Government regulators and the medical establishment are ignoring a wave of alarming reports from overseas that harshly criticise treatment for gender-dysphoric children, according to an open letter from the Australian Doctors Federation (ADF).
The ADF is a medical group founded in 1989 to protect the independence of the doctor-patient relationship.
Its letter, which was signed by more than a hundred health professionals, says that the gender affirmative treatment model (GAT), “risks the health and well-being of vulnerable children and adolescents.”
At the moment, children who feel uncomfortable with their birth sex – a condition called gender distress or gender dysphoria – can often be treated with puberty blockers and then subsequently with cross-sex hormones.
Until 2000 these treatments were almost unknown. But in the past 20 years, there has been explosive growth of gender dysphoria in many Western countries.
To deal with this, gender specialists at Royal Children’s Hospital Melbourne wrote guidelines for what they deemed to be appropriate care. Although the evidence base for the long-term effects of such treatment is weak, they have become the conventional wisdom in Australia in recent years.
But the ADF claims that the “Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents” are seriously unsafe. “Invasive treatments such as puberty blockers, cross-sex hormones and surgery hold known and potential risks of harm,” says the statement. “These include sterility, urogenital and sexual dysfunction, effects on bone, brain and cardiovascular health.”
Transgender medicine for children and teenagers is a highly contentious issue. Some girls who embark on the “gender affirmative model” end up having mastectomies. Anyone who transitions can look forward to a lifetime of coping with powerful drugs and infertility. Feeling that they made a life-changing mistake, a number of people have “de-transitioned” and denounced the gender experts who treated them.
Over the past few years, health authorities in Finland, Sweden, Norway, Denmark, Brazil, and the UK have all recommended that puberty blockers and cross-sex hormones be restricted in minors. The UK’s Cass review, the ADF points out, is “widely recognised as the most comprehensive review of paediatric GAT.” It concluded that the evidence base for GAT is “weak and uncertain”.
As part of the review, which was published in April last year, Cass’s team studied the Australian standards – and gave them a score of 19/100 for “rigour of development” and 14/100 for “editorial independence.” In other words, they were not considered reliable or unbiased enough to guide clinical care.
In April, Family Court Justice Andrew Strum handed down a blistering judgement in which he lashed the gender affirmation model, relying heavily on the arguments and evidence presented by the UK’s Cass review. He pointed out that even though they are commonly termed “the Australian Standards,” “they do not have the approval or imprimatur of the Commonwealth or any State or Territory Government.”
The ADF comments that: “The judiciary has set an example of considered, evidence-based, developmentally appropriate analysis, which Australian health bodies have so far failed to adopt, leaving Australian clinicians in legal jeopardy.”
The latest medical review has come from the United States. Last month the US Department of Health and Human Services found that there had been a “rapid expansion and implementation of a protocol that lacked sufficient scientific and ethical justification.” It complained that American doctors had failed to respond to “compelling evidence” that GAT had failed to deliver health benefits to troubled children.
Australian gender doctors need to change tack, says the ADF: “We call on Australia’s peak medical and professional bodies and institutions to cease the use of puberty blockers, cross-sex hormones, and surgery for children and adolescents due to the lack of evidence of benefit and known risks of serious harm.”
Furthermore, it requests “unambiguous advice to the profession that clinical practice should align with the Cass Review and the National Association of Practising Psychiatrists (Australia), which recommends psychosocial support as the first-line intervention for young people with gender-related distress.”
If the evidence is so weak, why are doctors reluctant to change course?
Dr Louise Kirby, the ADF’s gender medicine spokesperson, told The Catholic Weekly that the medical profession has been captured by activists who are pushing their ideology. Medical colleges are publishing “misinformation based on advocacy,” she said. Furthermore, “people don’t want to sign because they are worried they will lose their jobs or be accused of being transphobic or other sorts of things like that.”
In February the ADF called for a ban on puberty blockers, cross-sex hormones and surgery for children under 18, for a “national conversation on how to protect vulnerable adults up to the age of 25,” and for shuttering gender clinics providing harmful treatment.
This is not harsh or transphobic, she insists.
“It’s very important for people to understand that to do the most compassionate and caring thing for these children, we need to look after them and protect them during this time of uncertainty.
“And really, puberty is the solution for a lot of their problems. Through puberty, they work out their sexuality and over 85 percent of the gender distress just disappears.”