Gender transition: a medical minefield

The consequences of medicalising children who later feel they shouldn’t have been set on that path can be devastating. By Claire Chandler.

This article first appeared in The Australian.

Medical professionals have contacted me recently with concerns about the rapidly rising prevalence of children and teenagers (particularly girls) distressed about their bodies, and the associated increase in the prescription of puberty blockers and cross-sex hormones.

I asked one paediatrician how many colleagues in the medical fraternity had similar concerns regarding the increase in diagnoses of gender dysphoria and life-changing medical interventions. “Almost everyone I’ve spoken to” was the answer.

Giving expert evidence to the English High Court as part of Keira Bell’s successful case against the Tavistock gender clinic, US psychiatrist Stephen Levine said: “There is no other field of medicine where such radical interventions are offered to children with such a poor evidence base.”

He described a “toxic” environment in which critical and cautious voices were shouted down as transphobic, creating “an intimidating and hostile environment where silence and acquiescence are the inevitable consequence. It is left to those of us at the end of our careers, who have nothing to lose, to voice our concerns.”

One of the themes in that court decision was the judges’ surprise at the failure of the Tavistock clinic to produce adequate evidence or data in support of its medical interventions with vulnerable minors. Australian states responsible for gender clinics in public children’s hospitals seem at risk of a similar failure of transparency and accountability. Without access to good data, how can the public understand what is going on?

At the request of federal Health Minister Greg Hunt, states were working last year on an audit and review of under-18 gender dysphoria treatments across the country. It’s understood that the states’ top health bureaucrats considered this audit at a meeting last November, yet no public update was provided.

I wrote to the chair of that health bureaucracy forum in December asking that data from that audit be released publicly. I’ve had no response and we remain in the dark about what data the state-run gender clinics do and don’t have.

The limited data that has been released under Freedom of Information law shows an astronomical increase in referrals to children’s hospital gender clinics. If there were such a dramatic rise in children presenting with any other condition, we would expect that all relevant data would be made available so medical specialists could investigate the causes as well as the efficacy and safety of different models of care. Apparently, state bureaucrats are working on an improved model of care for children with gender dysphoria, but the public has been told very little about this.

A gulf has opened up between the scrutiny now being applied to these practices in the UK, which is turning up all sorts of concerns from experts, and limited media and public scrutiny being applied to medical practices and the supporting narrative in Australia.

Is anyone making sure children understand that it is not possible to literally be born in the wrong body? How do we account for the increasing number of young adult “detransitioners” who later regret medicalised gender change and are suffering the lifelong physical effects of puberty blockers, cross-sex hormones and surgeries? Do children and teenagers seeking affirming medical interventions understand they may feel differently about their identity and body in the future?

Nobody wishes to deny distressed children the support they require. But as we’ve seen in the case of Bell and other “detransitioners”, there can be devastating consequences of medicalising children who later feel they shouldn’t have been set on that path. It’s well past time governments running Australian gender clinics confronted this difficult reality and opened up to scrutiny.

Claire Chandler is a senator for Tasmania.