Inquiring mind
An Australian health minister puts the case for a nationwide review of gender clinics
Tasmania’s Liberal government has become the first Australian administration to recommend a national review of public gender services for minors.
The island state’s Health Minister, Guy Barnett, who is also Attorney-General, said he had written to his federal counterpart—Australia’s Labor Party Health Minister, Mark Butler—to ask him to consider the idea.
On Thursday, Mr Barnett said a national review of youth gender clinics undertaken by the federal government would “allow consideration of all available evidence from across the country”.
In the state of Western Australia, Liberal opposition leader Libby Mettam has announced a policy to ban puberty blockers, cross-sex hormones and transgender surgery for children under age 16, and to hold a review, should she be elected to govern.
In New South Wales (NSW), where the centre-right Liberals are also out of power, the state council of the party has passed a motion calling on state and federal governments to ban medicalised gender change for minors on the basis that informed consent is not possible.
In both those states, the Liberals cited the influence of England’s landmark Cass report issued on April 10. The centre-left Labor Party, in office federally and in other states, has been deaf to concerns about gender clinics; the Australian Greens, likewise, appear pledged to defend the contentious “gender-affirming” treatment model.
“Following publication of her 388-page report, figures including the [UK] Labour MP Dawn Butler repeated claims that Cass had not included 100 transgender studies in it. Calling the assertion ‘completely wrong’, Cass said… ‘If you deliberately try to undermine a report that has looked at the evidence of children’s healthcare, then that’s unforgivable. You are putting children at risk by doing that’.”—Dr Hilary Cass, interview, The Times, 19 April 2024
Go national
Tasmania’s Health Minister, Mr Barnett, weighed in on the gender clinic issue in response to the feminist group Women Speak Tasmania, which had written to him and other MPs urging an independent inquiry into paediatric gender medicine on the island and citing the example of the Cass review of health services for gender-distressed youth.
In his email to the group on Thursday, Mr Barnett said it was “highly important” that gender services for children and adolescents have “rigorous patient safety and clinical governance measures in place”.
“As such and given the Cass review was undertaken at a national level in the UK, it is preferable that a review of public gender services [in Australia] be undertaken by the Commonwealth [being the federal government],” he said.
“This will allow consideration of all available evidence from across the country, to ensure these services are best-practice, evidence-based, and that patient safety and wellbeing is paramount.”
Mr Barnett said he had written to Australia’s federal Health Minister, Mr Butler, “requesting his consideration of these matters”. GCN has sought comment from Mr Butler.
“[The Cass review-commissioned researchers at the] University of York, which is kind of the home of systematic reviews, one of the key organisations that does them in this country, found that evidence in this [gender medicine] field was strikingly lower than other areas, even in paediatrics. I can’t think of any other situation where we give life-altering treatments and don’t have enough understanding about what’s happening to those young people in adulthood.”—Dr Hilary Cass, interview, The New York Times, 13 May 2024
Buck-passing?
A spokeswoman for Women Speak Tasmania (WST) said the group “welcomes the Tasmanian Health Minister’s acknowledgement of the importance of the Cass review recommendations for standards of care at gender clinics in Australia.”
“However, we are disappointed at what looks like buck-passing back to the federal Health Minister, especially given the strong push for puberty blocker bans by Western Australian and NSW Liberals.
“WST remain very concerned that the Tasmanian Gender Service continues to prescribe the puberty blocker leuprorelin acetate, which has been banned recently in the UK.”
Under “right to information” law, WST requested patient data from the government-run gender service based in the city of Hobart. Tasmania’s Department of Health refused to supply data on treatment outcomes and follow-up monitoring of patients, partly on the grounds that it would be too onerous to extract information not kept in a searchable format.
The department did release some basic data on provision of treatment. The gender service gave puberty blockers to less than nine minors1 last year. The island is small; in 2021, its teenage population was about 60,000. The scale of hormonal treatment of dysphoric minors in the private sector is unknown.
Tasmania’s gender service also referred a small number of patients to the gender clinic at the Royal Children’s Hospital (RCH) in Melbourne, which wrote the 2018 “Australian standards of care” treatment guidelines for gender dysphoria used by affirmative clinics across the country.
That RCH document promoting blockers, hormones and surgery was rated poorly in an evaluation of guidelines ordered by Dr Cass. The RCH guideline has also been judged “untrustworthy” by a pioneer of evidence-based medicine, Professor Gordon Guyatt of Canada’s McMaster University.
Post-Cass truth
Like Australia’s gender clinic lobby, the federal Health Minister, Mr Butler, has played down the local relevance of the Cass report by citing differences in pathways to treatment.
The Cass report confirmed the experimental status of puberty blockers, which are to be confined to clinical trials. On May 30, UK Health Secretary Victoria Atkins announced an emergency ban on puberty blockers, which lack long-term safety data for gender-distressed young people. Ms Atkins said doctors could be struck off if they prescribed blockers in defiance of the Cass policy.
In her report, Dr Cass urged “extreme caution” in the use of cross-sex hormones with minors; this treatment also lacks a good evidence base. Blockers and hormones continue to be routine interventions in paediatric gender clinics across Australia.
Research commissioned by the Cass review included a survey with five Australian gender clinics among respondents. This Cass research was critical of a fast-track to puberty blockers used without safety data by clinics at RCH Melbourne, the Perth Children’s Hospital and the Queensland Children’s Hospital.
“[Unprecedented exposure to social media is] a social experiment. We don’t know what that’s done for the generation that’s coming through, what has been good and what is bad. Biology hasn’t changed in the last few years so it’s not that that’s changed things [pushing up the number of gender-distressed teenagers] … we do have to think very seriously about the impact of social media, not just in terms of influencers, but about the effect of long hours on social media.”—Dr Hilary Cass, interview, The Guardian, 10 April 2024
Bad reviews
Since 2019, there have been two misfire reviews of gender medicine nationally in Australia.
In August 2019, the then federal Health Minister, Greg Hunt, a Liberal, asked the Royal Australasian College of Physicians (RACP) for advice on gender dysphoria treatment after The Australian newspaper reported concerns.
In March 2020, the RACP sent to Mr Hunt its brief advice on “Care and treatment of children and adolescents experiencing gender dysphoria.” The four-page letter of advice did not mention puberty blockers, cross-sex hormones, trans surgery or the risks of these interventions, such as sterility and sexual dysfunction.
The college made the unsupported claim that a national inquiry “would further harm vulnerable patients and their families through increased media and public attention.” This line, adopted by Mr Hunt to reject a public inquiry, has been recycled ever since by gender clinicians, health bureaucrats and their ministers.
It emerged after the RACP published its advice that it had undeclared conflicts of interest—the college had a track record of promoting the hormonal treatments it was asked to review for Mr Hunt—and it had failed to pass on to Minister Hunt serious concerns expressed by endocrinologists, the hormone experts, during consultation for the response to the minister’s request for advice.
In May 2020, after the compromised nature of the RACP review was reported in The Australian, Mr Hunt gave an undertaking that an advisory body bringing together the top federal and state health bureaucrats would come up with a new national approach to paediatric gender care enabling consistent quality.
Mr Hunt said this body of health bureaucrats would also ensure “strong and balanced counselling and safeguards, workforce standards, monitoring of practices, and monitoring of long-term health and wellbeing outcomes”.
As part of this process, gender clinics in state children’s hospitals across Australia were audited and shortcomings in data collection were found.
However, in May 2021, it was reported that this federal-state review of gender care by health bureaucrats was quietly wound up without collecting any patient data or deciding upon a new national approach to treatment.
For privacy, the Tasmanian government stated that <5 males and <5 females were given puberty blockers last year.
Tasmania’s Health Minister and W.A.s State opposition leaders are to be congratulated for committing to investigating this travesty.
The children lining up at ‘gender clinics’ are heavily burdened with a hugely disproportionate prevalence of mental health disorders, a reality that would normally demand that medical professionals would adopt the most conservative approach possible – Rather It’s ever onward with the puberty blockers, cross-sex hormones and then the finale mutilating surgery.
The oft quoted suicidality self-harm and suicidality are a reflection of the mental health conditions that they carry. I can find no reference to a single suicide in this cohort in Australia and they are extremely rare elsewhere.
The protagonists of this ghastly process quote studies outlining positive outcomes as proof of the safety and efficacy following ‘transition’. Long term studies, 20 to 30 years confirm very much the opposite with high suicide rates, attempted suicide, depression, criminality and early death.
The global trend is overwhelmingly to a more a more conservative approach and if our medical professionals refuses to ‘stop digging‘ then legislation must force them to.
Vincent Keane, I am in NZ where we are told we have ten times the amount of kids on blockers than the rest of the world. On particular doctor is very keen on this. It seems that our medical profession is not swayed by Cass - the review doesn't apply to us as we do things differently.