Out in the open
Out in the open
Yes, Australia's best-known children's hospital gender clinic does indeed refer distressed minors for trans surgery ... but says there is no data available
For the first time, it has been officially admitted that an Australian children’s hospital is referring patients to the private sector for transgender surgery such as removal of a girl’s healthy breasts.
The public gender clinic of the Royal Children’s Hospital (RCH) Melbourne, which takes gender-distressed patients up to age 16, “may refer adolescents to a private specialist clinician to consider the appropriateness and need for surgery,” Mary-Anne Thomas, Minister for Health in the state of Victoria, said.1
Ms Thomas, who declares herself a proud feminist with “a passion for public policy”, was answering the latest in a string of formal questions on notice about the RCH gender clinic from Independent Liberal Party parliamentarian Moira Deeming.
Mrs Deeming told GCN that news of vulnerable girls having their healthy breasts surgically removed would cause “outrage” among mainstream Australians, “especially when they have it explained to them that there is absolutely no evidentiary benefit for this.”
Melbourne psychiatrist and researcher Dr Alison Clayton, who has written on the experimental nature of mastectomy for gender-distressed girls, said it was “a poorly evidenced, invasive and irreversible intervention for a poorly understood condition—that is, gender dysphoria—in adolescent biological females.”
She said mastectomy would “have life-long impact on sexual functioning and precludes the later possibility of breastfeeding.”
“I told my then psychiatrist I wanted to break my nose with a hammer and that I wanted to cut off my breasts. One of these comments carried more weight. My body dysmorphic disorder never faded but my trans identity did.”—Melbourne detransitioner Mel Jefferies, who regrets her decision as a young woman to undergo a trans mastectomy, Twitter, 19 August 2024
Screenshot: The group Genspect highlights the social push behind trans mastectomy marketed as “top surgery”
Chest reconstruction
No Australian children’s hospital has taken the momentous step to provide “gender-affirming” surgery on-site for minors who say they are distressed by a feeling of conflict between their birth sex and an inner sense of a trans or non-binary “gender identity”.
The former RCH gender clinic director, Dr Michelle Telfer, a pioneer of the contentious gender-affirming treatment model in Australia, is on the record as saying that “chest reconstruction surgery [double mastectomy] is an integral part of the transition process for trans males [i.e., females]” and is likely to improve mental health.
Mrs Deeming said Victoria’s governing Labor Party could act to stop the harm now, because its leadership could cite England’s cautious Cass review of youth gender care and explain to voters that “the science has been updated.”
“The longer they wait, the worse, the more culpable everyone will know them to be,” she said.
“ASPS [the American Society of Plastic Surgeons] currently understands that there is considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions for the treatment of adolescents with gender dysphoria, and the existing evidence base is viewed as low quality/low certainty.”—statement to commentator Leor Sapir, 23 July 2024
Fierce pride
In March, in the shadow of England’s National Health Service announcing an end to the routine use of experimental puberty blockers with gender-distressed children, a spokesperson for the department of Victorian Premier Jacinta Allan sprang to the defence of the RCH Melbourne clinic, saying, “We’re fiercely proud of the important work they do.”2
Mrs Deeming queried why Victoria’s government had been so evasive for so long when questioned about trans mastectomies for minors.
“If it’s life-saving care, why aren’t we providing it at our best public children’s hospital?” she asked.
She said the truth of the matter was that, like the vast majority of Australians, most rank-and-file members of the government’s own Labor Party “instinctively recoil from the idea that you’re helping a girl by removing her healthy breasts.”
Last year, Mrs Deeming’s questions to Health Minister Thomas about the RCH gender clinic produced no less than eight written answers stating that, “The Royal Children’s Hospital DOES NOT provide or refer children to surgical treatment.”
The use of the term “children” to exclude adolescents was not made clear.3
This led Mrs Deeming to ask whether the RCH gender clinic had changed its practices, given anecdotal reports that minors had indeed been referred to private surgeons for double mastectomies.
Last month, the Minister’s reply to this follow-up question distinguished between children and adolescents.
The Minister now stated that RCH “does not provide gender-affirming surgery to trans and gender-diverse children or adolescents” but may refer “adolescents” to private specialists for possible surgery.
“The RCH has been consistent in this approach over time,” the Minister said.
Mrs Deeming said she believed the Minister’s assurances last year were misleading.
“I love being pregnant and how it feminizes my shape. I do wish it didn’t trigger dreams about having breasts again. They’re so painful to wake up from. They feel so real. My body should be preparing to feed a baby. But nothing is happening up there. Just completely flat numbness.”—US detransitioner and mother Daisy Strongin, who regrets having a trans mastectomy at age 20, Twitter, 6 November 2023
Video: How did we get here?
No data
RCH Melbourne has refused a request under Freedom of Information law for data on gender clinic referrals to the private health sector for mastectomy since 2015, claiming this would require an “onerous” search of individual medical record notes.
“The information you have requested is not kept in electronic form in a way that RCH [can] produce a report by extracting it from an electronic database,” a hospital official told GCN earlier this month.
Citing this lack of data, Melbourne psychiatrist Dr Clayton, who is affiliated with the Society for Evidence-based Gender Medicine, said it was “very concerning” that the experimental practice of trans mastectomies for gender-distressed girls was “apparently being implemented without any external kind of oversight or regulation.”
In February, the mother of a 15-year-old girl who identified as a boy claimed on social media that her daughter had been referred by RCH to a private surgeon. RCH did not respond to questions about this from GCN.
Family Court decisions do document some trans mastectomy involving minors but there is no clear public data available showing the extent of this surgery in Australia.
When this little-known practice surfaces in mainstream debate, it arouses incredulity and strong disapproval.
Gender clinicians and trans rights activists—who usually assert that “gender-affirming care” is lifesaving—sometimes seek to dismiss public concern by claiming that no surgery is performed under age 18. This false claim went unchallenged during Australia’s last federal election campaign.
“A new analysis by the [New York-based] Manhattan Institute, using a more up-to-date all-payer national insurance database from 2017 to 2023, found evidence of 5,288 to 6,294 ‘gender-affirming’ double mastectomies for [American] girls under age 18. This includes 50 to 179 girls who were 12.5 or younger at the time of their procedure.”—Leor Sapir, City Journal, 12 August 2024
“The incidence of gender-affirming mastectomy [in the US] increased 13-fold (3.7-47.7 per 100,000 person-years) during the study period [2013-2020]. Of the 209 patients who underwent surgery, the median age at referral was 16 years (range, 12–17 years)...”—Tang et al, Annals of Plastic Surgery, May 2022
“Hundreds of trans teens under 18 have had breasts removed in Canada, new data show. Concerns have been raised about mastectomies in teens when uncertainties exist about long-term health effects and the possibility of regret.”—News report, National Post, 29 September 2023
Definitional denial
In May 2021, on the ABC Australian Story program, the then RCH Melbourne gender clinic director Dr Telfer was quoted as saying: “We don’t provide any surgery [for patients at the clinic]. To access surgery, one has to enter the adult system and that only occurs once someone’s over the age of 18”.
In November 2021, in reply to questions from The Australian newspaper,4 the RCH communications team said the hospital was “not aware” of the gender clinic referring patients for private trans surgery.
It is not clear when or how the RCH executive team became aware of this controversial practice at the clinic.
In July 2019, Dr Telfer told a mental health royal commission that “many” of her new “post-pubertal” female patients wanted what she called “chest reconstructive surgery.”
This surgery—double mastectomy—was “an integral part of the transition process for trans males [i.e., females],” she said.
She said RCH had the expertise to perform these operations itself but lacked the money.
“There is a significant gap in Victoria’s current health care system with the absence of public funding for chest reconstruction surgery despite the high demand for this evidenced-based5 intervention,” she said.
Dr Telfer cited a low-quality 2018 US study in which “transmasculine” girls answered a “chest dysphoria” survey after a double mastectomy. The survey had them rate agreement with statements such as “I get gendered as female because of my chest.”6
Of the 68 girls who underwent surgery, the youngest two were age 13, and 16 of them were under age 16.7
In May 2021, when RCH was given a funding boost by Victoria’s government, the hospital said it had “no plans” to introduce its own trans surgery program.
GCN put questions to Minister Thomas, RCH and Dr Telfer. GCN does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable youth.
Minister Thomas said referrals to private specialists for possible surgery were made in line with “gender-affirming” treatment guidelines from the RCH gender clinic and the World Professional Association for Transgender Health (WPATH). A peer-reviewed evaluation commissioned by England’s Cass review rated both these treatment guidelines poorly and did not recommend their use. WPATH stands accused of scientific misconduct. In her answer to Mrs Deeming, the Victorian Minister did not specify the type of surgery, but anecdotal reports suggest it is likely to be double mastectomy.
Puberty blockers are routine treatment at the RCH gender clinic, where they have been given to children as young as age 10. The Cass report also advises “extreme caution” in the use of cross-sex hormones for minors—a standard treatment option in Australian children’s hospitals—but has little to say about trans surgery for minors. During a recent Australian webinar, Dr Cass remarked in passing that, “In the UK, there is no intent to allow surgeries before 18.”
Under Victorian legislation, the term child is defined as “a child or young person who is under the age of 18 years.”
Disclosure: I was the reporter who put the question to RCH.
The term “evidenced-based”, rather than evidence-based, appears in the transcript.
The researchers declared the intervention a success because the post-surgical group reported less “chest dysphoria” than another group of patients who had not undergone mastectomy. The limitations of the study included its small sample size, cross-sectional design, use of a convenience sample for the non-surgical group, short follow-up period, and reliance on a “chest dysphoria scale” that had not been validated.
That study was also cited in a 2019 paper describing the first long-term study at the RCH gender clinic, Trans20, which recruited patients initially seen between 2017 and 2020. In that 2019 paper, the RCH authors stated, “there is an urgent need for more evidence to ensure optimal medical and psychosocial interventions.” The clinic is yet to publish any Trans20 data on the outcomes of medical treatment.
Cults do like secrecy; they need to act under cover of darkness in order to keep the truth hidden from potential recruits and from the public at large. I'm sure they have convinced themselves that they are doing so in order to "protect" the children they are mutilating and drugging from the "transphobic mob" that dares to question the tenets of their faith. Kudos for the few brave journalists that pass on the trans kool-aid and are asking the questions that need to be asked.
This again shows Melbourne's RCH as the 'Jonestown' of the trans cult in Australia. Victoria's weak media, together with a fully infected public service & neutered opposition will never let the truth be known. Thank God for Moira Deeming and the brave few who keep asking questions. Thank God for the journos like Bernard who dig below the surface. Thank God Victorians can still vote out the worst State government in our country's history.