Watch out!

Too many parents are blindsided by risky gender medicine

Photo by Tyler Nix on Unsplash

Dr. Jillian Spencer is a child and adolescent psychiatrist from the Australian state of Queensland. She was suspended from clinical duties at the Queensland Children’s Hospital reportedly because of a claim of “transphobia”. She had tried for many months to raise safety concerns about the medicalised “gender-affirmative” approach to treating children with gender dysphoria—Bernard Lane

Jillian Spencer

As a community, we’ve been increasingly worried about health and safety. Bike helmets became compulsory, cigarettes became expensive and put behind the counter. We’re used to hearing safety announcements at the airport to hold on to the handrail or not to let your kids stand up in the supermarket trolley. So, it’s understandable that many parents have been blindsided by the realisation that there are dangerous ideas about gender identity being pushed at their children. If parents seek help, they may be unable to prevent their children from suffering harm from treatments claimed to be “lifesaving”.

There are thousands of devastated parents across Australia who are hiding their own pain to stay emotionally connected to their child who has gender dysphoria. They fear that expressing their concerns will make their child pull away and this may, in turn, cause their child to walk further down the affirmation pathway—a choice actively encouraged by other people. It is an incredibly difficult situation for these parents who are sailing in uncharted waters in trying to protect their child from this very modern threat. 

I have my own public safety announcement, which I’d love to hear broadcast at the airport or the supermarket—parents, please carefully screen the mental health clinicians that you allow to engage with your child. It is wise for you to meet the clinician before any appointment with your child to check that you are comfortable with the approach they will take. 

Right now, there is an awful lot of pressure on child psychiatrists and other mental health clinicians to “affirm” children if they declare a gender identity at odds with their biological sex. There is also a generation of younger mental health clinicians who have been taught the “gender-affirmative” treatment model and not yet questioned it, despite increasing international scrutiny of this medicalisation.

“Denmark joins the list of countries who have sharply restricted youth gender transitions”—analysis, the Society for Evidence-Based Gender Medicine, 17 August 2023

Fear factor

Health professionals are keeping quiet about their concerns out of fear for their reputations, careers and livelihoods, and this creates a false impression that everyone thinks the affirmative model is a good idea. 

This conspiracy of silence is having a serious impact on the care being provided to children attending public mental health services. My concerns when working at the Queensland Children’s Hospital were not just about all the transgender pride flags in the waiting room, the rainbow lanyards and pronoun and ally badges. I was very concerned because I noticed that mental health clinicians felt unable to consider a child’s gender dysphoria as part of their mental health presentation. I am referring to the mental health teams working across the health district, so these aren’t just the clinicians working in the gender clinic.  

For example, mental health clinicians would talk about “a 12-year-old who identifies as a boy with anorexia” or “a 14-year-old who identifies as a girl who has overdosed.” The focus would be the anorexia or the overdose—never the gender dysphoria. It was never considered that we should try to help the young person recover from the distress of gender dysphoria. It was as if we were all pretending that this child had changed sex. No one felt able to think about why this child was feeling so uncomfortable in their body or feeling more comfortable identifying as the opposite sex. I felt that we were providing a very poor standard of care. 

Video: American therapist Stephanie Winn on the unprecedented explosion in teenagers with gender distress

How did we get here?

In the 1990s, there were researchers around the world, particularly in Amsterdam, who were noticing that trans adults were not faring well, physically and mentally. 

The researchers speculated that these negative outcomes were due to not “passing” as the opposite sex. So, they planned to try to change the ultimate cosmetic outcome by blocking the puberty of children suffering gender dysphoria.    

These researchers seem to have forgotten, or disregarded, what was already known from 11 studies of youth dysphoria that predated the Dutch use of puberty blockers. These studies showed that most children—60-90 per cent—recover from gender dysphoria through the course of adolescence and a significant proportion end up being gay and lesbian. 

The original study conducted by these Dutch researchers had major flaws such that its findings are considered biased and unreliable. They studied a group of 77 children who had demonstrated cross-sex identification from early childhood. They gave the children puberty blockers, cross-sex hormones and surgery. One of the group died from the complications of vaginoplasty, surgery to create an artificial vagina for a male. This was flawed research but the gender-affirming Dutch approach spread internationally, without the safeguard of high-quality clinical trials. It was like a lab leak from the Amsterdam clinic.

Therapists are being bullied and silenced by their professional peers—simply for disagreeing on best practice, particularly around children and youth experiencing gender incongruence. Young children are being encouraged to transition by gender clinicians; frightened parents are being de-skilled by activist teachers and social workers [while] highly ethical peers, who dare to question the wisdom of affirming children into believing they can change sex, are losing work and suffering vexatious complaints against their character [as] the numbers of young adults who regret radical surgeries and the irreversible effects of hormone therapy continues to grow.”—an anonymous member of Thoughtful Therapists, post on James Esses’ Substack, 17 August 2023

Suicide narrative

The affirmation pathway as it is now practised is to encourage all children to contemplate their gender. And when a child develops or presents with gender dysphoria, they are considered to be gender-diverse and are encouraged to socially transition. The family are firmly encouraged to support the social transition on the grounds that it is a lifesaving approach to prevent suicide, even though there is no reliable evidence that social transition or indeed the entire affirmation pathway improves psychological outcomes or reduces risk of suicide. 

Social transition prevents a child from recovering from gender dysphoria. It gets the child to feel comfortable presenting as the opposite sex. It makes it harder for them to see themselves in their biological sex. At the time that this is happening, the child is not able to understand that to continue presenting as the opposite sex, they will need to embark on a medical and surgical pathway from the start of adolescence which is lifelong and has very serious consequences like infertility, lack of sexual function and a range of health problems.  

The first medical step in the affirmation pathway is puberty blockers prescribed at the outset of puberty (Tanner Stage 2, which is roughly age 10-12) and claimed to be reversible. Puberty blockers were originally conceptualised as giving children time to think before starting irreversible cross-sex hormones. However, it is now known from their widespread use, that puberty blockers prevent the child from recovering from gender dysphoria. There is a high rate of continuation to cross-sex hormones and then to surgery. So, instead of 60-90 per cent of children becoming comfortable in their body through the course of adolescence, as many as 95 per cent of those on puberty blockers proceed to cross-sex hormones.

The side effects of puberty blockers are similar to menopausal symptoms: fatigue, hot flushes, mood problems and weight gain. Puberty blockers result in reduced bone mineralisation at a time of life when the bones should be reaching their peak strength. There are suspected effects on cognitive and emotional development. Last year the American drug regulator, the FDA, added a warning label to puberty blockers for a serious condition that causes raised intracranial pressure. Also, it appears that it isn’t quite so easy to just restart puberty after a few years on a puberty blocker.

If the full affirmation pathway is followed as recommended, the treatment will render the young person infertile and their capacity for sexual pleasure may be affected. Depending on their biological sex, cross-sex hormones are associated with health risks. For example, there is higher cardiovascular morbidity for females taking testosterone, and higher rates of some cancers and strokes from clots for males taking oestrogen.  

There are general risks that come with all surgery and specific risks from gender surgeries. There is a particular risk for boys who, due to the puberty blockers, may not have enough tissue for vaginoplasty, requiring the use of some of their colon. This is a much more dangerous procedure, as shown by the death of one of the original Dutch patients. 

Political capital: Dr. Spencer is among the women lined up to speak on sex-based rights in Australia’s federal parliament next month

Affirmation comes to Queensland

My understanding is that a growing number of referrals led to the gender service being established within the Queensland Children’s Hospital in 2017. It was set up so that the clinical notes of patients are put in the medical electronic clinical record and not documented within the separate mental health electronic clinical record. This reflects the ethos of the clinic that the children attending are trans and needing medical intervention. They are not considered to be suffering gender dysphoria, which is a mental health condition requiring mental health care.    

In 2017, when the gender clinic was officially established, there were 48 patients enrolled, according to Freedom of Information data. In 2021, that number had risen to 635. The clinic reportedly became “hectic” in mid-2022 after the pandemic broke. To manage this demand, the gender service extended its hours and introduced Saturday clinics. They assessed kids by telehealth. [Note: an earlier version of this article relied on a growth estimate from the clinic, but this appears to be incorrect—GCN.]

In 2022, the gender clinic reportedly had a staff to patient ratio of 1:70. This is very different to a Child and Youth Mental Health Service which provides multidisciplinary mental health care where you would expect a staff to patient ratio of about 1:20-25, or even fewer patients per clinician for more intensive teams treating children with complex problems. 

The model of the gender clinic is that it does not provide ongoing mental health treatment. If children are considered to require psychological work, they are referred out to private psychologists who are known to take an affirmative approach. However, as staff at the Tavistock gender clinic in the U.K. noted, once children are on puberty blockers, it is very difficult to get them to engage in therapy to work on their gender dysphoria.  

Children attend the gender clinic roughly every three months for their puberty blocker injections or hormone prescriptions. From what I have seen, the gender clinic will provide support during these appointments to assist the child to come to terms with being trans. If the child has doubts about being trans, this may be labelled internalised transphobia. The clinic speaks with the family to encourage them to support the child’s transition.  

The gender clinic believes that gender care starts in schools. The clinic has put a lot of effort into providing education to the school-based health nurses and guidance officers across the state of Queensland regarding how to affirm and socially transition children. 

When the gender clinic uses language like “state-wide capacity building” and “building an entire service network”, they mean spreading the use of puberty blockers by allowing doctors in other hospitals and health districts across Queensland to prescribe these off-label drugs. We are very lucky because recently, in response to a request from the gender clinic to expand the prescribing of blockers, the Queensland Health Medicines Advisory Committee restricted their prescription to those children engaged with the Queensland Children’s Hospital gender clinic.  

A key strategy by gender clinics has been to claim that the affirmation model prevents suicide. There is no reliable evidence that it does reduce the suicide risk in children with gender dysphoria. Some research suggests an increased suicide rate amongst children receiving “gender-affirming care’”. For example, a US National Institutes of Health multi-centre study in 2023 by Chen et al of 315 children receiving gender-affirming care over two years had two children die by suicide and 11 develop suicidal ideation. And this was research where any suicidal children were excluded from the group at the start of the study. 

Any health professional who tells a parent that they are at higher risk of losing their child to suicide if they don’t affirm them is wrong.

Parenting: The international group Genspect defends families sceptical of medicalisation as a response to a gender non-conforming child

Unresponsive

Working in the Queensland health system, I felt surrounded by a very large quality and safety bureaucracy. There were constant audits and accreditation processes. We had to complete learning modules on “Speaking Up for Safety.” Despite this, my attempts over a lengthy period to raise concerns about the safety of the affirmation model led nowhere. Raising concerns through avenues like the Children’s Commissioner, the Office of the Chief Psychiatrist, the Executive Director of the Mental Health Alcohol and Other Drugs Branch and with the Health Minister’s office also led nowhere. The chief psychiatrist advised that the appropriate avenue was the Office of the Health Ombudsman (OHO). 

Earlier this month, I received a response from the Office of the Health Ombudsman regarding a complaint had I lodged about a child prescribed puberty blockers after only two appointments at the gender clinic. Unfortunately, the OHO report shows that they don’t want to—or don’t have the ability—to assess the research studies misleadingly cited by the hospital in its defence.

In the OHO complaint, I also raised concern about the gender clinic’s written consent form which tells parents that, when puberty blockers are appropriately prescribed, they “can greatly improve mental health and quality of life.” I advised the OHO that there is no evidence that puberty blockers improve mental health or quality of life. 

They responded by saying no further action was required because a senior medical official of the hospital had said on a TV current affairs program that the consent form was being reviewed. This appears naive.  

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What to do?

We need to change our approach to supporting children with gender dysphoria. All adults, but especially teachers and health professionals, need to have a united front in saying—

“We understand that you’re feeling really upset and uncomfortable in your body. We will do everything we can to support you through this. But the risks and long-term consequences of transition are so serious that we can’t just assume that transition is the right way forward. Because of this, we are going to continue to use your birth name and pronouns. We will work with you to understand what you are going through and look at all the ways we can help you to feel better.”

I don’t think we can leave it to health services to pull back by themselves and I don’t think the organisations set up to monitor the safety of health services are up to the job. 

Which is why in Australia we need to campaign for an independent federal inquiry into treatments provided to children with gender dysphoria. Because many people in the community are unaware of this issue, we are likely to need the process of an inquiry to bring the community along with the necessary changes across schools and health services.  

Note: This is an edited text of Dr Spencer’s August 6 speech at the Cancelled Women Will Speak seminar in Brisbane. She has lodged a human rights complaint to determine whether it is lawful for Queensland hospital authorities to mandate staff to always use the preferred pronouns of children, always take an affirmative approach towards children with gender dysphoria and always refer gender-questioning children to the gender clinic. She is also collecting signatures from Australian doctors who support an inquiry into gender clinics. If any doctor wishes to sign her petition—and if any reader would like to join a mailing list for information on how to help fund her human rights complaint—please email her via ausnz@genspect.org