Doctor’s defiance on child’s sex swap

A doctor from one of Australia’s largest gender clinics says a child who believed taking cross-sex hormones would help her grow male genitalia is still able to show mature thinking in gender.

A complex family law matter has seen parents divided over whether their child can medically transition to become a boy.

A doctor from one of Australia’s largest public gender clinics says a gender dysphoric child who believed taking cross-sex hormones would help her grow male geni­talia is still able to show mature thinking in the area of gender.

The Federal Circuit and Family Court on Wednesday heard the child, whose parents are divided over whether she should be allowed treatment, exhibited a “lack of understanding” that could indicate she was not ready for medical intervention.

The doctor, however, said while the comments might indicate the child’s juvenile grasp of how testosterone would impact her genitals, it does not necessarily show an overall lack of critical thinking in the area of gender.

The matter – in which one parent opposes the prescription of cross-sex hormones and has previously told the child they would “grow out of it”, and the other who supports the transition – is in the midst of a multi-day hearing, in which various expert witnesses are giving evidence.

The Australian is bound by a strict suppression order that ­prevents – among other things – the publication of either parent’s gender or the names of any clinicians who have treated the gender dysphoric child.

The child’s doctor on Wednesday was asked whether she feared the child’s mental health would plummet if the testosterone did not have the desired affect. The court has previously heard the child was distressed by their gender dysphoria but not suicidal because she feared the afterlife.

Belle Lane, the barrister acting for the parent opposing the treatment, questioned whether the testosterone could “destabilise” the child’s mental health “if it doesn’t achieve her expectations … She might be severely dis­appointed with the results of the testosterone and that could destabilise her mental health, do you agree?”

The doctor disagreed.

“Testosterone will cause masculinisation, which is what (the child) would want, which would see an improvement of mental health and a decrease in distress about being misgendered or outed,” she replied.

The court heard the child told a separate clinician she believed testosterone would “grow her clitoris into a penis … but she would not be able to penetrate with it”.

The doctor said the child may be referring to “clitoromegaly” – the enlargement of the clitoris after taking testosterone – which is referred to colloquially among young transgender people as “t-dick”.

“(The child) shows a lack of understanding about how testosterone works on genitals,” Ms Lane suggested.

The doctor said “based on this interview, yes”.

Ms Lane continued to probe.

“What (the other clinician) concluded … is that (the child’s) responses do not show mature or critical thinking in the area of gender,” she said. “You’d agree with that?”

The doctor disagreed.

The court also heard debate over whether the doctor, when consulting the child on medical treatment, should have pressed the child on their desire for surgical intervention.

Ms Lane put to the doctor that if the child was “unable to undergo a double mastectomy as an adult, she will have aspects of a male body and aspects of a female body as well”.

The doctor agreed.

“If (the child) were to start testosterone prior to the age of 18, there would be a period where (the child) would have breasts still and have masculinised features,” Ms Lane asked. “What I’m putting to you is that combination could worsen (the child’s) gender dysphoria.”

The doctor disagreed, saying “I have not encountered that in my practice”.

Ms Lane: “You discount that as a possibility?”

Doctor: “Yes.”

Ms Lane pressed the doctor on why she didn’t “reality test” the child’s expectations of getting surgery in adulthood.

“You didn’t discuss phallo­plasty or metoidioplasty, did you?” she asked.

The doctor said the point of the consultation was to determine whether the child “understands what testosterone does”.

“Young people can (want) a lot of things, but that doesn’t mean we discuss it with them when they cannot access it,” she said.

“I have not explicitly discussed (the child’s) expectations about those (surgical) interventions because that was not what I was asked to do.”

Judge Peter Tree later tried to clarify the point Ms Lane was making.

“I have a bent finger,” he said. “If I went to the doctor and said, ‘I want you to straighten my bent finger’ but I let slip my whole goal in this was to become the world’s best concert pianist, would a doctor be obliged to tell me my goals of becoming the world’s best concert pianist are slim?”

Ms Lane said Justice Tree’s point was “not a relevant ­example” but he said he was asking the witness “whether the extent to which you go down the chain of purpose of intervention is relative and contextual”.

The hearing continues.