Melbourne’s Royal Children’s Hospital rules out breast surgery start with new funding boost

Melbourne’s Royal Children’s Hospital, home to the country’s most influential gender clinic, says it has ‘no plans’ to spend some of a multimillion-dollar funding boost on mas­tectomies for teens.

Melbourne’s Royal Children's Hospital. Picture: Getty Images

Melbourne’s Royal Children’s Hospital, home to the country’s most influential gender clinic, says it has “no plans” to spend some of a multimillion-dollar funding boost on mas­tectomies for teens.

In foreshadowing $45.4m in LGBTIQ+ funding in Thursday’s state budget, Victoria’s Equality Minister, Martin Foley, said the RCH youth clinic and the adult Monash ­gender clinic would share $21m to pay for “lifesaving mental health and wellbeing services”.

There is growing international concern about the lack of good quality evidence for the hormonal and surgical interventions with young people, and Sweden’s Karolinska children’s hospital recently ruled that puberty blockers and opposite-sex hormones can no longer be given to minors outside strictly supervised clinical trials.

Mr Foley’s office did not respond when asked what evidence backed up his claim of “lifesaving” ­treatment, and what the extra money would fund at RCH. How the $21m would be split between the Monash and RCH clinics was not clear on Wednesday.

In July 2019, RCH gender clinic director Michelle Telfer told Victoria’s royal commission into mental health that the hospital had the ex­pertise but not the funds to perform “chest reconstructive surgery” or transgender mastectomies.

Dr Telfer, a paediatrician, said “many” of the clinic’s 2018 intake of biological female patients diagnosed with gender dysphoria — a distressing feeling of conflict between the body and their inner sense of a male gender identity — wanted this procedure, and the only surgical options were interstate or overseas.

She told the commissioners her clinic needed “secure, long-term” increases in public funding.

Asked whether the 2021 funding boost would make RCH the first children’s hospital in Australia to offer transgender mastectomies, known as “top surgery” among gender clinicians, a hospital spokeswoman said it had “no plans” to do so.

RCH had previously refused to comment on Dr Telfer’s proposal, which The Australian first reported in December 2019.

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On Wednesday RCH did not answer when asked how many under-18 patients it had referred to private surgeons for mastectomies in the past five years. There is no public data on this but Family Court judges have ruled patients as young as 15 competent to consent to this trans surgery.

Regret over lost breasts, scarring and inability to breastfeed are elements in the emerging stories of “detransitioners” internationally who decide medicalised gender change was a harmful mistake.

RCH treatment guidelines, used nationally, say top surgery is “regularly performed across the world in countries where the age of majority for medical procedures is 16”. The guidelines caution that this irreversible procedure requires “considered and thorough assessment” taking into account the maturity of the teenager.

The 2018 document says the fact that a young patient with gender dysphoria also has mental health issues including psychosis “should not necessarily prevent medical (gender) transition”, although this may make it more complex.

One study Dr Telfer presented to the royal commission to show the psychological benefits of top surgery included two 13 year olds, five 14 year olds and nine 15 year olds at America’s biggest youth gender clinic.

The study had a small sample size, short-term follow-up after surgery, and 26 per cent of the post-surgical group could not be contacted to report on whether they were happy at the ­outcome.

Not all gender clinic patients receive medical treatment, which does not start until the onset of puberty, but there is no good public data on the pattern of interventions.

Victoria’s shadow health minister Georgie Crozier said under-18 gender dysphoria care was “a complex issue that needs careful management”.

“It is crucial that patient follow-up occurs and that data is collected for ongoing monitoring,” she told The Australian.