Quackery in a hurry

How 'gender-affirming care' got around the defences of commonsense and medical standards

Harbourside institutions of old Hobart, Tasmania. Photo by K8 on Unsplash

A scandal for the ages

Ordinary people less alert to “quackery”; the effects of clever marketing and well-connected lobbying; and the failure of normal quality and safety checks—all these have combined to produce a “gender-affirming” medical scandal likely to be studied for decades to come, according to Australian whistleblower psychiatrist Dr Jillian Spencer.

“Gender interventions have been marketed as a highly sophisticated health treatment, which worked to put it outside the realm of public debate,” Dr Spencer said last week at Women Speak Tasmania’s forum on youth gender distress held at Parliament House, Hobart, and hosted by MP Carlo Di Falco.

Dr Spencer, who faces dismissal for raising concerns about the safety of gender-affirming treatment mandated at the Queensland Children’s Hospital, said this model’s “supposed basis in health expertise functions to set aside the reasonable reservations held by members of the general public based on their own experience of childhood and adolescence as a period of immaturity and experimentation with identity”.

“I think it was the enigma of psychiatry that has provided a cover to make it seem normal to transition children, and none of this could have happened without the small group of gender-activist clinicians who subscribe to bizarre false ideas that there are more than two sexes, that a child can be born in the wrong body, and that people can change sex.

“Unfortunately, these days, people aren’t so alert to quackery. With the scientific progress of medicine, the general public lost awareness of the phenomenon of doctors providing discredited interventions for their own personal or professional reasons. We all forgot about the issue of the snake oil salesman.

“But when members of the general public come to understand what has been done to children, they become alarmed and angry.

“The existence of a powerful and well-funded political lobby championing these interventions means that we require decisive political measures by politicians to stop the harm.

“In my opinion, state-sanctioned harm to children has a nasty stench that will permanently attach to any politician who has endorsed the gender clinics. So, I encourage politicians to get it on the record as soon as possible that they do not support the transitioning of children.”

“Moral narcissism is active when one prioritises one’s own moral self-image over the social or actual consequences of one’s actions. So, to put it very simply, ‘it is better to appear good than to do good’. Moral narcissists seek attention for perceived rather than actual righteousness.

“The politicians and trans activists in this country suffer from moral narcissism. They have abandoned science and logic because they do not advance their own moral authority.”—psychologist and author Dr Dianna Kenny, Hobart forum

Gender co-opts grief

Dr Spencer recalled the case of a patient encountered in the Queensland Children’s Hospital mental health unit whose plight first led her to put her concerns in writing to the authorities in 2019.

Admitted with suicidal ideation, this girl had suffered the sudden death of a parent.

“It was clear that she was grieving and feeling really miserable and isolated and really struggling to find her place in the world, and she told me that she was really a gay man,” Dr Spencer said.

“She was seen by the gender clinic. When I looked at the notes from the gender clinic, I saw that she had said very little during her appointment. Nonetheless, she was started on puberty blockers from that first appointment.

“At that time, I hadn’t looked into the research enough, so I was placated in my concerns by the gender clinic telling me that they knew how to identify those children who would have an enduring trans identity, and they said she was one of them.

“It took me a couple of years to figure out that this is absolutely untrue. There is no way to predict if a child will persist in their gender distress. Studies from before the affirmation model clearly show that the vast majority of children won’t persist in their distress.

“The people working in gender clinics internationally are activists, and they conduct dodgy research to justify transitioning children. There are so many studies that falsely claim to have proven that there are benefits.

“The studies have issues like small number of subjects, short follow-up time frames, high dropout rates, outcome measures that aren’t validated, and the reporting of marginal results as highly positive. If one small sub-scale on an outcome measure improves by a couple of points after a couple of months, they’ll tell you that the interventions are improving the patient’s mental health.”

Dr Spencer said that in the five years to 2022, she observed “the gradual intrusion of more and more gender ideology” at the Queensland Children’s Hospital that is home base to the statewide gender service.

There were staff workshops on gender and pronouns, the proliferation of “a ridiculous amount of LGBTIQA+ signage and transgender pride flags”, and clinical case discussions “where we were pretending the child patient was the opposite sex”.

“And it was considered transphobic if you wanted to try to assist the child to feel comfortable in their own body”.

She said trans pride flags and other symbols of gender ideology in the hospital workplace were intimidating for staff who dissented, and the associated new language of affirmation—such as sex assigned at birth, gender identity and cisgender—also exerted social pressure to conform.

“The special language interferes with the relationship with the child’s family, as it signals that the clinician is not willing to explore the child’s relationship to their biological sex,” she said.

It also “imposes the political agenda onto parents, and I am constantly contacted by desperate parents who are trying to find a non-affirming doctor or therapist for their child”.

“The most compelling, yet least discussed, causative factor in institutional capture is social contagion. The same social forces that are influencing our young [gender-distressed] people are also affecting the bedrock social institutions that underpin our society. These in turn affect parents, teachers, doctors, lawyers, politicians and sporting officials.

“[In 1852 the author Charles Mackay wrote] that ‘Men think in herds, they go mad in herds, while they only recover their senses slowly and one by one’. Social contagion is embedded as a characteristic of human groups.”—Dr Dianna Kenny, Hobart forum

This is not medicine

In his Hobart presentation, academic psychiatrist Dr Andrew Amos said the pursuit of political rather than medical goals explained the unusually “rapid roll-out” of paediatric medical transition.

“Gender-affirming care in Australia doesn’t actually require the diagnosis of an illness to start vulnerable kids on a treatment pathway of social transition, puberty blockers, hormones and eventually the amputation of sexual organs,” he said.

Instead, there were just two requirements.

“First, for a child to say or do anything that a clinician can interpret to mean that their gender identity, which has no fixed definition, does not match their biological sex, and second, for the child to request gender-affirmative treatment,” he said.

“So, this protocol lacks all of the traditional features of medical treatment designed to protect patient safety and improve patient health. It doesn’t require the diagnosis of the disease.

“Gender-affirming care is designed to affirm an identity, not to treat an illness. Not unrelated, it has never been reliably demonstrated to improve patient health or mental health, and in fact, its advocates are now starting to say openly that the goal of gender-affirming care should be respecting patient autonomy, not improving patient health. They are moving the goal posts.

“Given that gender-affirmative care is not medical treatment of an illness, what is it? Well, advocates have explicitly described access to gender-affirmative care as a human right, and consider the refusal to provide it—based on usual medical safeguards—as the denial of that human right.

“Now, demanding the provision of a human right is a political act, while refusing treatment because it will harm a patient is a medical act, and I think this proves that paediatric gender medicine has been set up across Australia in response to political demands, not in response to requests for medical treatment.”

Although Dr Amos said trans ideology had been adopted across the medical, legal and educational systems, he argued the highest priority for pushback should be reform of Australia’s federal Sex Discrimination (SDA) Act.

In 2013, under the country’s first female prime minister Julia Gillard, amendments to the SDA removed biological definitions of the terms man and woman, and introduced as a protected characteristic the subjective concept of gender identity unmoored from birth sex.

Asked after the Hobart forum why he gave priority to this legal reform above a prohibition on paediatric medical transition, Dr Amos said—

“The replacement of sex by gender in Australia’s Sex Discrimination Act in 2013 gives legal cover for clinical activists to ignore the reality that transsexualism is a form of mental illness. Without this legal fiction it would be self-evident that affirming a gender different from sex is as unethical as reinforcing an eating disordered patient’s delusion that they are overweight when in reality they are malnourished to the point of death.

“In my opinion, the harms done by paediatric gender-affirming care are just symptoms of a more fundamental disease, which is the replacement of sex by gender in Australian legislation. Sex describes a reality of human nature, which is that men and women are meaningfully different and have specialised in ways that are complementary, mutually beneficial to men and women, and essential for the physical and psychological health of children.

“Gender and gender identity are concepts without clearly defined meanings which were more or less explicitly created to obscure the realities that there are two sexes, that it is not possible to change sex, and it is psychologically harmful to pretend it is possible to change sex.

“Depending on your interpretation, changes to the SDA in 2013 either gave gender equal status with sex, or replaced sex as a protected characteristic in Australian law. In my opinion, this was the equivalent of giving legal protection to anorexic patients’ right to assert that their delusional self-perception of being overweight has equal status with a doctor’s medical evaluation that they are at risk of death due to malnourishment.

“In effect, replacing sex by gender in law obscures the reality that the belief that one has a gender that is distinct from sex is a form of mental illness that requires psychological treatment, and satisfies the fantasy that it is possible for human beings to change sex.”

“Vladimir Lenin said, ‘Give me four years to teach the children and the seed I have sown will never be uprooted’.

“The trans ideologists have taken that very much to heart. They’re indoctrinating our preschoolers and our kindergarten children. Our schools are telling children about gender ideology, indoctrinating them.

“Children are told that men can have vaginas and girls can have penises. This can be very, very confusing and destabilising for young children.”—Dr Dianna Kenny, Hobart forum

Do no harm

Dr Philip Morris, president of Australia’s National Association of Practising Psychiatrists (NAPP), delivered his Hobart talk, via web-link, on the tension between the trans-depathologisation campaign of activists and the ethical duties of physicians.

“The history of homosexuality [which was removed from the diagnostic manual of mental disorders in 1973] has fuelled expectations among transgender advocates that a similar process of normalisation can occur for gender diversity, but the comparison is imperfect,” he said.

He pointed out that, unlike same-sex attraction where no doctors need be involved, trans identity not uncommonly comes with a demand for medical interventions, which in turn activates the principles of the Hippocratic Oath.

“The first is, Do no harm. The second is that the patient’s welfare is the primary focus of the doctor,” he said. This required a careful—and differential—diagnosis.

“The symptom of gender dysphoria is one thing, but the syndrome is another, and the syndrome may be caused by other underlying conditions, such as depression, in rare cases psychosis, or it could be because there’s substantial psychiatric comorbidity clouding the picture,” Dr Morris said.

He said the physician had to identify evidence-based treatment and be convinced that the benefits outweigh the risks—“and this is very difficult, because in the field of gender dysphoria treatment, the literature base is very weak”.

“The doctor has to be able to communicate the risks of the treatments to the young person and their parents, which means [the doctor needs] to know what the risks are to be able to communicate that,” he said.

Finally, “the doctor has to determine that there is capacity for both the young person and the parents to understand what the treatment is—and what the adverse effects might be—in order to be able to make fully informed consent”.

Dr Morris said this clinical framework had been encapsulated in the NAPP guide for “Managing gender dysphoria in young people”, which he said offered practitioners a beneficial, cautious, compassionate and non-ideological approach to treatment.

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GCN does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable young people.

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