Australia appears oblivious to a dramatic shift overseas favouring more caution in gender medicine
The gist
Australia is “asleep at the wheel” as the United Kingdom and other countries back away from “gender-affirming” hormonal and surgical interventions for minors who declare an opposite-sex identity, the New South Wales parliament has been told.
“I am talking about a sea change which has taken place [in the UK, Sweden and Finland while] we as Australians are asleep at the wheel,” said Labor politician Greg Donnelly, who has had long-standing concerns about youth gender clinics.
Last month he put on the parliamentary record the draft treatment plan for England, which would encourage thorough psychotherapy and the cautious “watchful waiting” approach as responses to young people with gender distress. The draft plan warns clinicians that an opposite-sex identity may be only a “transient phase”.
Drugs blocking normal puberty, still used as routine treatment for gender dysphoria in Australia, would be restricted to a formal research setting under the English plan.
This is consistent with serious concerns and uncertainties about puberty blockers raised by the interim report of the eminent paediatrician Dr Hilary Cass, who is leading an independent review of youth gender care.
England’s National Health Service was “further moving away, quite strongly, from the [gender]-affirmative orthodoxy that has been applied hitherto — which is being used, I submit, in NSW,” Mr Donnelly said during a hearing of the health budget estimates parliamentary committee he chairs.
He said young people in NSW were being “very seriously damaged” by gender-affirming hormonal and surgical interventions, while European countries which had been pioneers in youth gender medicine were now more conscious of the risks and unknowns of these poorly evidenced medical interventions.
He cited reports from concerned health professionals of “rapid” dispensing of puberty blocker drugs to children with only two or three appointments at Maple Leaf House, a Newcastle-based gender medicine hub servicing regional NSW.
“This rapid movement [to medicalisation] is completely contrary to what is happening overseas,” Mr Donnelly said.
Last Friday, Florida’s Board of Medicine voted to prohibit future use of hormonal and surgical interventions for minors with the distressful condition of gender dysphoria.
If England goes ahead with its draft plan for gender care, it will join Finland and Sweden in putting a stop to routine use of these interventions to bring about paediatric gender transition.
The world’s largest youth gender service, the London-based Tavistock clinic, is to close next year following advice from Dr Cass.
Video: British detransitioner Ritchie Herron has launched litigation over medicalised gender change, which he now regrets
The detail
What’s behind gender distress?
On October 6, the NSW Liberal Party Minister for Health, Brad Hazzard, responded to Mr Donnelly’s first round of questions by citing advice from his department that minors at Maple Leaf House had comprehensive assessment and diagnosis before any “gender-affirming medical treatment.”
“This occurs in close consultation with the patient, parents and treating medical teams, who must all agree that the treatment is in the best interests of the young person,” the minister said.
Parents internationally have complained that the affirmative treatment model misrepresents parental concern about risky transgender medicalisation as a failure to support the child — and even as neglect requiring intervention by child welfare authorities.
A health practitioner, who spoke to GCN on condition of anonymity, said he knew of one case where Maple Leaf House had “formally facilitated the removal of custody from a parent who disagreed [with medicalisation] or wouldn’t engage with [Maple Leaf House].”
This practitioner worried that Maple Leaf House was so focused on gender-affirming medical interventions that patients with non-gender problems — mental illness, autism, trauma or family issues — would not get the attention they needed.
The practitioner said similar concerns had been shared privately among 30-something other health professionals in the Newcastle region, including psychologists, psychiatrists and physicians.
“It is astonishing that Maple Leaf House appears to offer no mental health treatment, nor any ongoing follow-up of patients’ mental health,” he said.
“[Transgender] hormonal treatments should never occur outside the context of whole person management, monitoring and careful follow up of complex co-existing mental health issues.”
It was unclear whether or not the gender medicine hub believed that paediatric transition itself would relieve these other problems.
In a September statement responding to Mr Donnelly’s concerns, the government health district that covers Maple Leaf House said specialised assessment there involved clinicians expert in “psychological medicine, adolescent medicine and endocrinology”.
The statement stresses the need for mental health co-morbidities to receive expert care, but it is unclear whether Maple Leaf House itself provides that care, or does the referrals and follow-up to make sure patients get the help they need elsewhere.
Maple Leaf House, which services large regional areas of NSW, is reportedly facing a challenge in meeting demand, a Sydney medico-legal congress was told earlier this year.
By March this year, the service had seen more than 550 patients — up to the age of 24 — since it was opened in 2021 by Mr Hazzard.
At that point in March, Maple Leaf House was getting 10-12 new referrals a week.
In the period from April 1 to September 30 last year, 59 per cent of 376 patients were aged 17 or younger.
Maple Leaf House is one of two hubs for an expansion of “depathologised” gender-affirming treatment under a new 2022-2027 LGBTIQ+ Health Strategy in NSW, which is Australia’s most populous state.
Comment: England’s draft plan for gender care after closure of the Tavistock clinic is a “seismic” shift away from medicalisation
At the 31st Medico-Legal Congress in Sydney in March, a clinician from Maple Leaf House, Liz Nunn, spoke of children “desperate” for puberty blockers having to wait while attempts were made to track down and seek treatment approval from an estranged parent, as required by family law.
She cited a case in which the patient’s birth certificate showed only the mother, and there had been no contact with the father for 12 years.
If there is disagreement between parents, a Family Court application is necessary before a minor can be given puberty blockers, opposite-sex hormones or trans surgery such as mastectomy.
Ms Nunn said delay in medical treatment worsened mental health.
“I really can’t see why kids that are 14, 15, 16 can’t actually sign for their own treatment,” she told the congress.
“They’re allowed to, back at [Newcastle’s] John Hunter Children’s Hospital in the paediatric ward, they get to sign for their own operations if their parents aren’t there. And a lot of them are way under 16. And it’s legal.
“But these kids [at Maple Leaf House] are desperate.
“Puberty blockers are totally reversible. They don’t interfere with fertility as some people think, later on — it just suspends it for the time that they’re on the blockers.
“So I know I’m passionate about that, but I think it saves a lot of kids’ lives if we can just get them onto the blockers without searching for another parent that hasn’t given a damn about them for 12 years.”
(If early puberty blockers are followed by opposite-sex hormone drugs — which is the trajectory for the vast majority of patients, according to the limited international data available — then sterilisation is the expected result, as well as sexual dysfunction for male patients.)
Comment: Unpicking misinformation on youth gender clinics
A parent separated from his ex-wife and living apart from her and the children told GCN that his teenage daughter, who identifies as male, was referred to Maple Leaf House without “any kind of disclosure or consultation with me as a parent.”
He said his daughter had six months of “gender-support” counselling —apparently to prepare for possible medical intervention — before he knew anything about it.
At the six-month point, the father received an email from the service saying they “valued the input of both parents” and offering appointment times restricted to normal working hours.
A few more months passed before the father had his first meeting with Maple Leaf House clinicians, who briefed him on his daughter’s treatment.
“And they were pretty much already at the point of wanting to start puberty blockers. So, all of this is pretty appalling, because this is my child that they’re talking about.”
At that first meeting, the clinicians wanted the father’s approval to start chemical suppression of his daughter’s natural sex hormones, but he told them he would not decide until he had all the information about Maple Leaf House and its treatment options.
“They still insist that puberty blockers are reversible, but there’s just no way — you’re stopping a teenager in their growing years. A teenager grows differently because of puberty blockers, that growth is not reversible, at all.”
The father said the clinicians told him that if he did not approve puberty blockers, they would tell his daughter of his refusal, all her “gender support” would come to an end, and she would be discharged from the service.
“It came across as bad-mouthing me to my daughter — and I would become ‘bad dad’,” the father told GCN.
He felt his initial dealings with Maple Leaf House did not seem like a genuine consultation, and the clinicians appeared to assume he would automatically agree to medical intervention.
ABC News said it was contacted by several parents of patients at Maple Leaf House after reporting of Mr Donnelly’s initial concerns; those parents had mixed views about the treatments on offer.
The local “queer community” reportedly came to the defence of Maple Leaf House, claiming it is “life-saving.”
The promotion of gender medicine as the only fix for an otherwise dramatically high risk of attempted suicide is contentious and not supported by good-quality evidence.
At an October 27 health budget estimates hearing in parliament Mr Donnelly and the Health Minister, Mr Hazzard, clashed over the gender clinic issue.
After Mr Donnelly suggested the minister seemed unaware of February’s internationally significant interim report from Dr Cass, Mr Hazzard said he was aware of both the report — and also of “professional assessments that have raised concerns about it.” He did not give any detail.
Mr Hazzard said he believed Maple Leaf House was doing “an extraordinary job in the most complex of circumstances.”
When Mr Donnelly said the minister was “ignoring tragedy going on in NSW”, Mr Hazzard protested that the budget estimates committee was not the right forum for this debate.
“I’m over it, okay? I will not engage with you on this issue,” the minister said…
