Reality time for gender clinics

Children are being given experimental medical treatment with potentially profound consequences — including lost years of identity development, infertility as adults and impaired sexual function, and lifelong dependence on hormone drugs — such that they cannot give informed consent. This is the conclusion of the first serious judicial scrutiny of the recent surge in teenagers, mostly born female, declaring a transgender identity and receiving medical interventions supposed to refashion their bodies to fit an inner sense of “gender identity”. The ruling of the UK High Court in a challenge brought by Keira Bell, 23, who seeks to warn that medicalised gender change may be a harmful short-term fix for unrelated underlying issues such as trauma, has international implications.

The court did not dispute that specialists at gender clinics mean well, that these young people are indeed distressed and that those with faith in the “gender-affirming” approach and its hormonal interventions do believe they promote mental wellbeing and even prevent suicide. Trouble is, given the opportunity, the gender-affirming experts were unable to present quality evidence for their claims, and the judges accepted competing evidence that using drugs to suspend normal puberty might well lock children as young as 10-15 into a lifelong path of medical intervention with significant risks. The National Health Service Tavistock youth gender clinic failed to supply the court with basic data about treatment and patients. Neither did the Tavistock offer any clinical explanation for the worrying way in which teenage girls so rapidly emerged as the dominant group diagnosed with a condition once almost solely the preserve of preschool boys.

Lack of data and a failure to investigate worrying trends in treatment and regret are red flags. Australia’s major youth gender clinics insist they follow rigorous clinical standards but they have refused to release comprehensive data or to engage with informed critics. Can governments ignore an influential court ruling that young people are being given experimental medicine?

We use the same common law rule at issue in the Tavistock case, yet our Family Court has decided that children as young as 10 can give informed consent to puberty blocker drugs and a 15-year-old can authorise her own double mastectomy. These cases, involving superficial analysis and expert evidence only from the “gender-affirming” school, are likely to disturb hospital administrators, ethics boards and health department lawyers who compare them with the English judges’ careful reasoning based on current science, data and clinical insights. It may be that the Tavistock’s lawyers will identify possible appeal arguments, but it is striking that so much of the criticism of the ruling avoids the issues in favour of outrage about “transphobia”. What’s needed is open, thoughtful debate about the best response to this new group of often troubled teenagers being diagnosed with the bodily distress known as gender dysphoria.

This will need more therapeutic options, not less. Despite a weak evidence base the gender-affirming approach is so dogmatic that it champions the new wave of criminal laws against any therapy deemed to try to “convert” someone’s gender identity, Victoria being the latest with a draft bill. Cruel attempts to force adults to change sexual orientation appear to be mostly a historical footnote. Laws such as Victoria’s could criminalise ethical attempts to help a trans-identifying teenage girl re-embrace her biological sex and find comfort in her body after the trauma of sexual assault. But counselling to assist medicalised gender change for children is exempt from these cookie-cutter bans on conversion therapy. The risk is that some minors struggling with non-gender issues will seize on trans identity as a solution, will be uncritically “affirmed” by teachers or counsellors at school, and will be put on the path to needless medication.

Federal Health Minister Greg Hunt has asked the states to come up with a national framework for treatment of under-18 gender dysphoria, with an emphasis on “strong and balanced counselling”. But the process for this is not transparent and works by consensus, so it is hostage to uncooperative states. The major gender clinics are in Victoria, Queensland and Western Australia. Their governments have shown no serious engagement with international concerns about the affirmation model and its medical treatments. The first two support conversion therapy bans, and WA’s intentions are unclear. These laws could mean cautious, ethical psychotherapists will avoid taking on children who present with gender issues. Who suffers then? And states with laws that risk criminalising any therapy unless it’s the “affirmative” handmaid of gender transition are not serious about a new framework with balanced counselling.