Protected species

Why are gender-affirming practitioners not held to normal standards of healthcare?

Photo by Cristina Hernández on Unsplash

Health professionals who practise any version of “gender-affirming” care have been a protected species for more than a decade, unlike those practitioners who express any concern about the medical and surgical treatment of young gender-questioning people or who acknowledge that transwomen are men.

Trans advocates are so committed to their position that no comment or disagreement with any aspect of gender ideology is too mild to avoid accusations of bigotry or transphobia—even failure to state your own pronouns. Sometimes these accusations go no further, but often a trans advocate will take the complaint as far as possible, confident they can punish the offending colleague. It is easy to find cases online of health practitioners who have had their careers sabotaged by formal complaints to a professional body or regulating authority.

However, to my knowledge, it is rare for a gender-affirming practitioner to be the subject of a complaint at any level, certainly not one that has led to any disciplinary action. Hence the significance of the recent complaint to the Australian Health Practitioner Regulation Agency against the country’s most influential gender clinician, Dr Michelle Telfer, for “alleged breaches of professional standards, potential professional misconduct and failure to provide sufficient informed consent to patients”.¹

The complaint was lodged in June this year, and the decision to dismiss it came earlier this month. I find it difficult to reconcile the outcome with the seriousness of the complaint, which was based on findings and criticisms made by Family Court Justice Andrew Strum in a dispute over whether to prescribe puberty blockers for a child. The evidence before him, including Dr Telfer’s, was tested by cross-examination. It is unclear what process was followed by AHPRA to come to its view, what evidence was considered and rejected. To my mind, this leaves room for doubt whether AHPRA has a predisposition to minimise concerns about gender-affirming care.

By comparison, consider the treatment of the whistleblower psychiatrist Dr Jillian Spencer, who last week was sent a notice of termination by her government employer, Children’s Health Queensland. She had raised concerns about gender-affirming care at the Queensland Children’s Hospital and was suspended from clinical duties in 2023. In her frustration and distress, she talked openly in public about her treatment, which became a useful trigger to dismiss her from her job, but this seems minor compared to the issues raised against Dr Telfer.

It’s a mystery to me how health professionals whom I would otherwise regard as competent and ethical have become enthralled by an ideological treatment approach which explicitly denies biological reality.

Practitioners should have been at the forefront of the move to challenge the theoretical underpinnings of the claims and demands by trans advocates for gender-affirming care. Instead, they amplified the cause by taking the high moral ground embedded in the standards of the World Professional Association for Transgender Health. These purport to provide healthcare that is “medically necessary” and even “lifesaving”. This is the ace in the hole, the defence that shuts down any questioning not only of healthcare but also of the legal encoding of our humanity. In July, Australia’s government would not even allow debate on a bill to restore the biological definition of sex in the federal Sex Discrimination Act, as if mere discussion would inflict harm.

Senator Katy Gallagher, manager of government business in the upper house, said—

“We do not agree with the Senate being a place where individual harm can be done to young people across this country. That is what would have happened had we allowed this bill to proceed in the normal course, and we won’t stand for it (Emphasis added).”

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Video: Lawyer Glenna Goldis explains the US legal context in which gender clinicians face increasing pressure for accountability

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Why?

It seems to me there are different categories of health professionals who comply with gender-affirming care such that they do not recognise any level of poor practice.

Cynical advocates of queer theory. Their aim is to break down societal norms about sex and gender, to upend any biological definitions of woman and man, and to discredit “heteronormativity” and instead legitimise any type of sexual attraction, including all of the many fetishes. They openly acknowledge they will use any tactic to achieve this, regardless of any damage and pain they cause.

A case in point is Chase Strangio, a transman and lawyer for the American Civil Liberties Union. The New York Times recently reported Strangio’s contribution to a planning meeting for an LGBTQ campaign against state legislation that mandated bathroom use according to biological sex—

“Strangio disputed that a trans woman could be ‘born with a male body’ or ‘born male’; in his view, a trans woman was born a woman just like any other woman. There was no such thing as a ‘male body,’ Strangio told his colleagues: ‘A penis is not a male body part. It’s just an unusual body part for a woman’.”

“[Elsewhere, Strangio wrote that] Many advocates defend the use of the ‘born male’ or ‘born with a male body’ narrative as being easier for non-transgender people to understand. Of course it is easier to understand, since it reinforces deeply entrenched views about what makes a man and what makes a woman. But it is precisely these views that we must change.”

True believers in gender-affirming care don’t see themselves as promoting an ideology. They genuinely believe that anyone who claims to be trans—child, adolescent or adult—is without question trans, and that failure to affirm them may cause them to suicide.

This is not just an intellectual position, but a passionately held commitment. I recall that during an online clinician forum, one gender-affirming colleague became so distressed by what he regarded as bigoted and ignorant comments that he cried, “I save lives every day!”, at which point the moderator ended the discussion.

Others know best. Some rely on the fact that other clinicians use gender-affirming care and assert it to be best practice, so they assume it must be appropriate and safe to affirm with minimal assessment.

False parallel. Some health professionals make an erroneous equivalence between trans belief and young people who question their sexuality, concluding it is kind and necessary to affirm a gender identity, despite any misgivings. This is encouraged by stories of the “conversion” practices, including aversion therapy, used on gay people in the past.

No gatekeeping. There are clinicians who take the view that even if an assessment is indicated for young people, adult males shouldn’t have to prove they are transwomen regardless of any paraphilia or fetish such as exhibitionism, transvestism or voyeurism.²

The messiah complex. Psychiatrist Dr Andrew Amos has described the quasi-religious mission he observes in some gender-affirming medical practitioners—

“Being a doctor is an extraordinary privilege. No other role demands the same level of trust and intimate engagement with people. The intensity of this relationship causes some doctors to develop an almost religious sense of their own importance to patients. They stop seeing themselves as health professionals and start seeing themselves as saviours. This is called the messiah complex, and it has allowed many doctors to justify physically harming patients in order to achieve some delusional higher goal.”

Look around

In my experience, many of these affirmative clinicians aren’t aware of the broader social issues that encourage young people to adopt trans beliefs, such as the influence on young people of the positive, rosy picture shown by pro-trans websites. But the power and influence of trans advocacy extends beyond health services into schools and universities, the law, workplaces, female single-sex rights and sport—it is hard to identify a sphere of public life where trans ideology is not privileged over the rights and needs of all others. Global Pride organisations have run an effective international propaganda strategy.

Queer theory advocates and their foot-soldier trans activists have been extremely inventive in refashioning society to fit their worldview. There are clear parallels between trans activism and aspects of totalitarianism. From the outset, trans activists mastered the arts of propaganda, coercion and punishment.

Trans ideology was introduced with a simple premise that most people could agree with—trans people exist and have the right to live without discrimination. However, the back story is that queer theory is in fact a political movement to reshape society, presenting itself as a champion of freedom, but in reality only if the individual adheres to queer dogmas. For example, all forms of gender and sexual expression, including those recognised as a paraphilia, are to be recognised as valid and not in any way challenged.

As interventions such as puberty blockers and cross-sex hormones became the default for gender-questioning children and adolescents, some health professionals began to question the safety of those treatments. At the same time, it was becoming obvious that some men who were claiming to be women were damaging female sex-based rights, and women began to complain.

Then the punishment began. Complaints against concerned health professionals became common, with the risk of depriving them of their authority to practise. In cases such as Tickle v Giggle, women who dissent from gender ideology can be exposed to litigation backed by government agencies and well-funded activist groups.

Gender ideology’s stated goal of individual freedom is a façade that requires the total capitulation of any who disagree. The ranks of those persecuted for challenging trans ideology include not only health professionals but also authors, business owners, lawyers, teachers, students, actors—no-one is immune.

The indoctrination begins at school. Children as young as five are taught their body parts may not match their gender, creating the risk of a “school-to-clinic pipeline” for minors persuaded they were born in the wrong body. Then there is the requirement for “inclusive language” in schools and workplaces, and the increasing list of options for sex and gender on questionnaires and client information forms, even in medical records.

Media corporations such as Australia’s public broadcaster, the ABC, and the Nine Entertainment Company, home to The Sydney Morning Herald and The Age newspapers, have imperilled their independence by taking part in “inclusion” programs which are Trojan Horses for trans ideology. An essential aim of such programs is to require the hiring of trans people or trans allies to key positions in management, giving them potential influence over media content. In this way, any views contrary to the trans propaganda may be suppressed, and the public only hears the approved narrative of the “vulnerable and marginalised trans community”. As a result, most people in the mainstream are unaware of controversial issues such as gender medicalisation of minors or education policies allowing students to socially transition without the knowledge or consent of parents.

Even so, change is coming, with some media outlets now publishing more frequent and detailed stories about the damaging consequences of trans ideology on gender-questioning children and adolescents, and the impact of the policy of gender self-identification on female rights.

Who benefits?

No doubt gender studies academics such as Judith Butler believed they were freeing individuals from restrictive social expectations by redefining terms such as girl, woman, boy and man to reflect personal beliefs or desires, rather than biological sex. In reality, however, trans goals are essentially about male rights and the normalising of all the paraphilias at the expense of females, while children are the collateral damage of a strategy to legitimise adult activities.

Trans policies also create powerful financial incentives. Pharmaceutical companies gain lifelong customers for their hormone drugs, gender clinics are given extra funding to reduce long waiting lists, and surgeons have been awarded a new market in body modification surgeries—all of which add to the politics of denial and punishment.

What for me is unforgivable is the capture of health profession associations such as the Royal Australian College of General Practitioners, the Australian Psychological Society (APS) and others who either actively promote gender-affirming care or fail to address the harm being done to children and adolescents. For example, the APS spent two years developing new guidelines for the assessment and management of gender-questioning people but have yet to release them.

Although the early victimisation of health professionals who criticised gender-affirming care was meant to be a warning to others, more and more concerned practitioners are making contact with each other and forming alliances to share their views and apprehensions. Some are saying out loud what many discuss privately. Dr Amos doesn’t hold back—

“[G]ender-affirming guidelines forbid the application of the core psychiatric competencies of phenomenology and psychopathology to the assessment of gender diversity. They substitute the political goal of expanding personal liberty for the evidence-based medicine processes of clinical reasoning, rendering them incompatible with competent, ethical medical practice.”

Efforts to roll back gender-affirming care are rightly focused on preventing harm to gender-confused children and young people. However, the harm extends beyond the use of drugs and surgery to permanently alter a young person’s physical and mental characteristics. Just as concerning is the impact on youth of propaganda that continually repeats words such as “marginalised” and “suicidal”; this can drill into the young people’s perception of themselves.

Yet this theme of vulnerability continues even after transition, despite the reality that gender-questioning young people are now supported by governments, have their own healthcare services, are protected by law and feted with regular Pride days, and the trans flag flies prominently.

Failed model

While there are many health practitioners acting in good faith, the deep and damaging flaws in gender-affirming care can no longer be ignored by the profession.

This model of care fails to—

offer guidelines on how to identify those most likely to benefit from treatment and those who are a poor risk;

offer an alternative for those who may do better with other forms of care;

ensure that young people are given a sound and detailed explanation that no treatment can change their sex;

recognise it is impossible for children and adolescents to give informed consent to treatments that are irreversible, given the full consequences will take years to be realised.

As things stand, training on the assessment and management of gender-questioning clients takes the form of a brief workshop where it is not permitted to challenge what is being taught. This must change. Courses across the health disciplines must encourage a robust examination of all the contentious issues, grounded in biological reality.

Those practitioners who do speak out and refuse to be silenced, despite the threat to their reputation and employment, can take some comfort that more and more colleagues are supporting their stand. It is important that concerned health practitioners pressure their professional associations to put in place policies and guidelines that safeguard gender-questioning children and young people from gender-affirming care as it is currently practised.

Credit must also go to the increasing numbers of detransitioners who have braved abuse to tell their stories. Their poor treatment by clinicians is inexcusable, and is further evidence that gender-affirming care is about ideology, not sound practice.

Lawsuits against gender-affirming clinicians are beginning, which is not surprising given that many of the young people who were transitioned will grow up and realise they have been sold a lie. In my view, it isn’t good enough for practitioners to claim that gender-affirming care is a widely accepted practice, and that they have just been doing what everyone else was doing. The flaws in gender-affirming care are obvious. It rests on the denial of biological science and abandons the essentials of good clinical practice.

It is important to keep in mind that trans activism is a political movement, not a health initiative. Although trans activists try to claim similarities with gay rights and women’s liberation, there are significant differences. While both those movements wanted social change—women fought for equality with men, and gays fought to be respected as a normal variation in sexuality—neither relied on medical or surgical treatment to achieve their goals.

Dr Sandra Pertot retired not long ago after 50 years of practice as a clinical psychologist specialising in human sexuality, including sexual dysfunction, sexual orientation and gender diversity

CGN does not dispute that gender-affirming clinicians believe their interventions help vulnerable minors

1. After Dr Telfer was identified as the subject of heavy criticism in April’s re Devin ruling by Justice Strum, the Royal Children’s Hospital Melbourne issued a statement in her defence—“Associate Professor Michelle Telfer is a highly respected paediatrician, expert in adolescent medicine, and fierce advocate for the health and wellbeing of all children and young people. Throughout her career, [her] leadership has been instrumental in improving the research and clinical care of all children, in particular trans or gender-diverse children and adolescents, and those experiencing gender dysphoria.”

2. A paraphilia is defined as “an experience of recurring or intense sexual arousal to atypical objects, places, situations, fantasies, behaviors, or individuals. It has also been defined as a sexual interest in anything other than a legally consenting human partner.”