‘Gender clinics operate with weak evidence, most doctors unaware’

Many doctors are unaware that youth gender clinics carry out invasive medical treatments based on ‘low-quality’ evidence.

Choosing the right treatment path iStock

Many mainstream doctors are simply unaware that children’s hospital gender clinics carry out invasive medical treatments based on low-quality evidence, according to a new global watchdog body.

“We want to find the best treatments for these young people and we believe the answer should be found through scientific study, investigation and open debate,” said US physician William Malone, the spokesman of the new Society for Evidence-Based Gender Medicine.

“Even among endocrinologists and mental health professionals, let alone the rest of the medical community, I think there is a great lack of knowledge about what’s occurring (in the youth gender clinics),” he said.

Endocrinologists administer transgender hormonal drugs, while psychiatrists typically diagnose “gender dysphoria” — or distress with one’s biological sex — but those working in gender clinics are a very small subset of the profession.

After eight months’ organisation, SEGM has broken cover with more than 100 health and medical practitioner members at a time when scrutiny of the pro-trans “affirmative” treatment model is intensifying, and inquiries or reviews are underway in Australia, the UK, Sweden, Brazil and Germany.

Since the mid-2000s there has been an exponential rise in often troubled teenagers, disproportionately girls, seeking life-altering medical treatment for being “born in the wrong body”.

Many reportedly come to gender clinics with pre-existing mental health problems, autism, suppressed same-sex attraction, a history of child sex abuse or family trauma, and there is debate about whether they are getting the right treatment.

“The affirmative model essentially excludes investigation of underlying issues that may be causing sex confusion or gender dysphoria,” Dr Malone said.

“Such an approach to an adolescent female, for example, with an autism spectrum condition flies in the face of the ethical practice of medicine.

“We are also starting to see multiple (young adult) ‘detransitioners’ come forward and say, ‘Hey I had a lot of stuff going on and the gender clinicians did not do their jobs, they did not investigate why I was presenting with gender dysphoria’.

“‘They missed the actual cause and as a consequence I went down a path of medicalisation that I now regret’.”

‘How can they consent?’

Meanwhile, a former judge has questioned whether patients can lawfully consent to hormonal drug treatment at Australia’s biggest youth gender clinic, run by the Royal Children’s Hospital in Melbourne.

“Consent must be a matter of substance — it involves the interaction of competence and information,” he said, speaking on condition of anonymity.

Under common law, the “Gillick competence” rule has allowed children under 16 to be judged competent to give informed consent to trans medical treatment, but this is under challenge by litigation against the NHS Tavistock youth gender clinic in London.

In Australia, following the High Court’s 1992 decision in Rogers v Whitaker, patients also had to be given an explanation making it possible for them to evaluate the risks of the treatment, the former judge said.

“How can any such procedure be said to be adequately explained when, say, the Murdoch Children’s Research Institute website says ‘there is still a lack of good research data to inform clinical practice in this nascent field’?,” he said.

This concession comes from the official web page of MCRI biomedical researcher Ken Pang, who is involved with the RCH gender clinic and its long-term study Trans20.

The web page also claims “there is increasing evidence that providing supportive clinical care to transgender youth significantly improves mental health and wellbeing”.

Dr Pang was among the authors of a 2018 Pediatrics journal article billed as “the first systematic review” of hormonal treatment for trans youth.

It found there was 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 research under review suggested puberty blockers helped depression but had “no significant effect” on symptoms of gender dysphoria.

In December, RCH defended its gender clinic, saying the treatments were “based on the best available medical evidence”.

Dr Malone said evidence should be rated “moderate” or “high” under the accepted international grading system in order to qualify as “evidence-based”.

“The quality of evidence with paediatric medical transition (under the affirmative model) is low or very low, which means we do not know if the interventions will cause the desired result,” he said.

SEGM’s advisory board includes the Australia-based psychiatrist Roberto D’Angelo, who has launched a new support group in Sydney for detransitioners who feel gender change has not worked out as hoped.

A detranstioner called Jay will help with the group.

Also on the board is British psychotherapist Marcus Evans who resigned in protest from the governing body that runs the Tavistock gender clinic.

He felt concerns about the surge in atypical teenage-onset gender dysphoria were not being taken seriously, with clinicians discouraged from probing the causes by cries of “transphobia”.

Dr Malone, an endocrinologist, said most primary care doctors were oblivious to the gender clinic controversy partly due to mainstream media failures — “in particular, the continued misreporting of the suicide risk, and the claims that if you don’t immediately treat young people with hormones and surgeries, they will commit suicide”.

“We actually have no reliable data to demonstrate high rates of suicide among gender dysphoric young people, nor do we have quality data to show that hormones and surgeries prevent suicides. Some data even suggest very high post-surgery suicide rates.”

Dr Malone said SEGM had no political or religious affiliations, and one of its central concerns was that “gay and lesbian young people will be hurt the most” by medicalisation of minors who do not conform to gender roles.

The group’s members include former staff of gender clinics worried about the fast-tracking of patients for hormonal interventions without rigorous and thorough assessment.

Advocates for the affirmative model claim a clinical consensus and accumulating research showing improvements in the wellbeing and mental health of trans youth. They say the rising caseload of gender clinics reflects growing social acceptance and wider awareness of new treatment options.

The Australian sought comment from RCH, its gender clinic director Michelle Telfer, MCRI and Dr Pang.