A good start to reining in ‘rogue’ gender clinics

Cairns Sexual Health Service.

What would a “rogue” clinic look like, if it were following the child-led “gender-affirming” treatment model?

It’s been reported that the Cairns Sexual Health Service has been running just such a fast-and-loose gender clinic, giving puberty blockers to children as young as 12 without the safeguard of multidisciplinary assessment.

The benchmark that supposedly separates rogue clinics from Rolls-Royce operations is the Australian Standards of Care and Treatment Guidelines document issued by the Royal Children’s Hospital Melbourne and used by major gender clinics including the Queensland Children’s Gender Service.

Well, it would be convenient for champions of the gender-affirming approach to frame the Cairns revelations in this way. In July last year, Queensland’s then health minister, Shannon Fentiman, declared the gender-affirming QCGS to be top-notch following a review commissioned by Queensland Health. The key benchmark? The RCH Melbourne treatment guidelines.

In truth, that guidelines document is an activist charter, not a safeguard. It will be news to most Australians that the RCH document was found to be of little rigour and not recommended for use following an evaluation of international treatment guidelines for gender dysphoria.

That was the conclusion of peer-reviewed research commissioned by UK pediatrician Dr Hilary Cass, who led the landmark 2020-24 inquiry into youth gender medicine.

Cass-ordered research also criticised three Australian gender clinics – they were not named, but appear to be RCH, the QCGS and its Perth counterpart – for using an experimental fast-track to puberty blockers for very young “peri-pubertal” children. This, too, will come as a surprise to many Australians.

Over the past several years, the QCGS appears to have given more blockers per capita than England’s national Tavistock clinic.

Back to the Cairns service; it’s not at all clear what to make of the reported finding that 17 of 42 minors there were given blockers or cross-sex hormones – potentially leading to sterilisation and other harms – in a manner at odds with the RCH treatment guidelines.

The RCH document imposes no minimum age for blockers; the advice is to start puberty suppression in early puberty, which could be two or three years younger than that Cairns patient aged 12.

It’s also reported that this patient (and others presumably) was not vetted by a laundry list of specialists; the suggestion seems to be that the RCH document requires this multidisciplinary safety net.

The RCH treatment guideline does stipulate that “a co-ordinated, multidisciplinary team approach” is “the optimal model of care”. (Australia’s health ministers have used this multidisciplinary guarantee to argue that it’s fine for us to keep doling out puberty blockers when the UK has ended their routine use for gender dysphoria.)

And yet in Victoria, RCH’s home state, there have been steady anecdotal reports of 16- and 17-year-olds being started on cross-sex hormones by lone GPs.

In November 2023, this practice was ratified, without announcement or explanation, by means of a tweak to the RCH guideline stating it was now OK for GPs “with sufficient expertise and skill” to commence these minors on hormones without specialist backup. The wording was “carefully crafted” to discourage medical insurers from denying cover to these pioneering GPs, according to a gender clinician involved in the change.

Whether or not the Cairns clinic was working in multi-mode or solo-style, there is a more fundamental problem.

How does specialist expertise compensate for the lack of any good-quality data on the effects of puberty blockers and hormones given to gender-dysphoric minors? The lack of such data has been confirmed by multiple, independent evaluations of the evidence base, including peer-reviewed assessments commissioned by the Cass review.

Clinicians confessed to Dr Cass that they could not distinguish between those children who would grow out of the distress of dysphoria and those who might benefit from medical treatment. Dr Cass also noted that while international treatment guidelines, including the RCH document, advised the use of multidisciplinary teams, there was no consensus on the purpose of assessment.

At the Cairns clinic, we’re told, there was a lack of documented patient and paternal consent. That presupposes the possibility of consent. How can a 12-year-old – or parents – give informed consent to a one-way medical path derailing puberty and risking sterilisation, all without the quality data needed to understand the likely consequences?

The problem is not one of the occasional rogue clinic, but the Janus-faced nature of the gender-affirming treatment model. Looking to its masters in a taxpayer-funded health system, it emphasises diagnosis and assessment. Among the faithful, it speaks of child-led treatment and patient autonomy as touchstones; to medicalise or not becomes a question of a child’s “desire”.

American gender clinic whistleblower Jamie Reed put the dilemma this way: “Any model of care, multidisciplinary included, that follows an affirmation paradigm is destined to fail and therefore harm patients.

“Individually skilled practitioners are unmatched against the affirmation paradigm, because the paradigm has only one direction, one outcome built in.”

From Ms Reed’s former clinic at the St Louis Children’s Hospital in Missouri to the London-based Tavistock clinic, at the Careggi Hospital in Florence, Italy, and now the Cairns Sexual Health Service, we see a similar dynamic: a promise or requirement of standard medical safeguards undermined by revelations of activist medicalisation.

Queensland’s new Health Minister, Tim Nicholls, has a difficult job to do. He has to ensure his Queensland Health officials rediscover the need for evidence-based treatment and safeguarding of vulnerable young people. The suspension of puberty blockers and cross-sex hormones for gender-distressed minors, announced on Tuesday, is a good start.

Bernard Lane, a former journalist with The Australian, publishes Gender Clinic News