Puberty blocker drugs surge at Brisbane kids’ gender clinic

Queensland’s gender clinic has seen a 330 per cent rise, with an 85-fold spike in those taking controversial drugs to block puberty.

Teenage trans is on the rise, especially among those born female. Picture: Supplied

The number of children and teenagers at Queensland’s publicly-funded transgender clinic has risen 330 per cent over five years, with an 85-fold spike in patients taking controversial drugs to block puberty.

In 2018, there were 207 trans or gender diverse patients, up from 48 in 2014, at the Queensland Children’s Hospital clinic in Brisbane, with 171 on the puberty blocker Leuprorelin, and 30 getting the opposite-sex hormone testosterone, according to the first data obtained under FOI law.

Gender clinics in rich countries are witnessing a surge in teenagers, chiefly girls and often with multiple problems, suddenly identifying as trans and seeking “gender affirming” hormonal treatment and sometimes surgery to refashion their bodies and ease the distress of the condition “gender dysphoria”.

Clinics following the pro-trans “affirmative” approach claim their treatment is “life-saving” for suicidal trans youth and attribute the rising caseload to greater acceptance, dismissing any role for social contagion via online platforms or school peer groups.

Some practitioners fear that identity politics encourages the affirmative approach to fixate on gender, ignore underlying problems and downplay the risk of harm, with a rising number of regretful “detransitioners” ahead.

In a statement dated January 30, Britain’s national health service, which runs the Tavistock youth gender clinic, announced that a past president of the Royal College of Paediatrics and Child Health, Hilary Cass, would chair an independent review of the use of puberty blockers and cross-sex hormones.

Dr Cass said experts would make “evidence-based recommendations about the future use of these drugs” in this “fast-developing area of medicine with emerging evidence and high public interest”.

In an editorial tagged “pill-pushers”, The Economist on Friday advised more caution with puberty blockers, which stop development of “distressing” breasts or beards.

The London-based magazine faulted trans medicine’s reliance on “unconvincing” studies of suicide risk, and said “today’s rush into treatment smacks of a fad”.

In British litigation against the NHS Tavistock clinic, the High Court has been asked to rule that under-18s cannot give informed consent to puberty blockade with unknown long-term effects on physical, psychological and cognitive development. Scientists point out the brain is not fully mature until the age of 25.

The Brisbane clinic would not give a breakdown of patient numbers by birth sex, but almost all those on cross-sex hormones in 2018 were given testosterone, meaning they were born female.

In overseas centres, the vast majority of patients given supposedly reversible puberty blockers, which can start as young as 10, go on to irreversible cross-sex hormones, leading to potential sterility and other lifelong side-effects.

A worried mother asked the Brisbane clinic last year the percentage of girls on puberty blockers who were autistic — a trait common among young trans patients, together with mental illness — but was told a search had found no data.

Queensland’s Palaszczuk government has a draft law to ban “gay conversion therapy” which would also impose an 18 month prison sentence for any attempt to change the “gender identity” of vulnerable under-18s, potentially removing cautious psychotherapy as an alternative to “affirmative” medical interventions.

‘Save my life’

A handful of young Queenslanders who were born female — their ages are not always clear — have joined the global trend to launch appeals on the website gofundme.com, seeking up to $15,000 for “top surgery” or double mastectomy.

One post is headed “Save my life”, another says full-time school stands in the way of earning money for the operation. Under-18 top surgery in Australia is thought to be rare but there is no good data on trans medicine.

The children’s hospital gender clinic in Brisbane does not list surgery as an option.

Activists were angry when the clinic’s founding director, psychiatrist Stephen Stathis, was quoted in 2017 media reports saying only a minority of his patients would turn out to be trans youth diagnosed with gender dysphoria.

Many were simply “gender variant” and would go on to accept their biological sex, some having confused gender identity with sexual orientation, he reportedly said.

Occasionally young female victims of sexual abuse wanted to be boys in the belief this might have protected them, and hormonal treatment was not the right response, he said.

Dr Stathis said there were also teenagers who sought gender transition to stand out, one telling him: “Dr Steve … I want to be transgender, it’s the new black.”

On Friday a hospital spokesperson said: “Through Dr Stathis’ leadership (as medical director), the Queensland Children’s Gender Service provides contemporary, best-practice care to Queensland children and young people diverse in gender identity”.

Watch the gender clinic video here.

In online trans forums, young people debate whether or not the gender clinic at the children’s hospital is too “gatekeepy”, with accounts of four or more appointments including psychiatric assessment before hormonal treatment.

A Brisbane trans-friendly GP Fiona Bisshop — vice-president of the gender clinicians’ professional lobby AusPATH — is recommended online for her compassion, knowledge and use of the fast-track “informed consent” model.

The website of her Fortitude Valley clinic explains that informed consent means “there is no ‘gatekeeping’ approach or prolonged assessment process” before trans hormonal treatment.

The “affirmative” model sometimes frames hormones and surgery as a basic human right, and protests that involving psychiatrists or psychologists and requiring a gender dysphoria diagnosis “pathologises” trans people.

Dr Bisshop has said online that informed consent is not incautious treatment on-demand, most patients being “certain of their gender” when they ask for a prescription and not in need of counselling.

She is credited in educational material with handling hormonal transition for more than 400 patients; their age profile was not stated.

‘It’s not brain surgery’

She has said giving trans hormones is “not brain surgery” and GPs are perfectly capable of doing the job.

She supports the contentious 2018 “Australian standards” for affirmative treatment of gender dysphoric youth issued by paediatrician Michelle Telfer’s clinic at the Royal Children’s Hospital in Melbourne.

Those standards do away with the old requirement that teenagers reach the age of 16 before they begin lifelong cross-sex hormones, saying “informed consent for this treatment must be obtained from the adolescent and ideally, but not necessarily, consent should be also obtained from their parents, carers or guardians”.

The RCH document also makes a case for top surgery at 16.

“All treatment and care” at the Brisbane youth gender clinic is guided by the RCH standards, a children’s hospital spokesperson said.

The Royal Australian and New Zealand College of Psychiatrists disendorsed the RCH standards in September, pending “further review” of the evidence.

Meanwhile, the Endocrine Society of Australia, whose members look after trans hormones from adolescence on, has come out in favour of a medical colleges’ working group to review treatment issues with gender dysphoric youth.

“The main reason is that the evidence available is limited,” said Bu Yeap, a professor at the University of Western Australia who chairs the society’s medical affairs committee.

He favoured a “well-resourced, impartial” working group, “given that this is a controversial area, and some parties hold strong views”.

The Weekend Australian put detailed questions to the children’s hospital and to Dr Bisshop.