Silencer

Gender identity activists are quick to fire off complaints to a regulator with questionable impartiality

Australia’s health profession regulator Ahpra celebrates the International Day Against Homophobia, Biphobia and Transphobia

The gist

Australia’s health profession regulator has been warned not to allow activists to misuse the complaints process to silence legitimate concerns about the dominant “gender-affirming” treatment approach.

“Many health professionals have told me about their disturbing experiences of being accused by [gender-affirming] colleagues of trying to deny clients ‘lifesaving’ interventions, of being transphobic, or being incompetent because [gender-affirming] care is ‘best practice’,” clinical psychologist Dr Sandra Pertot said in a letter to the Australian Health Practitioner Regulation Agency (Ahpra) earlier this year.

“When all dissent is shut down, it is easy to make the case that ‘the science is settled’.”

Dr Pertot faced a formal complaint in 2021—the first in her career spanning five decades—after she commented in a podcast on the risky absence of differential diagnosis in the gender-affirming treatment model. The complaint went to the Australian Psychological Society, which upheld the legitimacy of differing views in the gender dysphoria field.

Partisans of the gender-affirming model assert the primacy of a self-declared “gender identity” floating free from biological sex, and insist that transgender and non-binary identities be affirmed, sometimes with invasive medical treatment to align the physical body with the felt identity.

Although gender-affirming clinicians claim mental health benefits for minors given puberty blocker drugs and cross-sex hormones, systematic reviews have found the evidence base to be weak and uncertain. Public health authorities in Finland, Sweden and England have shifted away from the confident gender-affirming model to more cautious treatment policies.

The Royal Australian and New Zealand College of Psychiatrists, which used to endorse gender-affirming guidelines for treatment of dysphoric minors, declares in its current policy 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.”

Therapists who express the view that the gender-affirming model is flawed or unsafe have been met with complaints to regulatory, professional and scholarly bodies; have been denounced to employers, stood down or dismissed; had speaking engagements cancelled or social media accounts suspended; and been subjected to online campaigns smearing them as bigoted transphobes.

“[British] Cabinet Secretary Simon Case was told in a letter signed by 42 [Whitehall] staff from 16 departments that ideology on gender promoted by trans activists has become embedded in the Civil Service in a ‘significant breach of impartiality’. It says the concept that ‘everyone has a gender identity which is more important than their sex’ is ‘treated as undisputed fact’. Staff who dare to air gender-critical views—meaning they believe there are two biological sexes that cannot be changed—suffer ‘serious harassment’ at work and live with a ‘pervasive fear’ they will be victimised, the letter adds. As a result, the letter says, the operation of government is being ‘distorted’ and the authors plead for ‘urgent action to ensure that Civil Service impartiality is upheld, and freedom of belief is respected’.”—news report, The Telegraph, 23 September 2023

Room for doubt?

In her letter sent in May, Dr Pertot urged Ahpra’s chief executive, Martin Fletcher, to investigate how complaints against sceptics of the gender-affirming treatment approach are handled, whether the regulator’s national boards for each health profession acknowledge “legitimate concerns” about this approach to treatment, and how the boards will respond to emerging data casting doubt on the safety of gender-affirming interventions.

In reply, a member of Ahpra’s national executive assured Dr Pertot that any complaint against a psychologist would be judged on “its individual merits” against the code of conduct.

That same month, Ahpra shared with its 142,000 LinkedIn followers a video celebrating the International Day Against Homophobia, Biphobia and Transphobia (IDAHOBIT) featuring Mr Fletcher and the regulator’s Victorian state manager Joe Goddard-Williams.

“I’m really pleased to be giving this message of support for IDAHOBIT,” Mr Fletcher says, wearing a rainbow lanyard.

“I’m also pleased to let you know that Ahpra is working towards Rainbow Tick [LGBTIQ] accreditation and we’ve also joined with Pride in Diversity to ensure that we are a safe employer for all LGBTQIA+ people.”

The video shows multiple markers of support for gender identity ideology, which is contentious and faces increasing challenge internationally. Pride in Diversity is an arm of the de facto trans activist organisation ACON, which promotes medicalised gender change for young people.

Asked how Ahpra could impartially handle complaints against gender-critical health professionals, a spokesperson using “she/her” pronouns said—

“There are rigorous processes in place to ensure those decisions are procedurally fair and made impartially.

“Ahpra’s CEO does not sit on decision-making committees.

“Ahpra supports all people to have safe and equitable access to healthcare regardless of their gender, sexuality, race, religion, beliefs or social background.

“Ahpra supports its staff to be who they are, and to treat everyone and each other with respect.”

Goddard-Williams, who has a master of arts in critical theory from Sussex University, reposted the video on LinkedIn with the statement—

“As a masculine-identified queer person, like many other LGBTIQA+ people, I’ve had trouble finding safe and inclusive support across healthcare and other institutions. Really proud of the work Ahpra is committed to doing to be an accessible and safe regulator for LGBTIQA+ people.”

To illustrate “engagement”, Ahpra’s 2021-22 annual report quotes a participant from its “LGBTQIA+ focus group” as saying, “I choose queer-friendly doctors. If I can’t find them locally, sometimes I make the 1,000 km roundtrip drive to Perth to find them.”

Since 2019, LGB groups have emerged internationally to argue that same-sex rights are categorically different from the grab bag of gender identities now championed by Queer Theory-influenced former gay rights lobbies such as Stonewall in the UK, GLAAD in the US or ACON in Australia.

“Gender dysphoria in young people is rising—and so is professional disagreement.”—investigative news report, the British Medical Journal, 23 February 2023

The detail

Goddard-Williams’ LinkedIn history of work experience includes the Ahpra role of engagement adviser, strategy and policy (2016-22), with this entry linking to the Nursing and Midwifery Board of Australia codes of conduct under the slogan “Being a midwife or a nurse means something.”

The 21-page code of conduct for midwives, issued in 2018 and updated in 2022, does not mention the word “mother”, a term discouraged by gender ideology for its “exclusion” of trans identities.

In a glossary, the code says—

“Woman or women is used to refer to those individuals who have entered into a therapeutic and/or professional relationship with a midwife. The word woman in midwifery is generally understood to be inclusive of the woman’s baby, partner and family. Therefore, the words woman or women include all the women, babies, newborn, infants, children, families, carers, groups and/or communities, however named, that are within the midwife’s scope and context of practice.”

The code insists on “culturally safe and respectful practice” by midwives—with the remark that “only the woman and/or her family can determine whether or not care is culturally safe and respectful.”

Midwives are also instructed to “respect diverse cultures, beliefs, gender identities, sexualities and experiences of women and others, including among team members.”

This same instruction and the same circular definition of “cultural safety” appear in the draft of the new code of conduct to be applied from 2025 by the Psychology Board, which has been checking complaints against the Australian Psychological Society’s code.

There is a pattern internationally of activists saying they “feel unsafe” when refusing to engage in public debate with anyone who disagrees with tenets of gender identity ideology or gender-affirming treatment.

“Words can indeed cause pain and distress but, in an updated form of the heckler’s veto, the demand for psychological safety has become a means of silencing debate.”—opinion article headlined “Young must learn to confront disagreeable ideas”, Joanna Williams, The Times, 25 September 2023

Video: US therapist Stephanie Winn talks to her colleague Leslie Elliott about a case of complaints being harvested via Twitter

Safety, but what kind?

Australian child and adolescent psychiatrist Dr Jillian Spencer, an outspoken critic of the gender-affirming treatment approach, has been asked by Ahpra to respond to a “[young transgender-identified] patient’s assertions that your comments made them feel unsafe and that you were transphobic?”

Ahpra’s 2020 Medical Board code of conduct also enshrines “cultural safety” for characteristics including “gender identity”.

“Cultural safety involves understanding what individual patients and/or their family believe is culturally safe,” the code for doctors says, adding that, “Culturally safe practice, like all good medical practice, does not require doctors to provide care that is medically unsafe or inappropriate.”

As is necessary by law, Dr Spencer had referred herself to Ahpra after the complaint from the young patient at the public children’s hospital in the state of Queensland.

A senior staff specialist, she had raised concerns over some months about the risks of gender-affirming care, its weak evidence base and rigid application across the hospital.

In mid-April she was stood down from clinical duties.

She has lodged a complaint with the Queensland Human Rights Commission over the workplace direction requiring her to use gender-affirming pronouns with patients and to refer gender-questioning children to the hospital’s gender clinic.

In her complaint she said—

“I became very concerned about the potential harm our hospital was doing in immediately using preferred pronouns, [which] unquestioningly affirms a child’s perceived identity and sets them on a treatment pathway of medical intervention that purports to transition a young person into an identity that they are likely to outgrow if interventions of this kind are not applied.”

She is seeking a recognition by the commission that rejection of the gender-affirming treatment approach is a reasonable professional judgment and a political belief protecting her from discriminatory measures in the workplace.

In the Australian state of Victoria, Dr Jereth Kok has been suspended from practising as a doctor since August 2019 under Ahpra’s emergency powers, as if he were a danger to the public.

There were complaints—not from his patients or other practitioners—about his social media posts and an article he wrote for a Christian magazine under the title A Medical Perspective on Transgender.

“One of the major allegations was that I publicly contradicted the ‘accepted practice’ of the profession in relation to gender transitioning,” Dr Kok told GCN.

The Medical Board justified “immediate action” against him partly because of his alleged—

“Commentary expressing and encouraging views regarding LGBQTI persons that (i) has no proper clinical basis and is contrary to accepted medical practice, and/or (ii) is otherwise demeaning.”

In one social media post, Dr Kok had shared an article headlined “Why a Generation of Girls is Fleeing Womanhood”, and he added a comment addressed to Victoria’s government, which at the time was proposing a ban on “conversion practices” that seeks to change or suppress someone’s gender identity.

Dr Kok’s comment targeted gender-affirming medical interventions such as puberty blocker drugs and synthetic cross-sex hormones—

“Dear Victorian government. The kinds of ‘conversion practices’ that need to be banned are the kinds that cause permanent brain- and bone-altering, sterilising disfigurement to healthy young bodies.”

Dr Kok conceded some of his posts could cause offence, but said many had been taken out of context or misinterpreted by the Medical Board—he denied, for example, that he had advocated violence towards racial groups.

His case is expected to go to a tribunal in 2024. To support his family, he has had to find work outside medicine.

In the tribunal case, Dr Kok’s law firm the Human Rights Law Alliance has filed two expert witness reports arguing that the gender-affirming treatment approach does not meet the standard for best clinical practice and that Dr Kok’s commentary is consistent with widely held medical concerns about this treatment approach.

In response, the Medical Board has abandoned its claim that Dr Kok’s criticism of the gender-affirming approach “has no proper clinical basis and is contrary to accepted medical practice”.

The doctor still faces other allegations, including that his commentary was “demeaning” of gender-affirming medical practitioners.

Video: “I think it is reckless and irresponsible for doctors to be giving hormones to children… they’re ruining their physiology.”—Dr Jereth Kok

“Cancelled by Ahpra for Posting Memes”—full interview here

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Social networks

GCN is aware of one high-profile psychologist, with a specialisation much in demand, who was targeted with orchestrated complaints to Ahpra, harassment and smears.

She had remarked on social media in 2018 that she recognised in her own practice signs of the Rapid-Onset Gender Dysphoria (ROGD) hypothesised by American researcher Dr Lisa Littman.

Rather than endure punishment by the complaint process, the psychologist gave up her registration in protest.

The theory that ROGD is spread online and via teenagers’ friendship groups is at odds with the gender-affirming dogmas that “trans kids know who they are” and that gender identity is beyond social influence—despite the risk of such influence among adolescents being acknowledged in the most recent standards of care issued by the World Professional Association for Transgender Health.

“When James Esses started the petition to safeguard exploratory therapy for gender dysphoric children, I shared it on a professional email group I’ve been in for 25 years. It’s a national group for university counsellors with over 100 members. There was a bit of pushback but it died down and I thought no more of it until 3 months later when I received an email from a law firm on behalf of my regulatory body… The complainant, a fellow university counsellor, had gone into my social media, Twitter and LinkedIn accounts and sent them screenshots of tweets and posts. I had 9 allegations to answer and if they were not satisfied I would have my membership terminated, there is no middle ground under this article, no temporary sanctions just termination!”—testimony, anonymous counsellor, collated by Thoughtful Therapists

Any feedback?

Earlier this year, Ahpra decided to take no further action on a complaint against a psychologist who had criticised a webinar titled “Trans- and gender-diverse clients: culturally safe practice for clinicians.”

After the webinar presenter asked for feedback—“good, bad, ugly, feel free to get in contact”—the psychologist said she felt the webinar was “a two-hour propaganda session.”

“This area of care for gender-questioning and gender dysphoric children and young people is a very fraught area of medicine and psychology, and this seminar did not provide balance, the science used is not robust, and the psychological knowledge [is] wanting,” the psychologist commented in the webinar feedback form.

The psychologist told GCN she was shocked at the vexatious nature of a formal complaint about invited feedback. The complaint went further, including her posts from private Facebook pages about the distress felt by parents of ROGD children and a proposed law against “conversion therapy” which would entrench gender-affirming medicalisation.

“After I found out about this complaint, I became so stressed that I got unwell,” she said.

She had lost one of her children to ROGD two years beforehand and had another child in and out of hospital with severe mental health issues.

She did worry about her reputation being sullied—“It really rocked my security in the social and professional world of psychology that I work in.”

Luckily, her workplace was “very supportive”.

“We’re talking about clinical psychology, where you’re supposed to be able to see and think and reflect on things in a very deep way,” she told GCN. 

“Putting a muzzle on our feedback? If we cannot speak about the type of therapy or the interventions, we can go down a very dark path in intervention—and it’s happened before in psychology and psychiatry.

“So we really need people on both sides actually discussing things and making sure that our treatment doesn’t cause further harm and actually helps people out of their distress.”

In responding to the complaint, the psychologist hired a lawyer and had help from the group Active Watchful Waiting Australasia, which advocates for a cautious therapeutic response to young people who present with gender issues.

The voluminous material sent to Ahpra was evidence of the fact that the gender-affirming model is contested, not the consensus.

This material included—

The interim report of the UK Cass Review of youth gender dysphoria care which, for all its tact, is no endorsement of the gender-affirming treatment model

Concern expressed by emerging LGB groups that medical transition of gender may involve the unethical “conversion therapy” of gender non-conforming youth who, if not medicalised, would grow up to be healthy LGB adults

A medico-legal critique of the gender-affirming model by Melbourne family law barrister Belle Lane

In a letter sent in July, Aphra reassured the psychologist that its inquiries suggested she was simply “advocating for an open-minded approach to clients and their individual needs.”

Ahpra found that she had “met the requirements” of the Australian Psychological Society’s Ethical Guidelines on Working with Sex- and/or Gender-Diverse Clients.

The society is expected to issue updated policy for this field by the end of 2023. A review panel began work in mid-2022 with the stated aim to ensure the society’s position “reflects a diversity of professional views and experience [based] on the available research and evidence.”

The society’s current policy recommends an affirmation-only approach.

In 2019 in the society’s magazine InPsych, psychology academic and Queer Theorist Dr Damien Riggs, a key influence on the society’s gender dysphoria policy, suggested psychologists had a duty to alert child protection authorities to those failing to “affirm” a child seeking treatment such as puberty blockers.

“… it behoves all clinicians as mandated notifiers to consider when less-than-affirming approaches (either on the part of other clinicians or on the part of family members) may constitute forms of neglect, and to make reports as needed to the relevant bodies to ensure that young people receive the affirming clinical care that they need,” he wrote.

On October 23, Canadian nurse Amy Hamm faces another round of disciplinary hearings before her licensing body, the British Columbia College of Nurses & Midwives, which alleges she “made discriminatory and derogatory statements regarding transgender people, while identifying [herself] as a nurse or nurse educator.”

Her problems began in 2020 when two strangers—one being a social worker with a declared interest in “structural violence and oppression”—took exception to her part in putting up a billboard in Vancouver which said “I [heart symbol] JK Rowling.”

At one point, the college’s case appeared to be that Hamm shared “the same [supposed] transphobic views as J.K. Rowling” and might not be capable of providing “safe, non-judgmental care” to trans patients. She had never had a complaint against her before.

The college sent her more than 300 pages of “investigation materials” trawled from her gender-critical writings and social media posts.

She stood her ground. Her lawyer, Lisa Bildy, put her position to the college this way—

“Men are not women. Humans are a dimorphic species. Women and men are biologically different from one another. Women and girls have sex-based rights as a result of those differences. Those rights are under threat. This is the truth. It has always been the truth. Speaking the truth should not be a punishable offense.”

Asked by the college to “describe any lessons learned” during the complaint-handling process, Hamm said—

“I have learned that the [college] does not stand up for women or their Charter [of Rights]-protected, sex-based rights. While I am being accused of potentially bringing my profession into disrepute, I believe it is the college—with [its] science denialism and bullying of women like myself—that brings the profession into disrepute.”

GCN acknowledges that people who make gestures of support for gender identity ideology—displaying pronouns, for example, or celebrating a Wear It Purple Event—may see this as merely respectful rather than as taking up a position in a contested and politicised domain.