Probe the clinicians

A historic forum in Australia hears pleas for an inquiry into gender clinics

Photo by Hush Naidoo Jade Photography on Unsplash

The gist

An inquiry into gender medicine in Australia would scrutinise the clinicians who promote these life-altering medical interventions, not the children who are their patients, paediatrician Dr Dylan Wilson has pointed out.

“There is nothing to be lost by an inquiry,” Dr Wilson told a historic forum on the implications of medicalising children with gender dysphoria held this week in the Australian state of Victoria.

“The scrutiny only needs to be placed on the medical professionals advocating for this treatment, there is no need to scrutinise children,” he said.

“Only medical professionals who fear such scrutiny would object [to an inquiry]. If they strongly believe in the [“gender-affirming” medical] pathway for which they advocate and commence [new patients], what would they have to fear?”

The October 3 event with the title “Child Safeguarding and Consent Forum” was staged in Melbourne at Victoria’s Parliament House and brought together politicians, medical and legal critics of invasive gender change for minors, as well as two detransitioners who regret irreversible treatment, and journalists.

Video: Psychiatrist Jillian Spencer talks to Libertarian Party politician David Limbrick (both also spoke at the Melbourne forum)

What ministers get told

Last November, six months after Mark Butler was sworn in as Australia’s federal Health Minister, he was briefed by his department on the debate over the best response to the fast-rising number of children diagnosed with gender dysphoria.

The briefing note conceded that the reasons for the increase in gender dysphoria were unknown but went on to warn Mr Butler of “possible harm caused to trans kids through public inquiries”.

The note repeated the unsupported assertion by the Royal Australasian College of Physicians (RACP) in 2020 that a national inquiry into gender clinics “would further harm [already] vulnerable patients and their families through increased media and public attention.”

After this 2020 RACP advice to Mr Butler’s predecessor as health minister, Greg Hunt, it emerged that the college had previously lobbied for easier, cheaper access to the puberty blocker and cross-sex hormone treatments it was asked to review for the minister.

Earlier this year, it was revealed that the RACP had failed to pass on to Mr Hunt serious concerns about the gender-affirming model expressed by endocrinologists, who were consulted as the experts in hormonal treatment.

Also this year, in a letter of reply to a concerned doctor, the RACP stated that its 2020 advice to the health minister “did not comment on the specific clinical issues such as the use of puberty blockers and other treatments.”

Mr Hunt did not heed requests for an inquiry into gender clinics, instead referring the issue to a federal-state forum of top health bureaucrats whose deliberations appear to have produced no result.

The November 2022 briefing note for Mr Butler includes contentious claims, such as—

“Research shows that puberty suppression typically relieves distress for young people experiencing gender dysphoria.

“Puberty suppression… is reversible in its effects.

“Prior trauma, mental illness and other conditions would be considered in the clinical and psychosocial evaluation of a young person presenting with gender dysphoria.

“A diagnosis of [autism spectrum disorder] will be taken into account in the therapeutic approach for young people experiencing gender dysphoria.”

There are also striking omissions, with the three pages of the briefing note released under Freedom of Information Law making no reference to the fact that systematic reviews in Finland, Sweden and England had found the evidence base for puberty blockers and cross-sex hormones to be weak and uncertain.

The consequent policy shift away from routine medicalisation in Finland and Sweden is not mentioned in the briefing note, and the account of England’s Cass Review of youth gender care says nothing of its fundamental concern about the rationale and effects of puberty blockers.

The use of puberty blockers to suppress natural but unwanted bodily development for “juvenile transsexuals” was pioneered by the Amsterdam gender clinic in the late 1990s, then disseminated internationally at ever increasing scale, especially by the American-led gender-affirming treatment approach.

“The complaint said that [America’s] Planned Parenthood violated the standards of care by prescribing [18-year-old] Fred estrogen without a thorough psychiatric assessment, and that his autistic traits had inhibited his capacity to consent. It also questioned whether 30 minutes was enough time for anyone to think through the implications of a permanent loss of fertility.”—news report, Aaron Sibarium, The Washington Free Beacon, 4 October 2023

The detail

At this week’s “Child Safeguarding and Consent Forum” in Melbourne, the paediatrician Dr Wilson challenged the claim by gender-affirming advocates that their hormonal treatments are “lifesaving” because they prevent suicide among transgender-identifying youth.

“There was no epidemic of gender-distressed children and adolescents committing suicide prior to the advent of this [affirmative] treatment pathway,” he said. “There has, therefore, been no drop in suicide in children as a result of this pathway being given.”

Dr Wilson noted that systematic reviews of the evidence base for puberty blockers and cross-sex hormones with minors had concluded there was “very low certainty” for any claim of mental health benefits.

Yet, as a paediatrician dedicated to helping children reach a healthy adulthood, Dr Wilson highlighted the “very high certainty” of medicine-inflicted “iatrogenic harm” by these hormonal interventions.

Early puberty blockers, as recommended by the gender-affirming model, followed by cross-sex hormones, are expected to sterilise children, with boys potentially rendered incapable of orgasm and synthetic testosterone exposing girls to pelvic pain and vaginal atrophy.

“These children reach adulthood without the ability to reproduce, they reach adulthood without the capacity to experience sexual pleasure—fundamental components of human existence are being denied for these children,” Dr Wilson said.

He invited the forum audience to, “Consider your younger self [at the onset of puberty around age 10-12]—could you have understood the future sex life you were giving up? Or the chance to have a family of your own?”

Dr Wilson said children were physically healthy when they entered gender clinics, and then suffered serious iatrogenic harm.

“They are sterilised, rendered asexual or sexually dysfunctional, have their bone density affected, have the effects of cross-sex hormones for the rest of their lives, have had their brains impacted to an unknown extent, and will be medical patients for life,” he said.

“It is not possible to go through the puberty of the opposite sex. It is not possible for humans to change sex.

“If you contrast very low certainty of improvements to mental health [promised by gender clinics], with a very high certainty of iatrogenic harm, why is this [gender-affirming] pathway still being administered?”

The myth of low regret

Dr Wilson said the frequent claim that fewer than 1 per cent of patients would regret medical intervention relied on dated surveys mostly of adults after surgery, with many former, potentially regretful patients unable to be found.

In today’s era of puberty blockers, adolescent females dominate gender clinic caseloads, and for these patients there is no long-term data on outcomes.

“If we do not know [long-term outcomes], how can children and their parents consent? The only way this is possible is if it is acknowledged that this is experimental,” Dr Wilson said.

“Experimental treatments should be supervised as part of experimental research trials.

“This is why in the UK, it has been determined and recommended by Dr Hilary Cass [who leads the independent review of healthcare for dysphoric youth], that puberty blockers only be commenced as part of a research trial.

“This is where the affirmative model is fundamentally flawed; the research trials are now following the assertion that this is standard medical care, instead of preceding this assertion.”

“We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time. NHS England recommends that access to [puberty blockers] for children and young people with gender incongruence/dysphoria should only be available as part of research.”—interim clinical policy, National Health Service England, August 2023

Questions unasked

Jay Langadinos, a young woman and detransitioner from Sydney, told the October 3 forum that she now understood her gender distress reflected trauma from not being accepted as a tomboy.

She said that prior to medicalised gender change she “wasn’t encouraged to explore my feelings and to discover where my distress came from, and I was fast-tracked onto hormones.

“If somebody had said to me, ‘What are you feeling? Why are you feeling it? Where do you think it’s coming from?’ I wouldn’t have transitioned, because then I would have realised that it was coming from trauma from my childhood.”

Another young female detransitioner, Mel Jeffries, who featured in last month’s De-Transitioning episode of the 7News Spotlight program, recalled the dismissive response from some people that she was “never really trans”.

She said the argument seemed to be that if she was trans, then the treatment was appropriate—but she would count as a genuine case of regret.

“But if I wasn’t trans, then that’s a failure of the medical system to not properly assess and figure out the underlying stuff,” she told the forum.

“I only just got an autism diagnosis early this year. So that was like, wow—that explains 90 per cent of my symptoms or experience.”

Likes and shares

Also presenting at the forum was Queensland psychiatrist Dr Peter Parry, who has almost 30 years experience in child psychiatry and a PhD in what he described as the “two-decade overdiagnosis epidemic” of bipolar disorder in very young children in the US, with potentially “several thousand deaths” from side effects of psychiatric drugs that most had not needed.

Dr Parry saw another potential medical scandal in the gender-affirming treatment model and the “inexorable rise” among teenage girls of gender dysphoria—a condition once very rare and typically confined to prepubertal boys.

He also drew parallels between the rapid increase in gender dysphoria and past episodes such as the satanic abuse panic and the epidemic in multiple personality disorder. And he said the causes of the current surge in diagnoses of autism spectrum disorder and attention deficit/hyperactivity disorder were still under debate.

“In terms of our biologically driven psychology, we are an animal species like any other that responds to positive reinforcement cues, especially to be in harmony with herd or tribe and the group narrative,” Dr Parry said.

He said the positive reinforcement driving the gender dysphoria epidemic included “social media likes and shares”, peer groups and new curriculum in schools.

“And another is the gender-affirmative care model that could well be retitled the ‘positive reinforcement model of care’,” he said.

Queensland child and adolescent psychiatrist Jillian Spencer, a critic of the gender-affirming model, highlighted for the forum audience a contradiction in the activist response to the epidemic of gender dysphoria.

“Despite claiming ongoing high levels of discrimination and abuse towards trans people, the gender activists will tell you that this incredible increase in adolescents presenting to gender clinics is all due to a reduction in the stigma of being transgender—this is a completely implausible claim,” she said.

If it were true, she said, there should be a dramatic increase in trans-identification in people of all ages across the lifespan, rather than an epidemic affecting mostly teenage girls.

She cited the case of progressive Sweden, which was the first country to legalise gender transition in 1972.

“Regardless of the lack of stigma in Sweden, they still saw a 1,500 per cent increase in gender dysphoria amongst females aged 13-17 between 2008 and 2018,” she said.

Dr Spencer noted that adolescent girls historically were the group most susceptible to “enacting social trends, particularly those related to distress turned inward.”

“There has been a strong social movement focused on enthusiastically celebrating and promoting trans people. This has been occurring online, through community events, in books, on our televisions and in schools,” she said.

“It is children and adolescents who are most sensitive to social cues and messages.

“When children and adolescents identify as trans, they are stepping into a role where they are perceived as brave, emotionally complex and misunderstood, and they feel they are part of an important social justice movement.

“This can understandably be an intoxicating persona for some adolescents. It can also be an escape from distress [over sexual abuse, for example] or a solution to social difficulties.”

Earlier this year Dr Spencer was stood down from clinical duties at the Queensland Children’s Hospital, which is home to a large gender clinic.

A patient of that clinic had lodged a complaint of “transphobia” against her.

She did not work in the clinic but for some months had been trying to raise concerns about the hospital-wide application of the gender-affirming model.

“In marketing their services, [University of Nebraska Medical Center clinicians and other Defendants] use pleasant sounding descriptions such as ‘masculinizing hormone therapy,’ ‘gender affirming hormones,’ and ‘gender affirming surgery for chest.’ The use of ‘therapy’ for these services is deceptive. The plain meaning of ‘therapy’ is ‘medicinal or curative’. The procedures marketed by Defendants are neither. Rather than healing, these procedures inflict harm that causes malfunctioning and malformation of the teenage body and brain.”—Complaint filed in US litigation brought by detransitioner Luka Hein, 13 September 2023

Flying blind

At the Melbourne forum, Dr Spencer pointed out there was no blood test or scan to confirm a diagnosis of gender dysphoria, making it “very dicey to be implementing such very serious long-term interventions on this basis.”

“It is important to know that gender clinics are not set up to provide mental health services.

“Their approach to assessing children and families is radically different to that of a child and adolescent mental health service.

“Because the gender advocates believe that the children presenting to gender clinics are naturally ‘trans’, the gender clinics are set up as medical clinics.

“Yet we know that the children presenting to gender clinics have incredibly complex mental health problems, and they are in desperate need of a proper mental health service.

“The gender clinics function as rapid assessment and treatment services—and the only treatment they provide is the affirmation model.

“From what I have seen is that, regardless of the complexity of the child’s background and presentation, the gender clinic always comes to the same conclusion.

“They conclude that the child’s gender dysphoria is ‘persistent, insistent and consistent’ [diagnostic catchwords], and should be treated with the affirmation model.

“Any other mental health or social problems the child is experiencing is attributed to that stigma of being transgender.

“And these problems are expected to resolve through treatment with social transition, puberty blockers, cross-sex hormones and gender surgeries.

“The concept of having a multidisciplinary team in a gender clinic is meaningless when everyone in the team is contractually obliged to follow the affirmation model, which is written into the gender clinic’s model of care.

“The information model is radically different from any other treatment approach in child psychiatry.

“Child psychiatry has always regarded the years of childhood and adolescence as a time of incredible growth and change.

“We have never regarded a child’s feelings or behaviours as fixed [unlike the idea of gender identity in which even preschool children are said to be ‘experts’, according to the gender-affirming model].

“We’ve always known that emotional and behavioural difficulties in childhood and adolescence ease with maturity.

“It is incredibly distressing for many of us working in child and adolescent mental health services to see how these gender clinics are operating.”