Transgender medicine review throws an inkblot test at a culture war

Mark Butler’s late-Friday announcement of a review of transgender medicine came apparently out of the blue. Why would a federal health minister, on the eve of a tight election, launch into an area of policy known as one of the touchiest culture-war subjects imaginable?

In an area that Butler himself described “contested and evolving”, the announcement acted like an ink-blot test. Everyone read their own views into it.

Health Minister Mark Butler.Credit: Alex Ellinghausen

Those who have opposed the medicine of gender transition – who say it’s a “social contagion” which has sucked thousands of young people, particularly girls, into dangerous medicalisation – hope it will upend Australia’s current practices.

Under the current national guidelines, written in 2018 in the country’s busiest gender clinic at the Royal Children’s Hospital in Melbourne, it’s assumed that a child’s statements about their gender identity should be taken seriously and acted upon. It’s called “gender affirming care”.

Opponents of this have been proposing an inquiry for years. They point to the UK, where a review by pediatrician Hilary Cass found, over 300 pages, that there were big problems with the evidence base for this care. She took particular aim at puberty blockers – the drugs given to children to stop puberty in the lead-up to being prescribed hormones to transition gender.

In the UK and a number of other European countries, transitioning has become considerably more restricted in recent years. So in Australia, opponents of trans medicine hope the review announced on Friday will be staffed by people like Cass.

Trans rights activists protest against the ban on hormone blockers in London in April 2024, introduced after the review by Hilary Cass.Credit: Getty Images

Supporters of trans medicine – including LGBTQ groups and practitioners – on the other hand also expressed optimism at Butler’s announcement.

They see proper national guidelines, enshrined by the National Health and Medical Research Council, as shoring up their approach against those state governments who, like Queensland did recently, have shown a tendency to adopt a more sceptical approach.

They are confident the scientific evidence will back their world view, and insist the council’s review be “led by the experts” – by which they mean practitioners already working in gender medicine.

When Butler and his assistant minister, Ged Kearney, talked on Friday about people with “lived experience” being involved on the panel, it was designed as a signal to them that transgender people and proponents of “affirming care” will be part of it.

Opponents, on the other hand – including those who’ve regretted their transitions and angry parents of young people who have been through the system – insist their lived experience must also be reflected.

In short, all sides are keenly aware that who staffs this inquiry is crucial. They are watching like hawks.

Out of all this we can say two things for certain. Firstly, that Butler’s seemingly rushed announcement (the National Health and Medical Research Council was not even ready to talk about it on Friday) was partly designed to stop Queensland’s health minister in his plans to pause the issuance of puberty blockers pending an inquiry. It’s not clear that’s been successful.

The second certainty is that Labor does not want an election culture war on this issue.

As Peter Dutton spoils for a fight against woke, we only need to look to the United States, where one of Donald Trump’s most effective election advertisements, on high rotation, was one that said: “Kamala is for they/them, President Trump is for you”. He has since banned transgender people from the military and cut federal funding for transgender medicine.

Spurred on by Queensland’s move this week, Butler’s Friday announcement now means that, to any accusation that Labor is for they/them, the whole issue is in the hands of the scientists. Labor hopes this will kick the can far enough down the road.

As for what actually comes of this review of the guidelines, well, that depends very much on who’s appointed to run it.

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