Urgent action needed on gender clinic regulations

As more details emerge from investigations into the treatment of young people presenting to clinics claiming gender dysphoria, the more urgent the need for a comprehensive review of practices becomes. The Weekend Australian has faced sharp criticisms from some quarters for daring to examine how vulnerable young people are diagnosed and treated using an affirmative model that effectively allows children to diagnose themselves as being a different gender to the one assigned at birth. Making this decision can lead to lengthy and sometimes irreversible medical interventions that are full of risk.

What is well known is that the use of puberty blockers and other medications can have lasting impacts, many patients come to regret their decisions, and underlying causes that could explain the symptoms can go undiagnosed. Events in Britain and Australia have justified our journalistic curiosity and strengthened our view that the broader medical establishment must pay closer attention to what is going on and take action. As we report on Saturday, senior physicians at the gender clinic at the Children’s Hospital at Westmead in NSW have studied the physical and mental health of 79 patients in a rare academic study of the outcomes following treatment of children with gender dysphoria. Their findings cast serious doubt on the scientific basis of the gender-affirming approach followed by the nation’s other children’s hospitals.

In an open access academic paper, CHW psychiatrists, endocrinologists and other physicians revealed that 88 per cent of the children who presented at Westmead’s gender clinic had at least one comorbid mental health condition, with more than 50 per cent diagnosed with behavioural disorders or autism. One in five of the children who consulted the clinic with gender-related distress later had these feelings resolve, and almost one in 10 of those with a formal diagnosis of gender dysphoria, some who had taken puberty blockers and cross-sex hormones, later discontinued transitioning.

The findings mirror those of BBC investigative journalist Hannah Barnes in her new book, Time To Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. In a clinical retelling, Barnes documents the way in which the Tavistock clinic provided a one-size-fits-all intervention based on an affirmative model that viewed the young person as the expert on themselves when it came to gender. Where once it was mostly boys who were referred to the clinic, by 2019-20 girls outnumbered boys by a ratio of six to one in some age groups, most markedly between the ages of 12 and 14. In September 2020, the National Health Service commissioned leading paediatrician Hilary Cass to review the Tavistock service and in March last year her interim report found that the “single specialist provider model is not a safe or viable long-term option”.

Britain’s The Sunday Times newspaper editorialised that Barnes’s investigation raised two pressing issues. The first was that the debate over trans issues and gender reassignment was so toxic, Barnes found it almost impossible to get the book published. The other was that, despite warnings stretching back 20 years, during which many vulnerable children were treated, it was only now that the Tavistock clinic’s flawed methods were being consigned to history. Its fundamental error was simply stated, the newspaper said. Children referred to the clinic and typically suffering from a range of problems, including family break-up, anxiety, mental and physical abuse, autism, eating disorders, and a history of self-harm, were put on a course of treatment beginning with puberty-blockers on the assumption that gender dysphoria was the cause, not the symptom, of their wider distress.

Like the Tavistock investigation, the CHW research found the adoption of a “neutral therapeutic stance” and provision of “a much more diverse range of treatment options and pathways” as an alternative to medical gender transition was necessary. The CHW doctors also have raised doubts about the standing of the Australian Standards of Care and Treatment Guidelines for trans and gender-diverse children and adolescents that follow the Netherlands model and are based heavily on the World Professional Association for Transgender Health guidelines. The Australian Professional Association for Trans Health standards are followed by most doctors treating patients with gender dysphoria in Australia. But the CHW doctors write the title is misleading and there are no official or authorised government-commissioned standards for assessing or treating gender dysphoria.

This situation needs to be urgently addressed. Given the mounting evidence, a serious review is needed to establish what would be the best approach. Evidence suggests that complex psychological forces not related to gender may be at play. This issue is not about ideological viewpoints on gender, it is about the right of young people to receive proper medical care. Inquisitive journalists have a duty to ask the hard questions and probe difficult issues regardless of the consequences. The ABC has shown itself to be particularly deficient in exploring this issue. For those prepared to ask, the trail has led to a compelling argument for changes that may lesson harm and provide greater comfort for vulnerable young people in need.