Politician's promise

An Australian health minister talks up her gender clinic review

Photo by Soragrit Wongsa on Unsplash

Queensland’s Health Minister Shannon Fentiman has belatedly acknowledged that her state’s gender clinic is under review—a review she claims will examine treatment approaches and the latest scientific evidence.

In recent comments reported by The Sunday Mail newspaper, Ms Fentiman said that “on reflection” a review was timely; in June last year the government had dismissed calls for an inquiry from whistleblower psychiatrist Dr Jillian Spencer and paediatrician Dr Dylan Wilson.

On December 19, GCN reported that the gender clinic review had begun, although the government had not announced it and refused to answer any questions about it. Queensland’s centre-left Labor administration is lagging in opinion polls as it heads towards a state election on October 26.

On January 28, Ms Fentiman told The Sunday Mail: “This is an emerging field with around 80 per cent of research on gender-affirming care only [being] published in the last decade.”

“So, it is important we continue to review our models of care and consider any evidence that becomes available to ensure we are providing gender-diverse children and young people access to the best and safest lifesaving care and support.”

No consensus

Last December in state parliament, Ms Fentiman appeared to recognise the lack of expert consensus for the gender-affirming model of care with its child-led social transition, early puberty blockers, cross-sex hormones and surgery.

However, the nature of the review and the makeup of the seven-person evaluation panel suggest that non-invasive alternatives to “gender-affirming care”—such as exploratory psychotherapy—will not be seriously considered.

The government-set task for the evaluation panel is to “examine the [gender clinic’s] current model of service delivery against the Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents.”

This contentious document, issued in 2018 by the Royal Children’s Hospital (RCH) Melbourne, has been the vehicle for entrenching the gender-affirming model in Australia.

The RCH treatment guideline was considered for inclusion in the online portal Australian Clinical Practice Guidelines run by the National Health and Medical Research Council (NHMRC) but did not qualify, The Australian newspaper reported in 2021.

An NHMRC spokeswoman said: “At the screening stage, it was determined that the [RCH] guideline did not include a funding statement, an evidence base for the recommendations or information about conflict of interest, and that it would not meet the portal selection criteria, so a full assessment was not carried out.”

The RCH document does not fulfil the requirements for a “trustworthy” treatment guideline, according to a pioneer of the evidence-based movement in medicine, Professor Gordon Guyatt of Canada’s McMaster University.

“When a child enters the clinic of a paediatric gender endocrinologist for their first injection of a puberty blocker, they have zero endocrine disease. That child’s hormone levels are all exactly where they should be. Their gonadotropins are normal, their sex hormones are normal for the stage of puberty. They have no disease.

“Yet when they leave, the paediatric gender endocrinologist has induced abnormal hormone levels. In that child, a doctor has deliberately suppressed normal hormone levels to treat, not endocrine disease, but that child’s mental distress.”—Paediatrician Dr Dylan Wilson, explaining why he will not refer patients to the Queensland gender clinic, May 2022

Blinkers on?

Dr Spencer, who for some time has warned of the lack of safety and evidence for the gender-affirming treatment approach, said Ms Fentiman’s comments were contradictory.

“The minister, on one hand, is acknowledging that a review is required because evidence is emerging in this area but then, on the other hand, she has largely restricted the review to considering whether the gender clinic is fulfilling the recommendations of the so-called ‘Australian Standards of Care’,” Dr Spencer told GCN.

“This document does not include any recent research. It doesn’t refer to any research that has been published since 2018. It was written by trans-activist clinicians. It needs to go straight into the bin.

“The review panel needs to be independent so that staff of Children’s Health Queensland [which runs the Queensland Children’s Hospital and its gender clinic] can come forward to discuss their concerns about the gender clinic’s model of care. They need to know that they can raise their concerns without losing their job. 

“There are a lot of child psychiatrists in Queensland waiting on the outcome of this review. We all want the review to put an end to this medical scandal.”

After many months attempting to raise concerns about the gender-affirming model within the Queensland Children’s Hospital, and following a complaint of “transphobia” from a troubled teenager, Dr Spencer was suspended from clinical duties last year.

Dr Spencer, whose work as a senior specialist in the children’s hospital brought her into contact with gender clinic patients, has highlighted hospital-wide employment contracts which mandate the gender-affirming model, thereby excluding the normal professional judgment of clinicians about how best to treat patients.

She said the panel reviewing the gender clinic “needs to be given the capacity to review a decent number of randomly selected, de-identified individual case files of past and present patients.”

“They need to be able to see just how badly the clinic is functioning—that the clinic is affirming children with very complex backgrounds and developmental disorders, placing them on puberty blockers from the start of puberty and prescribing cross-sex hormones from as early as age 14.”

Video: “My obligation to my employer to keep the harm to children secret, clashes with my obligation as a psychiatrist to speak out…”—Dr Spencer

“Given that the non-reproductive, neurological role of GnRH [gonadotropin-releasing hormone, analogues of which are used to suppress puberty] has been discussed for decades and is based on studies from many centres throughout the world, is it odd that the only people who appear to be, at best, unaware of its implications are practitioners in gender clinics for children who blithely seek to assure, from Tavistock to Melbourne, that ‘blockers are safe and entirely reversible’ and continue to administer them to vulnerable children.

“Does this represent an inability to pursue literature relevant to their speciality? Or does it represent the power of what can only be understood as ideology? After all, there is much more warning about the side effects of blockers than there ever was over the side effects of thalidomide on developing babies.”—Professor of paediatrics Dr John Whitehall, article on puberty blockers (GnRH analogues), Quadrant Online, January 2024

Evidence or dogma?

Although Minister Fentiman’s remarks in The Sunday Mail emphasise the volume of recent research in the field of youth gender dysphoria, an internal government document says that, apart from benchmarking the gender clinic against the RCH treatment guideline it already uses, the review will merely “consider international practice relevant to Queensland services.”

This could mean nothing more than a study of the clinical practice of other clinics wedded to the poorly evidenced gender-affirming treatment approach.

Psychiatrist Dr Stephen Stathis, who founded the Queensland gender clinic, recently acknowledged that the evidence base for medicalised gender change with minors is of low quality and conceded there are questions about the reversibility of puberty blocker drugs.

The highest quality recent studies on the use of puberty blockers and cross-sex hormones for minors with gender dysphoria are the systematic reviews of the evidence base carried out since 2019 in Finland, Sweden, the United Kingdom and the American state of Florida.

Those systematic reviews have independently found the evidence base for hormonal treatment of youth gender dysphoria to be very weak and uncertain, meaning there is no firm basis for the mental health benefits claimed by gender-affirming clinicians. As a result, key public health authorities in Europe have abandoned gender-affirming treatment policy and restricted hormonal interventions for minors.

“[There is] medical consent discrimination impacting trans young people when there is one opposing parent or a parent not in the picture, and we urgently need legal reform to instil equal rights for all young people, including trans people who want to consent to their own bodily autonomy and access to healthcare.”—Trans activist Jeremy Wiggins of Transcend Australia, a member of the panel reviewing Queensland’s gender clinic, criticises family law requiring court approval when one parent resists gender medicalisation of a minor, Churchill Trust video

Sceptics not welcome

The Queensland review panel includes at least three members of the gender-affirming lobby the Australian Professional Association for Trans Health (AusPATH), which opposes exploratory therapy.

One of those panel members is AusPATH president Professor Ashleigh Lin, who claimed in a recent media interview that Europe’s shift to a more cautious stance on gender medicine was the result of influence by an “anti-child and [anti]-adolescent-affirming lobby”. No evidence for this claim was presented in the article.

The panel does not include any of Australia’s well-known expert critics of the gender-affirming treatment pathway.

However, it seems likely that the panel’s chair, psychiatrist Dr John Allan, will be aware of the wider debate about the gender-affirming model and the dogmatism of its advocates.

He was president of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in 2019 when it quietly disendorsed the RCH treatment guideline and decided to take a closer look at the evidence for its recommendations.

The resulting 2021 RANZCP gender dysphoria policy said that “evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate.”

The college’s updated 2023 policy notes that, “Some individuals report they have been harmed by previous gender-affirming care and some have launched legal proceedings against healthcare providers.”

Time to treatment

Systematic evidence reviews in the UK were followed by a decision to close the London-based Tavistock gender clinic and no longer give puberty blockers as routine treatment, instead confining them to clinical trials such as are used to test experimental drugs.

Dr Spencer said the Queensland review should ask why the gender clinic had persisted with a three-session triage and assessment model—one 90-minute session, then two 60-minute sessions before any medical intervention—when the Tavistock service, with its model of four-six assessment sessions, had been judged “inadequate” (the lowest rating) in 2021 by the UK Care Quality Commission.

Dr Spencer said she was aware of a case in which it appeared that the Queensland clinic had given puberty blockers to a 12-year-old girl with complex family problems after one session involving minimal answers from the child to assessment questions.

Note: GCN has sought comment from the Queensland government and acknowledges that gender-affirming clinicians believe their interventions benefit vulnerable youth