Gender diversity a ‘normal variation’, doctor tells court

A clinician advising a young girl on whether to take cross-sex hormones told the child some side effects of taking testosterone were ‘reversible’ and said there is ‘scientific debate’ about whether the treatment could impact her fertility.

A highly complex family law matter has seen parents divided over whether their child can medically transition to become a boy.

A doctor advising a young girl on whether to take cross-sex hormones told the child some side ­effects of taking testosterone, including vaginal atrophy, were reversible or would not last forever, and said there was “scientific debate” about whether the treatment could have an impact on her fertility.

The doctor, who works for one of Australia’s largest public gender clinics, also says gender diversity is a “normal variation of human development” and refuses to admit it could be influenced by “external pressure”.

The case emerged as the latest development in a highly complex family law matter in which the parents are divided over whether their child can medically transition to become a boy.

One parent opposes the prescription of the cross-sex hormones, previously telling the child they will “grow out of it”. The other supports the transition, and is trying to claim full parental responsibility.

The matter is on the brink of becoming a “royal commission” into the Australian model of care for gender dysphoria, the Federal Circuit and Family Court heard on Tuesday, as lawyers debate the legitimacy of Britain’s Cass review which found Australia’s guidelines on gender-affirmative medicine lacked rigour and independence.

The Australian is bound by a strict suppression order that ­prevents – among other things – the publication of either parent’s gender, or the name of any clinicians that have treated the gender dysphoric child.

The doctor was asked by ­barrister Belle Lane, acting for the parent ­opposed to the child’s transition, how she could be sure whether a child’s gender identity would remain into adulthood before prescribing them medical treatment.

“You don’t have any test that gives with absolute certainty that a child’s gender identity will continue through their adult life,” Ms Lane said.

The doctor responded: “No such test exists and gender identity changes over time. There is no specific test to determine how someone will feel in the future about their gender identity but that doesn’t mean we … take it on face value.”

The doctor continued: “There is no way to predict in the future who someone will be, but we go with what we have and we make a prediction.”

Ms Lane questioned whether “those people for whom your prediction is not accurate” will be subject to life-altering changes caused by testosterone, such as “facial hair, male patent baldness, alopecia”.

The doctor admitted “there will be some changes that cannot be undone” such as “clitoral enlargement”. But she told the court that, when conducting a consultation with the child, she said vaginal atrophy was “reversible”.

“When the administration of testosterone is ceased, your body’s natural hormones will ­increase again, unless there has been surgical intervention to your ovaries,” she said.

Ms Lane requested the doctor provide “peer-reviewed evidence” to support the fact vaginal atrophy is reversible, but the doctor could not.

Asked about conversations she had had with the child about the impact testosterone would have on her fertility, the doctor said there was “scientific debate” around lasting effects.

“(The child) is someone who had had regular menstrual cycles, who had not had puberty blockers, and the impact on fertility on someone like that is different,” she said.

“What I told (the child) was ... it could have an impact on fertility.”

The doctor took issue with a suggestion that “social contagion” caused adolescents to change their gender identity, saying there was “no evidence that someone can develop gender ­incongruence due to external pressure”. But Ms Lane pushed her on this.

“If you leave aside the social contagion ... you’d agree with me peer influence is something significant in adolescents,” she probed.

The doctor agreed.

“And you’d agree with me that young people, including (the child), have access to social media ... and may well have some ­influence, positive or negative, from social media,” Ms Lane continued.

The doctor said “yes”.

Ms Lane: “And this influence, social media, can influence aspect of identity?”

Doctor: “Yes.”

Ms Lane: “Including gender dysphoria?”

The doctor disagreed, saying any presentation of gender incongruence that had been caused by peer pressure did not persist.

“Gender identity, if it is influenced by peers ... or related to peer pressure or questioning sexuality or wondering if you could be friends with this group or that, does not persist,” she said. “It fades. It dissipates over time.”

Judge Peter Tree used a hypothetical scenario in an attempt to summarise the doctor’s thesis.

“Often adolescents have a friendship crush,” he said. “If my friendship crush decides that they are transgender, I might entertain it. I might even go along with it for a bit. But is your point that ... unless I have this as my core identity, my crush influence isn’t going to influence my core identity?”

Doctor: “Yes, yes, Your ­Honour.”

She continued to say that, by the time a child appeared at her clinic, they had “done the work”.

“I don’t see everyone the day they realise they are not cishet (a person who is both cisgender and heterosexual),” she said. “(The patients) are the ones that tell their parents, tell the GP, wait months to see a nurse ... this cohort has done the work before they get to my door.”

The doctor also dismissed a suggestion that the child wants to transition to “appear straight”.

The court heard the child had been in a relationship with a biologically female peer. Justice Tree asked whether there was a chance the child was a “confused lesbian” and was “there is a possibility ... that a natal female who presents as gender dysphoric but who is same-sex attracted might be responding to a lesbian orientation in a way that isn’t recognising it, but rather seeking to subvert it” by transitioning to become male.

The doctor agreed that was a possibility but said it was not the case for the child at the centre of the proceedings.

“That could be a possibility for some people, but for (the child) I did not find any evidence of that for him,” she said.

The hearing continues.