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'Overreach' by conversion therapy watchdog
Legal academic challenges claim that it's illegal for parents to refuse to go along with puberty blockers
A parent “refusing to support” their child’s request for puberty blocker drugs to stop normal bodily development is breaking the law, according to an Australian human rights commission.
In the state of Victoria, the human rights commission is given a central role in policing a 2021 law against “conversion therapy”. The commission is charged with investigating conversion practices that target not only sexual orientation but also an inner sense of “gender identity”; it is also tasked with educating the public about this.
The draconian nature of Victoria’s Change or Suppression (Conversion) Practices Prohibition Act has been highlighted internationally by therapists concerned about the chilling effect of such laws on ethical, mainstream psychotherapy for young people with gender issues.
The website of the Victorian Equal Opportunity and Human Rights Commission gives several examples of illegal practices, including: “a parent refusing to support their child’s request for medical treatment that will enable them to prevent physical changes from puberty that do not align with the child’s gender identity and denying their child access to any health care services that would affirm their child’s gender identity”.
However, University of Queensland law professor Patrick Parkinson said this was an “extraordinary claim” by the commission — and wrong in law.
“In its published example, the commission would appear to take the view that it is unlawful for a parent to decline to take a child to a medical practitioner who will put the child on puberty blockers, rather than one who will consider other, less drastic, therapeutic options,” he told GCN.
Professor Parkinson said that under the Victorian statute, unlawful conduct had to be active and aiming to change or suppress a child’s gender identity.
“Simply refusing a particular medical intervention does nothing to change the child’s internal gender identity one way or the other,” he said.
Even if the commission were correct in its interpretation of Victoria’s anti-conversion therapy legislation, that state law could not override federal family law requiring court approval before treatment if one parent opposed a gender medical intervention such as puberty blockers, Professor Parkinson said.
Puberty blockers are a flashpoint in the international debate about the safety and ethics of medicalised gender change for minors. If children are given these drugs early in puberty (at Tanner stage 2, roughly ages 9-13), followed by cross-sex hormones, the expected result is sterilisation, according to the Society for Evidence-based Gender Medicine.
The prominent U.S. trans surgeon Dr Marci Bowers has pointed out that early puberty blockade will make intimate adult relationships difficult for natal males, because lack of exposure to testosterone renders them incapable of sexual orgasm.
A mother from Victoria, who spoke to GCN on condition of anonymity, said she believed the human rights commission was “attempting to force parents to permanently sterilise their children and damage their sexual function before they reach a level of maturity sufficient to understand what is being done to them.
“Regardless of how much the young person wants [puberty blockers], how can this be OK?
“How can we call Victoria a civilised society when this is going on? I would love to move away from here, as I feel Victoria is no longer a safe place to grow up for children who do not conform to gender stereotypes.”
Puberty blockers are given to young people who declare an opposite-sex or non-binary identity, and suffer distress at the prospect of going through the “wrong” puberty.
These off-label drugs — not approved for treating the distress of gender dysphoria — have been widely promoted as a reversible pause in development that gives teenagers a breathing space to contemplate the next possible step of irreversible cross-sex hormones.
However, on the limited data available, almost all patients do take that next step to lifelong synthetic hormones, and there is growing international concern about the known side-effects and unknown long-term risks of puberty blockers.
Sweden now limits these drugs to strictly controlled clinical trials. Finland gives priority to psychological approaches. In the UK, the independent Cass review of under-18 gender dysphoria care has so far been unable to say whether or not these hormonal treatments are effective or safe.
In all three countries, systematic reviews of the medical literature have concluded that the evidence for puberty blockers and cross-sex hormone treatment for minors is very weak.
In response to questions from GCN, the Victorian Equal Opportunity and Human Rights Commission appeared to back away from its claim that parental refusal to go along with puberty blockers is illegal.
A spokesman said: “Whether or not a parent’s conduct is a change or suppression practice will depend on the circumstances of the case.
“[The commission’s view] is that it would be unlawful (but not a criminal offence) to prevent a child from accessing health care service for the purpose of exploring and affirming their gender identity.
“Subsequent decisions about treatment are a matter for determination between appropriately qualified clinicians in consultation with a child’s parent”.
In Professor Parkinson’s opinion, the commission had abandoned its public statement and was making a much more modest claim, albeit one that was difficult to find in the text of the anti-conversion therapy law.
The spokesman said the commission had merely clarified its position, not changed it. The original claim remains unaltered on its website.
While criminal offences under Victoria’s anti-conversion therapy law can attract prison sentences, illegal practices may trigger education or investigation by the commission.
On its website, the commission says that under the anti-conversion therapy statute, “it is completely legal — and encouraged — to undertake activities that support or affirm someone’s sexual orientation or gender identity, including assisting a person who is undergoing a gender transition”.
“Medical and psychological treatment — in line with professional standards — that are necessary (in the health service provider’s reasonable professional judgement) are also legal.”
In America, puberty blockers have become caught up in partisan politics. Joe Biden’s Democratic administration has asserted that “gender-affirming care” (which includes blockers) has “a positive effect” on youth mental health.
Republican states have moved to restrict medicalised gender change for minors, leading to legal challenges by trans rights lobbies and parents of trans-identified youth.
In a February 2022 letter to the Texas Department of Family and Protective Services, state governor Greg Abbott claims that puberty blockade, together with other “sex change” procedures, is child abuse.
In a formal opinion that month, Texas Attorney-General Ken Paxton says puberty blockers “prevent a person’s body from developing the capability to procreate” and inflict “mental and emotional injury associated with lifelong sterilisation”.
In March, Mr Paxton served two drug companies, AbbVie Inc. and Endo Pharmaceuticals, with a detailed demand for documents to do with marketing, advertising and sales for off-label use of hormone blocker drugs.
In a statement, he said the demands were part of an investigation launched last December to determine whether these firms had “deceptively advertised and promoted hormone blockers for unapproved uses without disclosing the potential risks to children and their parents.
“I will not allow Big Pharma to misleadingly promote these drugs that may pose a high risk of serious physical and psychological damage to Texas children who cannot yet fathom or consent to the potential long-term effects of such use,” Mr Paxton said.
He said the drugs Supprelin LA and Lupron Depot had been approved by the U.S. Food and Drug Administration to treat children with central precocious puberty, in which puberty begins prematurely, while Vantas and other forms of Lupron were prescribed for palliative treatment of prostate cancer.
“But these drugs are now being used to treat gender dysphoria even though they are not approved for such use by the Food and Drug Administration,” Mr Paxton said.
A spokeswoman for Endo Pharmaceuticals said the company was “cooperating with the investigation”. GCN sought comment from AbbVie Inc.
In the U.S. Senate this month, acting director of the National Institutes of Health Dr Lawrence Tabak was asked about the safety of puberty blockers as an off-label treatment for minors.
Dr Tabak said the research in this area was limited to “observational studies”. This methodology is regarded as producing weaker evidence than an experimental study involving, say, random allocation of patients to a puberty blocker treatment group or a group receiving psychological treatment as an alternative.
In January, the U.S. law firm Girard Sharp, which specialises in mass tort and class action litigation, put out a national call for parents of gender dysphoric minors who might have been harmed by puberty blockers.
“Emerging research has raised potential red flags regarding the safety and efficacy of puberty blockers,” the law firm said in a statement.
“According to recent reports, the ramifications of using these drugs at a young age are unknown at this time, but some of the potential health consequences presented by puberty blockers may include low bone density and adverse psychological effects.”
The firm cited Lupron, Supprelin, Zoladex, Zytiga and Eligard as among the top drugs in the gender dysphoria market.
GCN sought comment from Girard Sharp.