Debate’s the cure, not a malady

The “dear minister” letter from the Royal Australasian College of Physicians powerfully reinforces the case for open and rigorous scrutiny of youth gender clinics, not that the college realises this. In a brief response to a request for “urgent” advice from federal Health Minister Greg Hunt back in August, the college admits these clinics give vulnerable young people life-altering treatments based on evidence weakened by “gaps” and “limitations” with no prospect of data on long-term outcomes any time soon.

The college warns of “danger” and “harm” — not from these novel “gender affirmative” treatments but from a national inquiry. Why? Because journalists would report the inquiry, and the public would pay “attention”. And this, the college claims, would harm the clinics’ young patients diagnosed with gender dysphoria (or distress at being “born in the wrong body”). The college was asked to give evidence for this claim, and failed to.

The college put itself in a difficult position. In 2015, it joined the identity politics campaign to reduce judicial supervision of opposite-sex hormones for under-18s. In 2018, it lobbied for taxpayers to fund controversial puberty-blocker drugs. So, the college had been promoting the treatment it was asked to review, and now admits the evidence for it is patchy.

Evidence is the key in the global debate about the safety and ethics of the affirmative treatment model applied by youth gender clinics. There are inquiries overseas, and former gender clinic staff are among the experts raising the alarm. The college’s letter ignores this debate, and also the emergence of “detransitioners” who say the clinics showed little interest in the non-gender causes of their distress.

What is the “clinical best practice” for responding to this global surge of troubled teenagers? That’s what the minister wanted to know. The college offers a vague endorsement of the affirmative approach, saying “social or medical” transition may be necessary. It does not even mention the hormonal or surgical treatment involved, let alone consider whether more cautious, less invasive therapy might be wiser. Yet the college’s unhelpful letter has been hailed by affirmative clinicians as if it dispels any doubt about treatment, and even underwrites their claims for more public money. This only confirms the need for a full and proper inquiry.