventions’ do not change, moderate or become more forgiving depending on geography.
These qualities and related ethics are cast in stone!
Bernard, in reply to your opening statement, politicians might act differently, were they to become aware of the ( intuitively) overwhelming majority of relevant clinicians ( paediatric adult and child psychiatrists, paediatricians, paediatric endocrinologists) are silently ( out of fear of career retribution) not in agreement with the status quo in relation to minors. A voluntary plebiscite/ secret ballot of those clinicians to obtain a majority opinion might see truth and reason gain a return, over the ideological misplaced compassion which is driving gender affirmative care for minors. Such a survey taken independently, say, by a group of concerned clinicians would put to shame, AHPRA, and the relevant colleges, unless one of these professional bodies were to agree to undertake such a survey, which would put the results beyond ethical or plausible challenge. Political responses are always guided by majority pressures, and this issue would prove a vote winner in most electorates, though I am likely to be overly ambitious for the ACT!