Shine a light
Australia's Senator Claire Chandler calls for an inquiry into gender clinics
A rising star of Australia’s centre-right Liberal Party, Claire Chandler, has called for an independent expert inquiry into medicalised gender change for minors.
Senator Chandler suggests a national inquiry into the evidence for treatment of young patients diagnosed with gender dysphoria could be modelled on England’s independent review led by paediatrician Dr. Hilary Cass following controversy over the London-based Tavistock gender clinic.
In an interview with GCN, Senator Chandler said: “We know that in Australia there has been a huge explosion in the number of young children accessing care at gender clinics.
“We don’t necessarily know exactly how all of these children are being treated, whether or not the way they are being treated is beneficial for their circumstances, whether or not it’s having good clinical outcomes.”
The number of minors enrolled in state children’s hospital gender clinics rose from less than 500 in 2016 to more than 2,000 in 2021, with the biggest caseloads in the states of Victoria and Queensland.
In Australia’s federation, the states deliver health while also drawing on federal funding; states pay for puberty blockers and cross-sex hormones enjoy federal subsidy.
Chart: Demand surges at Australia’s gender dysphoria clinics in children’s hospitals
Europe’s turn to caution
Senator Chandler cited official findings in Finland, Sweden and England that the puberty blockers and cross-sex hormones given by gender clinics internationally are based on very weak evidence and carry risks of harm and troubling uncertainties.
In each country, the recent policy advice is to restrict access to these hormonal treatments for minors, especially puberty blockers, which England’s National Health Service will confine to clinical trials as an experimental intervention.
Senator Chandler has been raising concerns for more than two years about the risks to vulnerable children from invasive medical treatments and the lack of good public data on the operation of gender clinics.
In the last few months, an Australian child and adolescent psychiatrist Dr. Jillian Spencer has become a rallying point for growing clinical disquiet over the dogmatic “gender-affirming” treatment model and its poorly evidenced hormonal and surgical interventions.
She went public with her criticism of the American-influenced gender-affirming treatment model after she was stood down from her job as a senior staff specialist at a public children’s hospital in Queensland; she was reportedly accused of “transphobia” after an interaction with a young patient from the gender clinic.
Dr. Spencer has argued that the gender-affirming model forces clinicians to go along with the social and medical transition of children despite the evidence base not showing that the benefits outweigh the risks and harms.
“It is incredibly distressing to be forced into harming other people’s children, or otherwise face potential loss of one’s career, livelihood or to be cast out of the workplace, as has happened to me,” she said at a Sydney women’s forum last month.
Earlier this month Dr. Spencer began circulating a petition for health practitioners who want an independent inquiry “to guide Australian doctors in what treatments for children are safe to be delivered, at what age and under what conditions.”
By last night, she had signatures from 36 child psychiatrists, 33 adult psychiatrists, 22 general practitioners and 10 paediatricians straddling all six states, albeit mostly concentrated in the three eastern states of Queensland, New South Wales and Victoria.
“Sadly, lots of people have contacted me to say they’re too scared to give their details,” Dr. Spencer said.
In September 2019, after The Australian newspaper began subjecting gender clinics to scrutiny, doctors launched an online petition for a parliamentary inquiry as requested by professor of paediatrics Dr. John Whitehall.
They collected 260 names in three and a half days before a spam attack by activists forced closure of the petition.
The signatories included 20 professors or associate professors, 14 paediatricians, 20 psychiatrists (nine of them child psychiatrists), and “many other doctors with a shared concern about the epidemic of childhood gender dysphoria and the lack of scientific basis for its current treatment”, organisers said.
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This week, the medical indemnity fund MDA National, which on July 1 cut back its coverage of private doctors involved in risky medicalised gender change for minors, has noted the renewed push for an inquiry in Australia.
“We understand that there is a growing number of professionals and politicians requesting an urgent review of the research to ensure that children and adolescents presenting with gender dysphoria and incongruence have the very best medical care,” MDA National’s spokeswoman told GCN.
She was responding to a decision by the Australian Medical Students’ Association (AMSA) to disaffiliate from MDA National on the grounds that its July 1 policy change would reduce the supply of youth gender medicine. AMSA’s statement claimed that gender-affirming treatment was based on “high-quality evidence” but did not reply when asked for references.
MDA National said it was disappointed at AMSA’s decision—the insurer had sponsored association events—but stressed that its main duty was to protect its doctor-members from “the risk of potentially high-value claims.”
The spokeswoman said the fund would “continue to monitor the legal landscape of this area of emerging risk and will update our policy coverage to reflect any changes in medico-legal risk as required in the future.”
Litigation by regretful detransitioners has begun in Australia, Canada, the United Kingdom and the United States.
“[The health professional defendants] lied when they told Prisha she was actually a boy; they lied when they told her that injecting testosterone into her body would solve her numerous, profound mental and psychological health problems; and they lied when they told her about the nature and effects of ‘breast reduction’ surgery, which in actuality was a surgery to remove her healthy breasts and render her incapable of nursing a child (should she even be able to conceive one, which, due to her taking testosterone for years, may not be possible)”—court complaint of 25-year-old detransitioner Prisha Mosley, North Carolina, U.S.,17 July 2023
This week Australia’s National Association of Practising Psychiatrists (NAPP)—which in 2020 issued a cautious, less medicalised policy on managing youth gender dysphoria—restated its view that a proper inquiry into gender clinics is needed.
“We support an objective national inquiry headed by a panel of experts that allows all sides of the debate to be expressed,” NAPP president Dr. Philip Morris told GCN.
“But the bottom line is that the inquiry must be based on the evidence base, not opinion.”
The Royal Australian and New Zealand College of Psychiatrists, a larger group than the NAPP, is expected to publish its updated position statement on gender dysphoria “later this year”, the president Dr. Elizabeth Moore has told members.
In 2021, the college adopted a more cautious policy, noting the “paucity of quality evidence” on treatment outcomes and acknowledging 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 policy was denounced as “inappropriate and harmful” by a group of Australian and New Zealand advocates of the gender-affirming way.
From March-September 2019 the college’s LGBT mental health policy had explicitly endorsed the gender-affirming treatment guidelines promoted as “Australian standards of care” by the Royal Children’s Hospital Melbourne, which is home to the country’s most influential gender clinic. Those guidelines have come under intense scrutiny.
Video: Senator Chandler denounces inquiries that went nowhere
In the hunt
After critical coverage of gender clinics began in mid-2019 in The Australian, the then health minister Greg Hunt asked the Royal Australasian College of Physicians (RACP) to conduct a review.
In March 2020 the RACP sent Mr. Hunt a four-page letter of advice. It did not describe gender clinic medical treatments, nor discuss their risks; there was no mention of less invasive treatment options.
Instead, the RACP asserted that the national inquiry being sought by some health professionals “would further harm vulnerable patients and their families through increased media and public attention.” No evidence was offered for this claim.
It emerged that the RACP, which trains paediatricians, had previously lobbied for cheaper, quicker access to the medical treatments it was called upon to evaluate for Mr. Hunt. The RACP did not reply when asked at the time if it had a conflict of interest.
Mr. Hunt then gave public assurances that a federal-state body of health officials—the Health Chief Executives Forum—would deliver a new, uniform model of clinical governance across Australia’s gender clinics and a common system for proper data collection. Nothing appears to have come of this.
GCN understands that in response to recent questions from members, the RACP has—
claimed that the Health Chief Executives Forum has not responded to its request for an update on the promised progress towards a national approach to gender clinics
acknowledged that its 2020 advice to Mr. Hunt “did not comment on specific clinical issues such as the use of puberty blockers and other treatments”
conceded that much has happened in the field of gender dysphoria in Australia and internationally but says it has no plans to update the advice it gave to Mr. Hunt
stated that it does not intend to develop clinical guidelines or position statements on the treatment of gender dysphoria
Against this background, Senator Chandler said an expert inquiry independent of government was “clearly required to lay the facts on the table and stop the buck-passing and the culture of silencing that everybody from parents to medical professionals to journalists have experienced and have been targeted with in this debate.”
She said the inquiry would also have to be independent of “the youth gender industry.”
“We can’t be in a situation where the [gender clinic] industry, which has in effect created its own rules, is then put into a position of reviewing those rules,” she said.
“And [the inquiry] must be run in a very transparent and evidence-based way that takes into account some of those international findings that we’ve seen in other jurisdictions [such as Finland, Sweden and England.]”
In the Australian Senate’s next sittings, starting on July 31, there is expected to be a vote on a motion for a committee inquiry into youth gender medicine.
Moved last month by Senator Pauline Hanson of the populist-right One Nation Party, the motion urges inquiry into questions including—
“whether children are being rushed into gender reassignment treatment”
“whether psychiatrists such as Dr. Jillian Spencer … who question the use of puberty blockers without an appropriate mental health assessment are being silenced”
“whether Australia should follow the United Kingdom and many European countries in adopting a more cautious approach to the prescription of puberty blocking drugs, amid concerns the evidence base for their efficacy is lacking”
“whether the Commonwealth should take a greater oversight and regulatory role in the prescription of puberty blockers and cross-sex hormones to children following the admission from the federal government that it has no idea how widely the drugs are being prescribed off-label for gender dysphoria”
Asked about this proposal, Senator Chandler said a parliamentary committee inquiry would be better than no inquiry at all, but the numbers in the Senate would not favour an independent inquiry, and in any case, it would be better for an inquiry to be “removed from politics, if possible.”
The ruling centre-left Labor Party (with 26 of the total 76 senators) is seen as uncritically committed to the gender-affirming model, while the Australian Greens, with 11 senators, have lobbied for a taxpayer-funded expansion of these medical treatments.
The Liberal-National opposition, with 31 senators, will have a conscience vote on Ms Hanson’s motion. One Nation has two senators.
Note: GCN sought comment from federal Health Minister Mark Butler and Assistant Minister for Mental Health and Suicide Prevention Emma McBride