It's official

Australia's most influential gender clinic announces change at the top

Photo by Patrick Perkins on Unsplash

The change of leadership at Australia’s most influential gender clinic has been confirmed.

Paediatrician Dr Cate Rayner and psychiatrist Dr Tram Nguyen introduced themselves as the new leaders of the clinic at the Royal Children’s Hospital Melbourne in a recent newsletter to patients and parents.

They took over from paediatrician Dr Michelle Telfer, who was the gender clinic’s director from 2012 to 2022, lead author of the 2018 RCH treatment guideline promoted as “Australian standards of care”, as well as president of the “gender-affirming” lobby the Australian Professional Association for Trans Health (AusPATH) from 2018 to 2020.

“Michelle has been a visionary leader, with fierce courage, integrity and also compassion, and the service has been steered by her with determination through times of great change,” Drs Nguyen and Rayner say in the gender clinic newsletter dated May 30 and obtained by GCN.

Their note says Dr Telfer “has moved into a new and exciting role within the RCH. She continues to work with our [gender clinic] team, both seeing patients and as an advocate”, but there is no reference to her returning as director.

It was Dr Nguyen who spoke for the clinic in the Four Corners TV program on gender medicine aired by Australia’s public broadcaster, the ABC, earlier this month.

Video: Texas Republican Dan Crenshaw on the evidence gap in gender medicine

Six months is up

In December last year Dr Telfer told gender-affirming colleagues she had served her last day as gender clinic director “until mid-2023”, saying she was taking up a new job as acting chief of medicine for RCH for six months.

The webpage profiling the hospital executive simply states that Dr Telfer is “the current chief of medicine”; the gender clinic webpage has Dr Rayner as acting director of the clinic and Dr Telfer as “acting chief of medicine”.

The hospital administration, which appears to have made no public announcement about the 2022 change of leadership at its high-profile gender clinic, did not reply to GCN’s request for clarification.

Often in the media, Dr Telfer was an advocate for easier and faster access to medical treatment for minors diagnosed with the distress of gender dysphoria, and for children’s hospitals to offer “chest surgery” (mastectomy) to dysphoric girls who reject their birth sex.

The RCH treatment guideline cites an alarming but low-quality statistic implying that 48 per cent of trans-identifying youth will attempt suicide if not given “gender-affirming care”. The document says the fact that a minor is suffering from psychosis or depression “should not necessarily prevent medical transition”.

The ABC paid tribute to Dr Telfer in 2021 as “a world leader in providing lifesaving treatment for children and teenagers with gender dysphoria, guiding them through their first steps towards transitioning.” 

“Since no high-quality evidence for the benefits of puberty blockers has been found in systematic reviews, it is unsurprising that even the doctors who work in this field have described themselves as building the plane while flying it.

“With mounting concerns for the possible harms associated with the medical pathway of puberty blockers and cross-sex hormones (including reduced bone density, disruptions to neurodevelopment, impaired sexual function and infertility)—not to mention the growing numbers of detransitioners for whom this was never an appropriate treatment pathway, one might extend their aviation metaphor as an attempt to build a plane while flying it, while someone else throws out all the parachutes and sets an engine on fire.

“Who would put any children on that plane? Or volunteer to pilot it?”—professor of clinical neuropsychology at University College London Sallie Baxendale, 7 July 2023

Trusting the experts

In the 2017 re Kelvin case, Dr Telfer and her hospital persuaded Australia’s Family Court that medical understanding of gender dysphoria and its treatment had advanced such that judges could safely wind back their supervision of decisions to give minors puberty blocker drugs, cross-sex hormones or mastectomy. A draft of the RCH clinic’s confident treatment guideline appeared to be pivotal in the case.

However, the court’s liberalisation of access to gender medicine—and the gender-affirming treatment approach, spearheaded in Australia by the RCH clinic—have come under increasing scrutiny.

In a Melbourne case last week involving a 13-year-old boy who identifies as a girl, the court was told by family law barrister Belle Lane—appearing for the court-appointed children’s lawyer—that it should consider “the risks and the advantages” of gender medical treatment and the fact that “the science isn’t settled”.

Ms Lane said the evidence before the court showed a range of views about whether the medical treatment could affect the child’s future fertility, sexual function, brain development and bone density, according to a news report by Guardian Australia. (The mother has since withdrawn her application for a court order authorising treatment.)

Ms Lane’s submission to the court was a departure from the past tendency of independent children’s lawyers—supposed to zero in on a child’s best interests—to echo the treatment recommendations of gender clinicians. Family Court judges have almost always endorsed medical treatment for minors in past cases.

In the coterie of family lawyers, two significant developments have been noticed.

In a case in November last year, the unnamed gender clinic abruptly withdrew its recommendation of puberty blockers for a child of primary school age, leading to settlement of a dispute between parents over treatment.

This is believed to be the first instance where an Australian judge has had the benefit of multiple expert arguments against the case for medicalised gender change of a minor.

The second development came in May with wide circulation of a 135-page dossier written by Ms Lane, who set out the international controversy over gender-affirming medicine, which the Family Court had been “largely unaware” of; the dossier was based on a presentation given by Ms Lane the month before to family law judges.

The Lane dossier challenges the RCH treatment guideline’s claim to status as “Australian standards of care” and suggests it represents “just one opinion” in the medical debate. RCH did not carry out a systematic review of the evidence base to inform the guideline.

Guidance, please

Ms Lane’s dossier also raises concern about a potential lack of independence in treatment advice, given the overlap between the clinicians involved in running the RCH clinic, writing the RCH treatment guideline and leading AusPATH, which is not only a professional association but also a trans activist lobby.

The guideline was the subject of trenchant criticism in a confidential 2019 letter from the Medical Affairs Committee of the Endocrine Society of Australia, The Australian newspaper reported earlier this month.

And the failure of the guideline to grade the quality of evidence supporting its treatment recommendations showed it is not a “trustworthy” guideline, according to a pioneer of the evidence-based movement in medicine, Professor Gordon Guyatt.

In May last year, Dr Telfer announced she would lead the first major revision of the RCH treatment guideline.

In February this year, however, AusPATH said it would take charge of the revision because Dr Telfer had “relinquished her leadership” of the project as part of her change in roles at the hospital.

This week, the progressive-left Labor government in the state of Victoria—a strong supporter of gender ideology in schools and the RCH gender clinic—restated its health system’s reliance on the RCH guideline.

“[The guideline brings] together available scientific evidence on how to provide optimal care to trans and gender diverse young people to maximise their health and mental health outcomes,” the Minister for Health Mary-Anne Thomas said.

“The guidelines will be reviewed and updated by relevant bodies as new evidence comes to light.”

Ms Thomas was responding to a question from the Victorian politician Moira Deeming, who called for an urgent review of gender-affirming treatment of children and the potential exposure of the state to legal liability in the event of litigation by detransitioners.

Ms Deeming had highlighted the decision by medical indemnity fund MDA National to restrict cover for private doctors involved in risky medicalised gender change of minors. She also cited the Lane dossier’s emphasis of the lack of evidence for gender medicine internationally.

GCN understands that another large indemnity fund, Avant, has been giving its practitioner-members medico-legal advice related to gender medicine guidelines and court decisions. Avant is the indemnity fund for psychiatrist Dr Patrick Toohey in the negligence claim brought by detransitioner Jay Langadinos.

Note: GCN sought comment from RCH. GCN does not dispute that gender-affirming clinicians genuinely believe their interventions help vulnerable young people