‘Open way for transgender surgery on demand’

Transgender people should get hormonal treatment and sex-reassignment surgery on demand, a trans adviser to the Victorian government says.

Gender conundrum. Picture: Istock

 

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.

Transgender people should be given hormonal treatment and sex-reassignment surgery on demand without a diagnosis or assessment by a psychiatrist, according to a trans adviser to Victoria’s Andrews government.

“The trans experience is not a mental illness, and (trans people) should not have to get a gender dysphoria diagnosis (for medical treatment) — the process should be self-determined,” says activist Jeremy Wiggins, co-chair of the government’s Trans and Gender Diverse Expert Advisory Group.

Treatment of even more ­patients diagnosed with gender dysphoria, or distress about their biological sex, is the rationale for $12.4m in extra state funding since 2015 for Victoria’s two public gender clinics for children and adults.

Mr Wiggins said “access to hormone therapy and surgeries should be depathologised and unnecessary psychiatric assessments removed”. He also said doctors had used their oath to “First, do no harm” to deny trans people treatment. He suggested the need for a diagnosis had forced some trans patients to lie — or “be performative” — to get access to medical care.

Mr Wiggins cited a 21-year-old who identified as “agender”, or no gender, telling a trans youth survey: “I lied and said I was a binary trans man to gain access to the services I needed. The psych was very focused on gender norms and binary identities, and I felt judged and ‘not trans enough’ because some of my hobbies are traditionally ‘feminine’ things.”

In a report this year flowing from the first Churchill Fellowship awarded to a trans man, Mr Wiggins said trans people with mental health problems “should not have their gender-affirming healthcare delayed or denied”.

He said transgender surgery — and post-surgical care including for complications from procedures done overseas — should be available on Medicare in all public hospitals.

Philip Morris, acting president of the National Association of Practising Psychiatrists, said any doctor acting ethically had “to justify treatment by a careful assessment of the problem — and informed consent comes from the patient being given information about the condition they have, the available treatments and the pros and cons”.

There are reports of trans youth being coached online on what to say to meet the diagnostic criteria for gender dysphoria, and some champions of the dominant pro-trans “affirmative” approach to treatment claim this diagnosis taints trans identity with illness.

Hormonal treatment and surgery, such as double mastectomies, are promoted by gender clinics around the world as “lifesaving” treatments, with questionable claims about suicide risk linked to dysphoria.

There is growing concern about vulnerable youth with complex problems being rapidly “affirmed” as trans and put on track for experimental medical treatment amid social media hype and identity politics, with pressure to reduce safeguards as “gatekeeping”.

Critics of the affirmative model say not enough time or care is put into investigating how often gender confusion is a function of pre-existing issues such as mental health problems, autism, suppressed same-sex attraction or family trauma.

The Royal Australian & New Zealand College of Psychiatrists last week announced a review of evidence for treatment of young people with dysphoria, stressing the need for “comprehensive biopsychological assessment” by child and adolescent psychiatrists together with other clinicians.

Last month, The Australian revealed the pro-affirmation college had abandoned its reliance on 2018 treatment guidelines issued by Melbourne’s Royal Children’s Hospital gender clinic and criticised for lack of caution and overplaying empirical evidence.

The government has said they are “the world’s most progressive” guidelines and represent “the most stringent safety standards.”

The guidelines claim being trans “is now largely viewed as part of the natural spectrum of human diversity” but is “frequently accompanied by significant gender dysphoria.”

The document says trans youth with depression, anxiety or psychosis complicate clinical decisions but this “should not necessarily prevent” them being given trans medical treatment for dysphoria.

The RCH standards acknowledge the “significant contribution” of the trans community and the government’s trans expert advisory group co-chaired by Mr Wiggins.

The Wiggins report pays tribute to the “very supportive” Andrews government for enabling “an authorising environment to create action and change.” Mr Wiggins is also a member of the Health and Human Services Working Group of the LGBTI Taskforce co-chaired by Equality and Mental Health Minister Martin Foley.

Trans power

At last month’s Fremantle conference of AusPATH, the gender clinicians’ professional body, Mr Wiggins gave a presentation and reprised his report’s slogan: “It is critical that trans and gender diverse people are in positions of power and have the respect and agency to make leadership decisions about our health care.”

Conference tweets included a trans person’s complaint about “gatekeeping” practitioners: “They have never saved me from a mistake, they have only gotten in my way, delayed access to important interventions and sometimes abusing their total monopoly over my access to trans healthcare.”

Flinders University academic Damien Riggs, an expert influence on the Australian Psychological Society’s trans policy, has argued that parents who seek a diagnosis for their trans child are guilty of a form of “identity-related abuse.”

In a paper last year Dr Riggs, whose expertise includes “queer psychology”, said he told one such parent that psychosocial assessment of a young child was “unnecessary” and “does not provide an any more objective take on the child’s gender than that already provided by the child.”

He has also called for medical treatment without a gender dysphoria diagnosis, pointing out that women who learn they have a genetic risk of breast cancer are able to have a Medicare-funded mastectomy “without a current diagnosis of pathology.”

“It therefore seems unreasonable that a person who wants their breasts removed because they do not identify as female has to be diagnosed with a disorder,” he said.

The Australian sought comment from Victoria’s government, Mr Wiggins, the APS and Dr Riggs.

‘Unlawful’ to consent

Meanwhile, in Britain, a crowd-funded campaign to prevent a 15-year-old autistic girl being given puberty blocker drugs at the NHS Tavistock gender clinic in London has been extended in the hope of raising enough money to cover legal costs.

The girl’s mother, known as Mrs A, said she reluctantly put her daughter on the clinic’s waiting list. The girl was going through a period of gender confusion, Mrs A said, and could not lawfully consent to hormone suppression drugs with unknown long-term effects.

Mrs A is seeking a court order to stop the clinic giving these drugs to vulnerable young people. She has been joined in the threatened litigation by a former psychiatric nurse at the clinic, Sue Evans.

Ms Evans said on Friday the clinic had suggested a meeting to discuss the issue but had not agreed to cease administration of puberty blockers.

“We are hoping to get my costs capped but at the moment we are trying to raise £50,000 minimum (for legal expenses),” she said.

More than £18,000 has been raised from 500-plus pledges, including from outside Britain.

Ms Evans said she wanted to clarify the campaign was not aimed at a compensation payout: “We are seeking a judicial review in an attempt to get a ruling from the court that the current practice at the Tavistock is unlawful.”

The NHS has insisted safe and effective treatment is the priority; it said all the evidence for trans medical care was under review, and an updated guideline would be issued next year.

‘Erasing’ girls and boys

In Canada, parents Pamela and Jason Buffone have lodged a human rights complaint against Ontario school authorities after their six-year-old daughter was taught in a gender identity lesson that “there’s no such thing as boys and girls.”

The teacher also reportedly showed the class a YouTube video called “He, She, and They?!? – Gender: Queer Kid Stuff #2,” according to Radio Canada International.

Ms Buffone said her daughter had been left confused and upset, confided she was unsure she wanted to become a mother when she grew up, and asked if she could see a doctor about the fact she was a girl.

Last month the lawyer handling the case, Lisa Bildy, put an amended application to Ontario’s human rights tribunal (which recently threw out an “improper” complaint made by trans activist Jessica Yaniv, who identifies as a woman and had claimed female beauticians were duty-bound to give her penis and testicles a Brazilian wax.)

Ms Bildy said the Buffones’ daughter had suffered discrimination on the basis of her female sex, with the teacher Janine Blouin using her authority to “deny the existence of the female gender and biological sex, and to undermine the value of being biologically female and identifying as a female.”

Ms Buffone said the school should “take steps to refrain from treating other gender-conforming children this way in the future. I also want them to stop teaching the idea that boys and girls don’t exist.”

Ontario school authorities said they were pledged to offer safe and inclusive lessons for all students.

The ‘wrong’ lesson

A Texas-based psychotherapist Sasha Ayad — who helps teens with gender, sexuality, body image and risky behaviour, said the promotion of gender theory at school risked creating a new generation of patients with persistent gender dysphoria.

Critics of the affirmation model complain it ignores or misrepresents past research showing that the vast majority of children with early-onset dysphoria — around pre-school age — grow out of it or “desist” and accept their biological sex, with many of these young adults emerging as gay or bisexual.

This “desistance” literature is cited to reinforce the case against risky medical treatment of today’s social media-era of teens who declare trans identity out of the blue and often with no history of childhood confusion about gender. A more cautious “watchful waiting” approach is often urged as an alternative to uncritical affirmation of trans identity when social contagion is suspected.

But Ms Ayad has argued contemporary culture is creating new risks for school children.

“If they are introduced to propaganda that tells them ‘feeling uncomfortable” in your body is an indicator that you’re trans, then even pre-pubertal onset of (gender dysphoria) and trans identity may not be natural,” she said.

“A watch and wait approach worked only when the larger cultural landscape and social environment allowed for desistance. Today, with trans agendas being pushed onto younger and younger kids, the possibility of desistance will likely be decreased.

“This is iatrogenic (harm caused by intervention) and classroom sessions (pushing gender theory) are literally creating trans-identified children who then become dysphoric after adopting the new label. This is irresponsible and dangerous.

“I don’t think it’s necessarily wrong to teach children about people who have different experiences or who may be trans. The problem is how incredibly nebulous the concept is and how easily it can be adopted by a malleable and psychologically immature child.”