The fear factor

Courts have been warned to be on watch for reckless claims about suicide risk

Photo by Emmanuel Olguín on Unsplash

The gender clinic of an Australian children’s hospital has come in for criticism over its handling of suicide risk.

The Queensland Children’s Gender Service has been in the news because of growing concern among doctors about the risks of the gender-affirming treatment approach and the off-label use of puberty blockers.

The clinic’s fact sheet for parents has been challenged by family law barrister Belle Lane, whose 135-page dossier covers key issues in the gender clinic debate. The document is based on Ms. Lane’s presentation to Australian family law judges in April.

The fact sheet highlights a quote from the parent of a “10-year-old trans boy”—

“The real concern was the statistic on suicide… I didn’t want my son to be one, so I supported him in the decisions ahead and informed him as best as possible.”

In her dossier, Ms. Lane says: “Just in case parents thought they might not be responsible for the risk, the fact sheet continues and lays risk firmly at the feet of the parents, [by claiming]—

‘Studies show that strong parental support of their gender diverse child leads to a 95 per cent reduction in suicide attempts, comparative to parents who are unsupportive or only somewhat supportive.’

Ms. Lane notes the troubling “transition or die narrative” used internationally by champions of the medicalised gender-affirming treatment approach.

There is no good evidence that children diagnosed with the distress of gender dysphoria have a uniquely high suicide risk; nor is there any high quality evidence supporting the mental health claims made for the gender-affirming model.

“Studies purporting to find that hormones reduce suicidality are typically designed in such a way that valid inferences about cause and effect cannot be drawn. Considering that roughly three-quarters of teenagers who present to gender clinics these days have pre-existing mental health conditions like depression and autism, which are themselves risk factors for suicidality, it is probably more accurate to say that teenagers with suicidal inclinations are more likely to gravitate toward a trans identity”—Leor Sapir, Tablet, 21 February 2023

Where’s the evidence?

In her dossier, Ms. Lane puts judges and the legal profession on notice about the use in court of alarming claims of suicide risk without solid support in the research literature.

In Australia, family law judges are called upon to decide whether or not to approve puberty blockers, cross-sex hormones or surgery if the parents of a dysphoric minor disagree about treatment.

The conflict is often presented by activists as an expert clinician and a “supportive” pro-treatment parent allied against an “unsupportive”, even “abusive” parent who resists “lifesaving” medical intervention.

In the dossier, Ms. Lane says: “The threat of a child’s suicide weighs heavily on parents and on the court.

“It will be potentially helpful to understand what the parent(s) have been told about risk of suicide to understand the extent to which that fear is informing their decision-making.”

Ms. Lane suggests that in family law proceedings involving whether or not to go ahead with medical interventions, the court should be properly briefed on any claims of suicide risk.

“There are tools for assessment and management of suicide risk and protocols in hospitals and services,” she says.

“If a risk of suicide is asserted, the court should have information about the assessment of the risk, what steps have been put in place to manage the current and any future risk.

“Suicide risk of children and young people is managed by treating mental health professionals each day.”

Ms. Lane observes that the alarming statistics on suicide risk deployed by gender clinics usually come from anonymous online surveys “which rely on self-reporting and frequently conflate suicidal thoughts and non-suicidal self-harm with serious suicide attempts and completed suicides.”

To support its suicide prevention claim, the Queensland gender clinic’s fact sheet cites a low-quality survey from a Canadian advocacy project TransPULSE, which collected data online and on paper from young people aged 16-24 who had received healthcare in Ontario.

Ms. Lane notes the weakness of the methodology—“There was no evidence of follow up of the participants to ascertain the extent of the young person’s consideration of suicide, the factors leading to it, its duration and intensity.

“Further, there was no evidence of what actions the young people had allegedly undertaken which were self-described suicide attempts and whether they were in fact life-threatening.”

“The proportion of individual patients [at the London-based Tavistock youth gender clinic from 2010-20] who died by suicide was 0.03 per cent, which is orders of magnitude smaller than the proportion of transgender adolescents who report attempting suicide when surveyed. The fact that deaths were so rare should provide some reassurance to transgender youth and their families… It is irresponsible to exaggerate the prevalence of suicide. Aside from anything else, this trope might exacerbate the vulnerability of transgender adolescents”—Dr. Michael Biggs, journal article, 2022

Donations, please

In her dossier, Ms. Lane also questions the use of suicide risk statistics by the donation-seeking foundation of the Royal Children’s Hospital Melbourne (RCH), which is home to Australia’s most influential gender clinic.

The foundation’s website says, “In Australia, societal attitudes to gender diversity have become more understanding, however there remains stigma and discrimination, particularly for young people. Australian data shows 80 per cent of transgender young people self-harm and 48 per cent attempt suicide before the age of 24.”

These figures come from the anonymous, online Trans Pathways survey which used a non-random sample, meaning that the 48 per cent figure cannot be generalised to all trans-identifying youth.

Ms. Lane also notes that the survey sample reported significant mental health co-morbidities, such that, “One cannot conclude that any suicide attempts were attributable to a single cause, namely their transgender identity.”

She highlights the fact that a 10-year audit undertaken by the RCH gender clinic reported no suicides and a self-harm rate of 24.8 per cent, significantly lower than the Trans Pathways figure of 80 per cent quoted by the hospital foundation.

“It is puzzling that the RCH Foundation would rely upon the Trans Pathways survey when it has its own peer-reviewed published study from which to draw,” she says.

In mid-December, the RCH gender clinic’s high-profile director Dr Michelle Telfer made it known that she would take up a six-month appointment as acting chief of medicine at the hospital. RCH did not reply when GCN asked this week for confirmation that Dr Telfer would return as gender clinic director.

“[The Dutch protocol medical treatments for trans-identifying adolescents] emerged in the late 1980s to early 1990s in large part in response to the suboptimal outcomes of transitioned adults, with the hope that early gender transition may improve outcomes. Despite claims of the lifesaving nature of gender transition for adults, none of the many studies convincingly demonstrated enduring psychological benefits. The longest-term studies, with the strongest methodologies, reported markedly increased morbidity and mortality and a persistently high risk of post-transition suicide among transitioned adults”—Levine & Abbruzzese, journal article, 2023

What’s in a name?

An Australian judge has allowed a male child to officially take a new, “non-binary name” despite doubts about the child’s account of dire mental health effects if his request were refused. Nor was there expert evidence about the likely harm, Family Court judge Jenny Hogan acknowledged.

Even so, Justice Hogan ruled in favour of a change to the child’s birth certificate, saying she considered “unacceptable” the risk of “a repetition of the previous self-harming behaviour” by the child.

Under the heading “Urgency of name change”, the child’s affidavit said that upcoming applications for a driver’s licence and other documents would bring anxiety and distress because his birth name was associated with trauma and sadness.

In her recent decision, Justice Hogan said the child’s rationale for the name change also related to distress, panic attacks and self-harm linked to his parents’ (unstated) “beliefs” about the condition gender dysphoria, and their refusal to consent to (unstated) “treatment”.

However, the judge said material from a psychiatric consultation at the (unnamed) gender clinic “gives rise to some concerns about the weight that can safely be accorded to the child’s assertions” about being unable to tolerate his birth name.

She said the psychiatrist’s notes suggested the child had “been able to deliberately present as binary male and very masculine so as to be taken seriously within the medical system and the courts.”

The child had also “been able to refrain from expressing a view about themself as having a non-binary gender because of concerns about the impact of that expression on the court proceedings”, the judge said.

And the child tolerated being called “son” at least by one of his guardians, referred to as “Ms Corcoran” in the judgment.

An unusual feature of the case was that the Corcorans by consent orders took over parental responsibility from the child’s parents, known as the “Haenkels”, except in regard to decisions about gender dysphoria treatment.

Under those orders, the Corcorans are required “to advise the parents of [treatment] decisions, seek a written response from them, give consideration to such response and to provide advice of the decision taken or made.”

The orders also restrict parental communication with the child’s school and contact with the child, unless he initiates it.

In his affidavit, the child says the Corcorans have supported his expression of gender identity and he regards them as family.

Note: Children’s Health Queensland, the body responsible for the gender clinic, has refused to answer any questions about its processes on the grounds that GCN is not “a recognised news media outlet”. RCH was contacted for comment. GCN does not dispute that gender-affirming clinicians genuinely believe their interventions help vulnerable young people