Identity extremism

Cass lashes the autonomy fetish; doc Telfer unmasked; Dutch reversals; global champions of puberty; US crackdown on dodgy marketing of gender meds; doping scandal redux; Canada's outspoken medicos

Photo by Stefan Steinbauer on Unsplash

GCN in brief

Not normal

Norway | Gender medicalisation of the body is a form of “identity extremism”, according to Margrethe Voll Storaas, a research fellow in philosophy at the Norwegian School of Sport Sciences. In Samtiden magazine, she argues that it should not have taken an inquiry by the Norwegian Healthcare Investigation Board to see the folly of the country’s 2020 “gender-affirming” treatment guidelines.

She writes: “For six years, there has been an official process of depathologisation of trans medicine: a cultural process that removes the psychiatric framework surrounding patient needs that, until now, have been viewed as mental illness, with good reason. When the body feels so fundamentally wrong that a person seeks medical help to look like the biological sex they are not, or as if they have no gender, we find ourselves outside the realm of normal psychology.

“Originally, depathologisation meant that diversity of expression was not pathological. Most people can agree on that. The problem arises when medically dependent body modification is considered merely an expression. [The Norwegian LGBT lobby] FRI writes: ‘Some people change their bodies in order to express their gender in other ways.’ This touches on a deeper view of the body.

“When we declared homosexuality healthy, acceptance was right—healthy and consensual sexuality should never have been pathologised. But homosexuals never asked to block puberty in order to ‘have time to figure out’ whether they were homosexual or not. They never asked for medication ‘to be themselves’ or to be ‘corrected’ through surgery. That is the demand in the trans struggle.”

Double unDutch

America | Another attempt to replicate the pioneering Dutch clinic’s positive findings on puberty blockers has failed. The multi-centre US study led by gender clinician Johanna Olson-Kennedy has reported no mental health improvements for a group of 94 minors, with an average age of 11.2 years, after 24 months on puberty suppression. In their preprint paper, the researchers speculated that mental health would have declined were it not for puberty blockers. Last year, Dr Olson-Kennedy said the discouraging results had been held back because it was feared they would be “weaponised” by opponents of “gender-affirming care”.

In the 2019 protocol paper setting out the plan for this project, she and her co-authors said: “Results from this study have the potential to significantly impact the medical and mental health services provided to transgender youth by making available rigorous scientific evidence on the impact and safety of early treatment based on the sexual development stage.”

UK researchers associated with the now-defunct London Tavistock clinic had also failed to reproduce the Dutch results with their 2011-15 “early intervention study”; they too delayed release of the bad news, and ultimately published on the same preprint website, medRxiv, as their US colleagues.

Leading from behind

The Netherlands | The country that spearheaded paediatric medical transition—badged as the Dutch protocol for “juvenile transsexuals”—has inadequate treatment guidelines and lags behind newly cautious health authorities elsewhere in Europe, according to Jilles Smids, a philosopher at the Erasmus University Medical Centre in Rotterdam. In the Dutch Journal of Medicine, Dr Smids points up the high rate of medicalisation at the Amsterdam gender clinic, where 84 per cent of 1,487 adolescent referrals were diagnosed with gender dysphoria between 2000 and 2018, and 78 per cent began medical transition.

He says the two current guidelines (covering physical and psychological domains) “do not prescribe the holistic care and strong restraint in medical intervention that [the Cass review] believes adolescents need.” With Dutch guideline revision delayed, Dr Smids says there should be interim treatment advice for gender-distressed minors in the Netherlands based on the Cass report and other systematic reviews of the evidence base.

Philosophical fetish

International | In a guest editorial for The American Journal of Bioethics, the former head of England’s Cass review, paediatrician Baroness Hilary Cass, and her co-authors have tackled the fetishising of “autonomy” by ethicists who promote gender medicalisation of minors.

They write: “Placing autonomy ahead of comparative patient welfare considerations is an unusual stance … [A]ccording to Beauchamp & Childress, the most cited US textbook in bioethics, autonomy has no higher status than the other medical ethics principles, such as beneficence and non-maleficence ... [In the UK], if the practitioner believes that the risks outweigh the benefits of a treatment, or that the treatment is not in the best interests of the patient, then autonomy is not a consideration, because the practitioner is professionally unable to prescribe. To do so would equate to considering that smoking cigarettes is not in a child’s best interests but still allowing them to smoke on the basis of autonomy.”

Shades of grey

America | The New York Times has uploaded a six-part podcast, The Protocol, “exploring the story of medical treatment for transgender young people—how the care began, the lives it changed, and the legal and political fights that could end it in the US.” Presumably because it involves journalist Azeen Ghorayshi, whose past coverage has departed somewhat from affirmative orthodoxy, the podcast was attacked as “transphobic” by some activists before it dropped. Commentators informed about the realities of gender clinic practice say The Protocol is like the curate’s egg—good in parts.

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Video: Why do journalists turn away from the topic of paediatric gender medicine?

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International | To keep track of the fast-growing research literature on paediatric medical transition, the Society for Evidence-based Gender Medicine has launched the SEGM Digest.

Need to know

Australia | Australia’s most influential gender-affirming doctor Michelle Telfer and the gender clinic at the Royal Children’s Hospital (RCH) Melbourne have been unmasked as the targets of severe criticism by Family Court Justice Andrew Strum. In April’s landmark ruling, which protected a 12-year-old gender non-conforming boy, known as “Devin”, from puberty blockers, the identities of RCH Melbourne and Dr Telfer, the former gender clinic director, were suppressed by court order.

Last week, however, Justice Strum upheld an application by The Australian newspaper arguing that the identification of Dr Telfer and her hospital would serve the public interest and arm parents with vital information. It was front-page news for The Australian, which offered comprehensive coverage including an editorial. So far, RCH’s hometown newspaper The Age and the national broadcaster the ABC—both of which have uncritically showcased Dr Telfer and paediatric medical transition—have had nothing to say about this dramatic development.

In his ruling, Justice Strum found that the RCH gender clinic had failed to undertake a comprehensive assessment of Devin, made a diagnosis only belatedly and with a view to the imminent court trial, and offered only one treatment, being puberty blockers as the first step on a lifelong path of medicalisation.

Meanwhile, the hospital, which faces tighter budgets in the indebted state of Victoria, says it is “excited to bring health professionals a series of webinars on understanding gender-affirming care options for trans and gender-diverse young people”. One of five webinars, costing $33 each, promises to explain “Testosterone use, menstrual suppression and safe binder practices” for girls who reject their female sex. The webinar involves GP Dr Michelle Dutton from the Orygen youth mental health service run by psychiatrist Professor Pat McGorry.

In a media statement last week, RCH claimed its gender clinic “delivers a world-leading, multi-disciplinary model of care”. The statement did not mention Dr Telfer, who now serves as chief of medicine at the hospital. By contrast, in the state of Queensland, whistleblower psychiatrist Dr Jillian Spencer continues to be harried by her public sector employer Children’s Health Queensland.

In 2023, Dr Spencer spoke out about her concern that the gender-affirming model mandated at the Queensland Children’s Hospital risked harming vulnerable patients. After a troubled minor lodged a complaint of “transphobia” against her, Dr Spencer was suspended from clinical duties; she had an unblemished record as a senior clinician. Now her superiors have told her she cannot return to work because she spoke publicly about her disquiet over the politicised milieu of the hospital with its Pride, Wear it Purple and IDAHOBIT celebrations, and staff involving mentally unwell children in trans activist displays, journalist Des Houghton has reported in The Courier Mail.

GCN emailed the office of Queensland Health Minister Tim Nicholls to ask why Dr Spence had not been reinstated to clinical duties when the newly elected government had vindicated her long-standing concerns by pausing hormonal treatment and commissioning an independent review; there was no reply.

The panel membership for that review, led by psychiatrist Professor Ruth Vine, has been announced. The expertise of the six members includes child and adolescent psychiatry, endocrinology, ethics, social work, judicial work in a children’s court, health law, governance and regulation of practitioners.

Australia’s National Association of Practising Psychiatrists led by Dr Philip Morris has updated its guide for cautious management of gender distress in young people; Dr Spencer is among the co-authors of this document.

Puberty rights are human rights

International | The group Genspect, which advocates for non-invasive responses to gender distress, has issued a Memorandum of Understanding on the Role of Puberty in Adolescent Development to defend this crucial stage of human growth and to create “a public registry of [signatory] organisations that refuse to support medical experiments on children.”

Wes thinks again

United Kingdom | Litigation has led to UK Health Secretary Wes Streeting “actively reviewing” whether to restrict or ban cross-sex hormones for minors. Detransitioner Keira Bell and two parents had challenged in court Mr Streeting’s failure to extend his more cautious policy from puberty blockers to cross-sex hormones. Although the challenge was dismissed earlier last month, it was revealed in court that an expert working group had been set up by England’s National Health Service (NHS) to consider the warnings found in reports from two gender clinicians submitted by Ms Bell’s legal team, according to journalist Hannah Barnes of the New Statesman.

Finland’s Professor Riittakerttu Kaltiala, a prominent psychiatrist involved in her country’s 2020 shift away from gender medicalisation of minors, argued that cross-sex hormone use was “not safe [for] any minors.” She said the current NHS policy implied that such treatment was safe for 16- and 17-year-olds, whereas “the evidence relied upon in the policy does not support that conclusion.”

The report by Swedish paediatric endocrinologist Professor Jovanna Dahlgren stressed the extra danger of starting hormone treatment in minors. “If the treatment is started in young years, many years with daily treatment with cross-sex hormones will increase the risk of cardiovascular disease… and stroke… [and] can decrease fertility, impair liver function and increase the risk of cancer in both genders,” she said.

The parents’ group Our Duty has expressed concern about the vulnerability of 17- to 25-year-olds—still regarded as adolescents with developing brains—in “affirmation-only” NHS adult gender clinics.

On notice

America | Healthcare providers in the US have been sent an official warning about the lack of evidence for youth gender medicine, the risk of harm and the need to abandon reliance on the low-quality treatment guidelines. In his May 28 letter to providers, US Secretary of Health and Human Services (HHS) Robert F Kennedy Jr recommends a careful reading of the Gender Dysphoria report issued by his department earlier this month.

He says the HHS report aligns with the findings of European countries such as Sweden, England and Finland, which have “sharply restricted” access to hormonal treatment for gender-distressed minors. He also puts providers on notice that HHS will stand by whistleblowers who raise concerns about harmful gender interventions. A portal for whistleblowers has been set up.

Detransitioners Chloe Cole, Luka Hein and Kaya Clementine Breen have filed amicus briefs in federal appeal courts arguing for a reversal of lower court injunctions blocking President Trump’s January 28 executive order against paediatric medical transition.

Dope

Germany | Commentator Paul Steger has revisited the East German doping scandal as “a tragic blueprint for the health effects of testosterone on female bodies.” He argues that the lessons of that epoch could help both detransitioned and trans-identified females.

Singaled out

America | Journalist Jesse Singal has eviscerated the bad-faith response of the American Academy of Pediatrics (AAP) to the HHS Gender Dysphoria report. He says that report “solidly sums up the present state of the controversy and the lack of evidence for youth gender medicine treatments.”

But the supposed experts of the AAP, who continue to evade requests that they revisit their own contentious 2018 affirmation-only position statement, have published a travesty of a response to the HHS report. Mr Singal says the AAP leaders “have misrepresented, deflected and, in most cases, refused to answer any follow-up questions. This is a jarring case study in how experts have mortgaged their authority, leaving the average person simply trying to understand this issue better—not to mention parents and young people considering these treatments—in a very difficult situation.”

Borderline

Finland | Young people seeking gender reassignment in Finland have a higher rate of personality disorders than the general population, according to a new study. The most common form is borderline personality disorder (BPD), reflecting a fragmented and unclear sense of self. BPD is linked to elevated rates of suicidality, self-harm, depression and anxiety—conditions also prevalent in gender clinic caseloads.

The new Finnish study found that 15 per cent of the gender reassignment group had a personality disorder diagnosis, as opposed to only 2.1 per cent of the control group.

The study is the first comprehensive, long-term national research drawing on health registers and centralised gender clinics, taking in 3,665 gender patients between 1996 and 2019. The group of females seeking to masculinise had a 4.6 per cent rate of BPD, compared with lower rates in the general population for males (0.3 per cent) and females (1.8 per cent). The results also show that diagnosis of BPD has become more common in recent years, and not only among gender patients.

Sharp practices

America | The US Federal Trade Commission appears to be preparing to pursue the gender-affirming medical industry for “unfair and deceptive trade acts and practices”. An internal memo obtained by The Daily Wire ahead of a July workshop on paediatric medical transition says: “There is now considerable reason to believe that the doctors and medical providers pushing [gender-affirming care] on minors are knowingly deceiving parents by exaggerating [its] ‘benefits’ and downplaying its harmful side effects.”

The title of the workshop is “The Big Lie: The Dangers of Gender-Affirming Care for Minors.” The trade commission memo says the oft-cited medical consensus favouring gender-affirming care is a mirage.

“While several politicized medical organizations that promote [gender-affirming care] for minors as the best standard of medical care might claim a ‘consensus,’ there is in truth no widespread medical consensus as to whether [it] is the correct course of action for gender dysphoric youth,” the memo says. Meanwhile, the US House of Representatives has passed a tax bill that would prohibit federal funding of gender medicalisation under the Medicaid program or the Affordable Care Act; the bill was amended to extend the ban from minors to adults.

Consent denied

Australia | Detransitioner Mel Jefferies, a 33-year-old Australian woman who began testosterone treatment in 2011 followed by a double mastectomy, has commenced a civil action against a Melbourne GP, a psychiatrist and Monash Health, the largest public health service in the state of Victoria, The Age newspaper has reported. The claims have yet to be tested in court.

“Jefferies says her years of mental health issues were not under control at the time of her treatment and were exacerbated by the testosterone prescribed by her doctors and surgery,” The Age said. “Her statement of claim says she has a permanently ‘deepened voice, hirsutism, clitoromegaly [a clitoris significantly larger than normal], vaginal pain/discomfort, abnormal body odour and acne, and pelvic floor dysfunction (as indicated by urinary incontinence)’.”

Ms Jefferies told the newspaper: “I didn’t have the capacity to give consent—most of the time I was in transition I was going through crisis after crisis.” There is another Australian detransitioner lawsuit on foot in the state of NSW.

Buyer remorse

New Zealand | Not so long after New Zealand’s Ministry of Health published a report confirming there is little evidence in favour of puberty blockers, the local gender-affirming lobby is pressing another arm of government, Health NZ, to issue an overdue update to a treatment guideline for gender medicine. This may seem odd; surely such an update would take account of the very weak evidence base and not please the affirmationists?

But, as journalist Yvonne van Dongen explains, Health NZ awarded a 2023 contract for the guideline update to the gender ideologues of the Professional Association of Transgender Health Aotearoa (PATHA). And PATHA’s 2018 NZ guideline-to-be-updated was among the documents found by England’s Cass review to be of low quality and complicit in a pattern of “circular referencing” which created the illusion of a solid consensus in favour of the evidence-lite gender-affirming model. So, the NZ health authorities are in a pickle.

Affirmative Austria

Austria | A German-language podcast is giving parents a voice in affirmative-captured Austria. Podcaster Faika El-Nagashi, a political scientist and former MP with Austria’s Green Party, says parents feel abandoned as key parties—the social democrats, New Austria and the Greens—campaign to prohibit open-ended, developmentally literate psychotherapy as unethical “conversion therapy”.

Writing in Cicero magazine, Ms El-Nagashi, a human rights activist and lesbian, says the cautious “watchful waiting” approach has hardly been tried in Austria, where “an affirmative approach dominates, which regards parental objections as a hindrance.”

“Anyone who asks about causes [of a young person’s distress] is quickly under suspicion. Anyone who hesitates, loses influence—or custody. In this climate, young people are sent down a one-way street—at an age when they are not yet considered capable of making decisions in many other areas. Parents find themselves in a paradoxical situation: they are supposed to guide, but not question. They are supposed to protect, but are not allowed to warn.

“Now, for the first time, affected parents in Austria are speaking publicly in a podcast about their experiences with a system that disenfranchises them and that they can no longer trust. They talk about schools that carry out social transition without consultation—the change of names and pronouns. Of counsellors who portray critical parents as a danger. And of courts that replace parental care with state approval. Parents are demanding consequences—from politicians and state-funded agencies. They are calling for a rethink and a protective framework that does justice to the reality of life for young people and families.”

Cone of silence

Canada | A group of Canadian doctors has released a statement deploring the affirmative capture of media outlets and medical associations in the country. “We, a group of 14 Canadian physicians, feel it is vital for the public to know that many—and perhaps most—physicians believe there must be restrictions on gender therapies that permanently change a minor’s body,” the group says.

“It is hard to know what percentage of physicians oppose ‘gender-affirming care’ for minors because many are afraid to speak their minds in a climate where any dissent is couched as ‘transphobia.’ Physicians who speak out have been subject to investigations and penalties by regulatory organizations, particularly after the passing of federal Bill C-4 in 2022, which potentially makes it a criminal offence to refuse support of a child’s belief that he or she is transgender.”

Meanwhile, an expert report from Quebec has been given a mixed review by retired lawyer Peter Sim, an acute observer of gender ideology at work in Canada. He says the “recommendations in the report are cautious and are often little more than calls for further study. Nevertheless, the report makes a valuable contribution by taking seriously concerns which most Canadian governments and the media have either dismissed or ignored.”

On healthcare, Mr Sim says, the expert “committee shows no understanding of the concept of evidence-based medicine or the findings of multiple systematic reviews that gender-affirming treatments are based on low-certainty evidence.” On detransition, contrary to misleading claims that the rate of regret is known to be very low, the committee does acknowledge that while the true rate is unknown, the number of detransitioners appears to be increasing.

Surgeon says No

America | Plastic surgeon Dr Richard T Bosshardt, a senior fellow at the watchdog group Do No Harm, has deplored the Queer theory capture of many in the medical profession, resulting in “children receiving needless, dangerous, and life-altering surgeries—all based on the lie that people can change their sex.” In City Journal, he argues that the euphemistic term “top surgery” disguises the gravity and risk of double mastectomies performed on girls as young as age 13 in the US.

“Neither top surgery for a person with gender dysphoria, nor breast reconstruction for a ‘detransitioner’ who regrets her initial procedure, results in a natural, functional chest. In both cases, minors are left with permanently disfigured bodies, and potentially lifelong medical complications,” he writes.

Klink’s clinic

Ireland | Two doctors have been given permission by the Irish High Court to go ahead with a challenge to the alleged failure of the Health and Information Quality Authority (HIQA) to ensure the safety of gender non-conforming children referred abroad for assessment. Professor Donal O’Shea, an endocrinologist at the adult National Gender Service and his colleague, psychiatrist Dr Paul Moran, say they do not oppose the gender-affirming model but are troubled by the risk of “inappropriate and irreversible medical treatment,” The Irish Times reported.

On May 26, a lawyer for the doctors, Joe Jeffers SC, told the court that HIQA “had a care pathway established by [Ireland’s public Health Service Executive], whereby Irish children are now being referred to a private clinic in Antwerp, Belgium, by a non-medically trained ‘trans-activist’.”

Mr Jeffers said the clinic at ZNA Hospital, Antwerp, was operated by an endocrinologist by the name of Dr Klink. It has no “model or care” nor discernible operational guidelines, Mr Jeffers submitted. Children from Ireland used to be sent to the London-based Tavistock gender clinic. (Update, June 18: The ZWA Hospital is public, not private, and its new Antwerp Gender Care Centre states that, “Psychological support is the foundation of our gender care. At the same time, we also offer medical and social support to transgender and gender-diverse people and to people in their environment.” The centre says it offers “personalised, gender-affirming care”, and “medical interventions such as hormone treatment” are available for minors. Thanks to a doctor in Belgium for this clarification—GCN.)

Lifting the veil

Australia | One month before Australian federal Health Minister Mark Butler’s surprise announcement in January of a “comprehensive review” of the de facto national guideline for treatment of youth gender dysphoria, his officials reminded him of the fact that the guideline had “performed poorly” in an evaluation run as part of England’s Cass review. (This detail was among material redacted from previous documents released under Freedom of Information law on the grounds that it trespassed on the “thinking processes” of government, but some of this material has been restored following an appeal by GCN.)

In public statements, Australia’s centre-left federal government has sent mixed messages about youth gender clinics, and it has been unclear the extent to which it is reacting to international evidence contrary to gender-affirming care, as opposed to accommodating and shielding the LGBTIQ+ lobby.

In the December 2024 brief from senior officials in his Department of Health and Aged Care, Minister Butler was also advised that the de facto national guideline—issued in 2018 by the Royal Children’s Hospital (RCH) Melbourne—required updating, according to FOI documents. (Officials were responding to a request from Mr Butler for “urgent advice” following the December 2024 decision by his UK counterpart, Health Secretary Wes Streeting, to impose an indefinite ban on private prescribing of puberty blockers for reasons of safety.)

A key section of the urgent brief for Minister Butler, sent on December 17 last year, is headed “Considerations for Australia’s approach to puberty blocker[s]”. An update of the “national” RCH Melbourne guideline, carried out according to the 2016 guideline development standards of the National Health and Medical Research Council (NHMRC), was put to the minister as “Option 2”.

Option 1 remains redacted from the latest FOI documents, but it may have been related to development of new national guidelines. On January 31 this year, Mr Butler said he had asked the NHMRC to review the RCH guideline and develop new national guidelines. His then-deputy, Assistant Health Minister Ged Kearney, described the RCH Melbourne guideline as “excellent” and merely in need of an update; she too had been sent the urgent brief noting the verdict of the Cass review on the guideline.