AMA lends weight to fears on trans kids’ medicine

The AMA Queensland has taken a stand on the safety and ethics of transgender drugs and surgery for children.

Queensland Health Minister Steven Miles. Picture: AAP

 

EDITORIAL: We will not shy away from uncomfortable topics that deserve attention. This is particularly so when the health and wellbeing of vulnerable children are at stake.

The Australian Medical Association Queensland has taken a stand on the safety and ethics of transgender drugs and surgery for children, calling for a host of practitioner groups to come together and devise new national treatment guidelines.

The organisation covering more than 9600 doctors says it “strongly supports” the concerns of branch member Philip Morris, a leading psychiatrist, who has questioned the capacity of under-18s to make decisions about life-altering hormonal treatment or surgery “now shown to be not without harm”.

There is intensifying global debate about the pro-trans “affirmative” treatment model for minors suffering gender dysphoria — distress at “being born in the wrong body” — with the UK and Brazil joining Australia and Sweden as the latest countries with reviews on foot.

Social contagion is suspected in a surge of often troubled teenagers, mostly girls, declaring trans identity. Affirmation activists say it’s just greater acceptance, and downplay the rise of regretful young adult “detransitioners”.

In Queensland, medical bodies were blindsided by the Palaszczuk government staging consultation over the summer holidays on a draft law to ban “gay conversion therapy” which also potentially criminalises cautious therapeutic alternatives to “gender affirming” medical interventions.

Conversion therapy conjures up images of coercive, sometimes painful attempts to change the fixed sexual orientation of adults but trans activists have conflated this with ethical exploration of a young person’s still evolving identity.

“Practices that try to change or suppress a person’s sexual orientation or their gender identity have always been immoral and unethical — now they will be illegal,” Queensland’s health minister Steven Miles said in November when introducing the legislation, which carries a maximum 18 month prison sentence.

“Gay conversion therapy is based on the belief that being LGBTIQ is a disorder that requires correction.”

‘Threat to sex-based rights’

Queensland’s Human Rights Commission, the Australian Psychological Society and the LGBTI Legal Service support the government, while critics include Christians, health practitioners, and women who say “gender ideology” threatens sex-based rights.

The new legislative ban could lead to prosecution of doctors including paediatricians, endocrinologists, psychiatrists, surgeons and GPs offering evidence-based therapy to children and adolescents with gender dysphoria, the AMA warned in a last-minute submission ahead of Friday’s public hearing into the bill by a state parliamentary committee.

Branch president Dilip Dhupelia said the government’s claim there was clear evidence of conversion therapy taking place was “far from the truth”, and in any case new treatment guidelines for gender dysphoric youth “would eliminate any non-therapeutic practices … overnight”.

He said the government was basing its “entire case” on the 2018 conversion therapy report from La Trobe University and the Human Rights Law Centre which draws on 15 interviewees, only two of them transgender.

His submission urges medical colleges, the National Health & Medical Research Council, the Medical Board of Australia and Dr Morris’s National Association of Practising Psychiatrists to form a joint committee to craft the new under-18 treatment guidelines.

The “affirmative” model in Australia has been spearheaded by the country’s biggest youth gender clinic at Royal Children’s Hospital in Melbourne, which has promoted its own 2018 treatment guidelines as “Australian standards”, but these have come under sustained criticism.

The RCH guidelines are used by the gender clinic at the Queensland Children’s Hospital, which posted an 85-fold increase in patients on puberty blockers over five years, with 171 taking these controversial drugs in 2018.

The clinic does not offer “gender affirming” surgery such as double mastectomy, which is believed to be rare with under-18 patients in Australia, although there is no good data.

At a December public briefing, the Queensland health department’s legislative policy manager, Karson Mahler, traced the anti-conversion therapy bill back to a 2018 roundtable held by Health Minister Steven Miles.

Mr Mahler said the roundtable featured “a very diverse group of stakeholders”; when asked which medical bodies were present, he cited the AMA Queensland.

Nobody from the organisation was there, an AMA spokeswoman said on Tuesday. The Human Rights Law Centre was at the roundtable. Mr Miles’s office did not reply when asked for a complete list.

In its submission on the bill, the group Fair Go for Queensland Women wanted to know if the roundtable had considered the argument that transitioning children who did not fit gender stereotypes itself was a form of conversion therapy.

“(There is) nothing wrong with a male child who likes dolls over trucks and nothing can or should be done regarding this personal preference,” said group spokeswoman Stephanie Hughes.

“Similarly, there is nothing wrong that needs to be ‘fixed’ about a female child who is assertive or rough and tumble.”

The Coalition of Activist Lesbians Australia said the bill appeared to ignore the emergence of detransitioners, a trend that highlighted the risk of “false positives” among teenage girls.

“These mostly young women in their 20s (many of them lesbians) were all diagnosed with gender dysphoria in their teens, were put on puberty blockers and often cross-sex hormones as well, as part of supporting their transition to transmen,” the submission says.

“The numbers (of detransitioners) are unknown, but there are hundreds seeking online help from the women who have told their transition stories.”

COAL points to the new charity, the Detransition Advocacy Network set up last year by a young British woman, Charlie Evans, a science writer who had lived as a transman.

Apart from damaged bodies, some detransitioners suffer from trauma and struggle to find professional help in an “affirmative-dominated” health system, clinicians say.

‘Show me the evidence’

In Brazil, a medical organisation that handles regulation of doctors and professional ethics has been asked to justify its approval of trans hormonal treatment and surgery for young people.

The Federal Council of Medicine last month made public a September 2019 resolution signalling no ethical problem for practitioners giving puberty blocker drugs or cross-sex hormones at 16 or doing surgery at 18.

A 2013 ruling by the federal Health Minister Alexandre Padilha set 21 as the threshold age for surgery and 18 for hormonal therapy but this was undermined by an ethics opinion issued the same year by the doctors’ organisation FCM, according to a non-political group campaigning for more caution called In The Right Body.

The group said the result was impunity for doctors giving puberty blocker drugs to children as young as 10 and cross-sex hormones at 16.

Last week, Brazil’s Chief Prosecutor Ailton Benedito, an outspoken conservative Christian who runs the independent Federal Public Ministry, announced an investigation into the legal and factual basis for September’s resolution by FCM.

FCM has 30 days to answer questions about the short-term and longitudinal evidence for the efficacy of these treatments, their side-effects, the proportion of young people who come to regret medical intervention, and the degree of overlapping mental illness in young people diagnosed with gender dysphoria.

The Australian sought comment from FCM.

This week, the Brazilian media outlet Jornal da Cidade quoted psychiatrist Akemi Shiba saying doctors had signed a petition against the FCM resolution on under-18 treatment.

“Teenagers don’t have much idea what they want for their lives, so it’s not a good time to make decisions of this magnitude,” Dr Shiba said.

“There may be cases of false positives (in diagnosing gender dysphoria) … We have to be very careful with this population, it has changed, increased.”

“There are no long-term studies that show the harm that (puberty blockers) can bring, at a time of great brain development, what effects it can have on the brain.”

The prosecutor’s intervention was “a big deal, a tremendous thing”, said Eugenia Rodrigues, spokeswoman for the group In The Right Body, which also campaigns against “transgender ideology”.

Ms Rodrigues, a journalist in Rio de Janeiro, said the Benedito investigation had been largely ignored by Brazilian media outlets, although FCM’s belated announcement of its resolution in January had been given plenty of coverage, some misrepresenting it as imposing greater caution on doctors.

She said many Brazilians had “no idea what is happening” with risky medical interventions in children and teens.

In 2019, Brazil’s Supreme Court declared “transphobia” a criminal offence — one judge citing violence against LGBT people — under a law with prison sentences up to five years.

Ms Rodrigues said the vast majority of “trans youth” treatment was concentrated in Brazil’s richest and most populous state of Sao Paulo, which has a public health system and is home to more than 40 million people.