Health leaders reject the need for oversight of transgender medicine
Health authorities admit they have no idea how many gender transition drugs are being prescribed to children, while rejecting the need for oversight of their use.
Australia’s most senior health leaders have dismissed suggestions the commonwealth should take a greater oversight and regulatory role in the prescription of puberty blockers and cross-sex hormones to children as the federal government admits it has no idea how widely the drugs are being prescribed off-label for gender dysphoria.
Therapeutic Goods Administration chief medical adviser Robyn Langham was asked in Senate estimates if it was appropriate the federal agency regulates the use of androgen-blocking drugs that are approved for the treatment of prostate cancer but are prescribed off-label to children to halt the progress of puberty.
There is concern among some physicians in Australia and internationally at the long-term effects of the puberty-blocker drugs on children experiencing gender dysphoria being prescribed the medications from as young as 10 years.
Professor Langham said it was up to individuals doctors to use their clinical judgment in prescribing the drugs and the TGA had no role in the matter. “Where doctors wish to prescribe off-label, we do not regulate doctors’ practice,” she said in response to questions from Nationals senator Matt Canavan.
“When a doctor chooses to do that, they do so in the full knowledge that they are accepting all of the legal responsibility, that they understand the research and they get full consent of their patients.”
Commonwealth health department secretary Brendan Murphy also rejected any need for greater oversight of gender-affirming medicine and the treatment of children in the wake of the Cass review in the UK, which identified “gaps in the evidence base” on the prescription of hormone drugs to children.
“Our position is that where these services are provided by very expert, multidisciplinary clinic services, such as a Royal Children’s Hospital in Melbourne, we have to rely on the best clinical advice we have,” he said. “They have their own governance structures that look at look at those things.”
Professor Murphy said the federal government had no idea how many children were being prescribed puberty blockers, because data on the off-label use of drugs on the PBS was not collected.
“We wouldn‘t know for sure,” he said. “The drugs that are prescribed in a clinic, such as at the Royal Children’s Hospital, are normally prescribed through the hospital system, and we wouldn’t have access to that data,” he said.
In the wake of the decision by medical indemnity insurer MDA National to withdraw providing insurance cover to doctors in private practice prescribing cross-sex hormones to those under 18, the insurer’s president, Michael Gannon, said it was “keeping a very close eye on the evidence as to whether or not the effects of (puberty blockers) are reversible”.
“We think there are so many unknowns,” said Dr Gannon, a former president of the Australian Medical Association. “We came to an authentic view that there is likely to be significant claims from individuals through expressed regret years down the track about decisions they made when they were very young … there might be multimillion-dollar claims.”
Dr Gannon said doctors in clinical practice had “seen this complex social issue, complex set of considerations, turn from something that involves a very small number of people, to an issue of the questioning of personal identity being made by a sizeable minority of teens”.
Some members of state parliaments, such as Victorian Liberal Democrat David Limbrick, have also begun raising the issue with greater urgency in light of the shifting international evidence.
“With the changing view on what’s happening with gender medicine around the world, great caution needs to be taken around Australia,” he said. “If the TGA is not monitoring this, they should be. I definitely support some sort of review into gender medicine for children … If some children on puberty blockers are being treated inappropriately, it could lead to catastrophic, lifelong issues.”
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