Hunt urged to probe transgender surge among girls

Updated | Greg Hunt has been urged to make sure an inquiry looks at the role of social media in a surge of teenage girls coming out as transgender.

Health Minister Greg Hunt. 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.

Health Minister Greg Hunt has been urged to make sure an inquiry into risky medical treatment for children and adolescents looks at the role of social media in a surge of teenage girls coming out as transgender.

Online forums coach teen­agers how to pitch their gender change to parents and doctors, with one tip being “find out what they want to hear if they’re gonna give you T (testosterone) and then tell them just that”, according to a 2018 survey of parents by US researcher Lisa Littman.

Sydney psychologist Dianna Kenny said the role of social contagion in the epidemic of often troubled girls declaring trans identity had to be examined.

“They suddenly find total acceptance (in online trans groups) — but the only way to be validated is to transition, and if they ever develop doubts they are cast out into utter darkness,” she said.

Dr Kenny, a former psychology professor, and other researchers have written to Mr Hunt calling for a broad and independent national inquiry.

John Whitehall, a professor of paediatrics and child health, sent his own letter to the minister on Tuesday, arguing a federal parliamentary inquiry was the best way ahead.

Professor Whitehall said in his opinion “public policy and medical ‘best practice’ (on treatment of young people with gender dysphoria or discomfort with biological sex) is being declared in haste without a sufficient foundation of fact and reflection.”

He highlighted the responsibility of state and territory health ministers and the governing boards of public hospitals treating children and adolescents with gender dysphoria.

Lobbyist and adviser

The Royal Australasian College of Physicians, asked by Mr Hunt last month to inquire into concerns about the safety and ethics of gender treatment for children and adolescents, has a potential conflict of interest.

The RACP took part in lobbying to make it easier for trans adolescents diagnosed with gender dysphoria to get treatment with cross-sex hormones, which carry a risk of infertility and other side-effects.

After presenting at the 2015 RACP congress, the director of the country’s biggest gender clinic for young patients, Michelle Telfer, featured in an RACP media statement saying legal restrictions on treatment for teens under 18 exposed them to ­“increased risk of depression, anxiety, self-harm and suicide”.

Some health professionals worry that under the pro-trans “affirmation model” — spearheaded in Australia by Dr Telfer’s clinic at Melbourne’s Royal Children’s Hospital — vulnerable young people are hurried into life-changing medical treatment before safer therapy has been exhausted.

Dr Telfer is also lead author of the 2018 RCH “Australian standards” for treatment of young people, president of the gender clinicians’ professional body and may be a pivotal figure in any ­inquiry. The RACP refused to comment. The Australian does not suggest any impropriety.

Teen transition

Overseas reports suggest the share of girls among teens suddenly declaring themselves trans during puberty may be 80 per cent.

Westmead Children’s Hospital in Sydney, which said it gave puberty blocker drugs but not irreversible cross-sex hormones or surgery, had 50 ­referrals last year and its overall caseload was 61 per cent biological female.

The RCH caseload of young patients rose 41 per cent to 228 referrals last year; the hospital refused a request for a sex breakdown.

The so called “Dutch protocol” of ­puberty blocker drugs, cross-sex hormones and sometimes surgery used by gender clinics around the world was developed for persistent gender dysphoria that typically started when very young, Dr Kenny said. But the vast majority of children with early onset gender dysphoria “desisted” or recovered as they matured, with many emerging as gay or bisexual.

A leading authority, Canadian psychologist Ken Zucker, said it was unclear whether the medical literature on classic gender dysphoria applied to today’s late-onset adolescents.

“It’s one of the most urgent clinical issues in the contemporary gender dysphoria scene because we only started to see these (late onset) kids about 10-12 years ago,” Dr Zucker said.

He said one of the puzzles of these adolescent girls seen by clinicians was that many seemed to come from “families that say they are progressive, that they’re liberal and they’ve never imposed strict gender role expectations on their daughters.

“Their mothers are competent and have jobs out in the world (and they) are truly baffled by their daughters, ‘why is my kid rejecting femaleness’?”

Bruce Jenner effect

In the 2015 RACP media statement, Dr Telfer said the transgender population was not increasing but a more accepting society encouraged more patients with gender dysphoria to seek treatment.

“When you have people such as Bruce Jenner coming forward, more media attention means the longer the waiting list for our gender service gets,” Dr Telfer said.

After The Weekend Australian reported that Professor Whitehall and other researchers were seeking a national inquiry, Mr Hunt asked the RACP on August 16 to urgently examine the concerns raised.

“It is important that we have a nationally consistent standard of care that is evidence based and with appropriate safeguards to protect the interests of the patient,” the minister said in his letter.

The RACP covers paediatricians but not other health and medical staff working as multidisciplinary teams in public hospital gender clinics.

On August 20, the RACP released Mr Hunt’s letter, which asked the college to “consider and advise” on clinical best practice.

In a statement, the college said it would ask its expert groups for advice but said its chief role as an organisation was to train specialists and it “does not conduct inquiries.” It would not say more.

Inconsistent care?

The RACP said it “strongly supports supportive and welcoming care” for young people with gender dysphoria and cited the RCH “Australian standards” for treatment.

Critics in Australia and overseas have questioned the status of those standards and whether they accurately reflect the state of medical knowledge about the treatment of young people with gender dysphoria.

Victoria’s Andrews government has acclaimed the standards as “the world’s most progressive”.

The standards were praised in an anonymous Lancet editorial last year as “a framework for provision of respectful, gender-affirming care of transgender and gender diverse children and adolescents”, but both editorial and standards were criticised by a multi-author letter for “imprecise language and overplayed empirical evidence.”

Asked about clinical practice at RCH, Health Minister Jenny Mikakos said: “The national (RCH) standards ensure that children who are treated at gender clinics are protected by the most stringent safety standards.”

The RCH standards document — whose four authors were all from RCH — do not carry the imprimatur of the National Health & Medical Research Council as an endorsed national guideline, a status meant to signal “a guideline is of high quality, is based on the best available scientific evidence, and has been developed to rigorous standards.”

A spokeswoman for the NHMRC said it was “theoretically possible” for an endorsed national guideline to be developed by an expert committee drawn from a single clinic “but it would be unusual for the relevant expertise at the required level to be found in one place”.

In small print acknowledgments, the RCH standards document thanks clinicians elsewhere for “consultation and feedback” and notes the “significant contribution” of transgender people and lobbyists.

On August 13, a spokeswoman for NSW Health Minister Brad Hazzard said his officials would seek advice from the federal health department on “whether clinical guidelines for gender dysphoria should be developed at the national level to ensure a consistent approach among states and territories.” Mr Hazzard’s office had nothing more to say this week.

Mr Hunt’s spokesman said there was “no change” in the minister’s position that concerns were best referred to the RACP, and cited advice from chief medical officer Brendan Murphy who, like Professor Whitehall, is a fellow of the RACP.