Gender clinics highlight cancer risk of opposite-sex hormones

Teenage girls who identify as transgender boys are being warned of a potential cancer risk from gender clinic medical treatment.

There is an emerging group of young “detransitioners”, mostly women, who regret gender change and its medical interventions.

Teenage girls who identify as transgender boys are being warned of a potential cancer risk from gender clinic medical treatment and told they may later wish to have their uterus and ovaries removed to eliminate this possibility.

And parents in NSW are being cautioned that “some doctors, psychologists and psychiatrists” are opposed to medical treatment of the mental condition gender dysphoria (distress at feeling “born in the wrong body”), according to documents from the Children’s Hospital at Westmead in Sydney obtained under FOI legislation.

Parents who give informed consent at Westmead for drugs to block a trans-identifying child’s unwanted puberty must acknowledge that the long-term medical effects and safety of these drugs — like the ultimate outcomes of gender transition — “are not fully understood”.

The NSW material is based on that of Australia’s busiest and most influential gender clinic at the Royal Children’s Hospital Melbourne, whose consent documents seen by The Australian do not warn families there are doctors who believe the medical path is a wrong turn. RCH did not reply to a request for confirmation.

Westmead does gender medicine on a smaller scale than RCH, with 169 under-18 patients in 2019 compared with 325 in Melbourne; not all get medical treatment.

In 2016 medical colleges and a trans activist group asked the NSW government for $8m to set up a large RCH-style gender clinic network and predicted demand in the state could outstrip Victoria’s.

They got only a fraction of the money, and Westmead supplies only puberty blocker drugs, which it has described as “completely reversible”.

It refers its young patients elsewhere for the irreversible opposite-sex hormones testosterone and oestrogen, or surgery such as mastectomy. Even so, the hospital’s informed consent warnings do cover opposite-sex hormones.

Asked whether it kept track of these former patients, Westmead said this was done by the adult healthcare services or private practitioners that provided treatments coming after puberty blockers.

Clinical reports suggest most children started on blocker drugs — which Australian clinics still promote as reversible, despite new more cautious advice adopted by Britain’s National Health Service — go on to opposite-sex hormones. Blockers may be given around age 10-12, with hormones cutting in around 15-16.

UK preview: Australian TV series about a 12-year-old trans girl

There is international debate about the safety, ethics and evidence for this “gender affirming” treatment approach — spearheaded in Australia by RCH — which takes its lead from a child’s self-declared trans identity, and has seen a global surge in hormonal and surgical interventions to make young bodies look more like the opposite sex.

Psychotherapist Marcus Evans, who resigned from the foundation that runs Britain’s Tavistock youth gender clinic, says there is “considerable evidence that children are signing up to treatments with long-term implications, with very little real understanding of the consequences for their future adult lives.”

Some clinicians say the apparent lack of interest of many trans youth in treatment side-effects should itself be cause for stricter safeguarding.

On Thursday NSW Health Minister Brad Hazzard said the state was running “an independent review of all international, peer-reviewed material” on under-18 trans care.

NSW Health confirmed this review began in November 2019, without any announcement, and was separate from an “audit and review” of youth gender clinic treatment this year agreed by the Australian Health Ministers’ Advisory Council following intervention by federal Health Minister Greg Hunt.

RCH clinic director Michelle Telfer claims these medical treatments are “lifesaving”, and cites a 2017 anonymous online study with 48 per cent of a non-representative sample of trans youth saying they had attempted suicide.

Patient information for girls identifying as boys at Westmead says “the effects of testosterone on the ovaries and other female organs over time are not well understood”.

It says “the danger of inducing abnormalities such as ovarian cancer has not been extensively studied”.

“Many female-to-male transgendered people later have their ovaries and uterus removed by surgery, which eliminates any such risk,” the document says, warning that it’s “very important” for those who keep female organs to be monitored by specialists.

Clinicians report some “transmasculine” patients may resist gynaecological examinations as too psychologically confronting, and go along with surgeons who pitch removal of female reproductive organs as a more complete “affirmation” of their male gender identity.

RCH’s 2018 treatment guidelines — promoted as “Australian standards” and used in other state health systems — do not discuss the possible link between opposite-sex hormones and cancer risk.

However, information given by the clinic to teenage girls considering lifelong testosterone says “recent studies do not show an increased risk of cancer”.

Photo essay: on bodies changed by opposite-sex hormones

“A lot of detransitioners feel very alone in this, so my partner and I are lucky... we love each other.”

In the darkest and most confusing times we can endure, be courageous and even find love.

From The Detransitioners 🦎https://t.co/TBgDTPk7G2 pic.twitter.com/WOATr4oyMn

— Laura Dodsworth (@BareReality) August 19, 2020

A physician who spoke on condition of anonymity highlighted the risks of the early hysterectomies undergone by young biological females on testosterone, and regretted by “detransitioners”.

“Normally, it is very unlikely for young women between the ages of 18 and 35 to get a hysterectomy, even in cases of debilitating conditions such as fibroids and endometriosis, or for young lesbians who are certain they don’t want to have children,” she said.

“Doctors decline to perform these procedures unless they are absolutely necessary for a patient’s health and wellbeing and no other treatment option is available, because the risks of early hysterectomy are thought to be unacceptable”.

She said early menopause was associated with risks including osteoporosis, cardiovascular and neurological diseases and premature death.

Research consent material for the biggest US gender clinic, at Children’s Hospital Los Angeles, where director Johanna Olson-Kennedy has referred girls as young as 13 for double mastectomies, gives a clear warning that hormonal treatment sterilises patients.

“If your child starts puberty blockers in the earliest stages of puberty, and then goes on to gender affirming hormones, they will not develop sperm or eggs. This means that they will not be able to have biological children,” the information sheet says.

RCH recommends children talk over future fertility before they start puberty blockers, and offers the option for biological males who cannot produce sperm to have testicular tissue frozen, a technique it admits is “experimental in pre-pubertal humans” and has so far only worked in animals.

Trans youth often say they have no interest in having their own children, although this is at odds with the stated wishes of many trans adults.

"Psychiatrists have been urged to be very cautious about endorsing gender clinic treatments for under-18s after an international scandal over false claims of mental health benefits for transgender surgery." @SEGMtweets https://t.co/cnnqipxMX7 @australian

— Bernard Lane (@Bernard_Lane) August 11, 2020

RCH consent material warns boys signing up for oestrogen drugs they may end up with the same risk of breast cancer as a biological female, and no reduction in the risk of prostate cancer.

Girls are told that testosterone may lead to vaginal atrophy, elevated risk of heart disease, liver disease, stroke, weight gain, obesity, Type 2 diabetes, and more aggressive behaviour.

RCH tells under-18s these risks are “very uncommon” in young people, but gender affirming treatment is relatively new and there is no evidence about the effects of taking lifelong opposite-sex hormones.

In a rare public response to critics last year, the hospital said its treatments were based “on the best available medical evidence” and subject to strict governance guidelines.

RCH head of research Ken Pang was among the authors of a 2018 Pediatrics review article reporting only “low-quality evidence” that puberty blockers and opposite-sex hormones did what they were supposed to do physically, and evidence on their “psychosocial and cognitive impact (was) generally lacking”.

The literature review suggested puberty blockers helped depression but had “no significant effect” on symptoms of gender dysphoria.

In a July article for a British psychiatric journal, Dr Evans says: “Are children of 12 and under really aware of what it will mean to become an infertile adult, who cannot have an orgasm (because gender clinic treatment may interfere with proper development of genitals) and has to remain a patient dependent on hormones and medical care for the rest of their lives?

“Do girls know what it will mean in the future to have to undergo hysterectomy to avoid vaginal atrophy?

“It is also important to discuss openly that, although patients may decide in the long term to transition, they cannot eradicate the biological realities of their natal sex and will have to find some way of living with the losses involved.”

Surgery push: a female “detransitioner” recounts her experience

my doctor was encouraging me to plan my hysterectomy when I was 18 years old. I had an ultrasound and was told my reproductive system was in fantastic condition despite the cross sex hormones. after sharing this with my doctor, he said, “don’t you want one anyway?” https://t.co/JsO9mR4cwe

— Elle Palmer (@EllePalmer1) August 19, 2020

RCH patient information warns that opposite-sex hormones can affect mood, sometimes showing up as anger or depression.

The hospital’s consent material says some who take opposite-sex hormones “ultimately regret this decision, are unhappy with the effects of treatment and choose to revert to their gender assigned at birth”.

No rate of regret is given and the term “detransitioner” is not used.

Young people are also cautioned about social exclusion if they undergo gender transition after having “spent years developing and sometimes asserting their gay or lesbian identity”.

And RCH warns trans youth to be conscious of the limitations of medical treatment, to be careful of the “impact of peer influence as you develop a social identity”, and not to focus “too much on your gender identity” at the expense of developing more broadly as a person.