States pushed to ensure transgender safeguards

Federal Health Minister Greg Hunt is urging his state counterparts to act on transgender safeguards.

Minister for Health Greg Hunt has asked for a nationwide approach to treating under-18s with gender dysphoria, the feeling of being ‘born in the wrong body’. 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.

Federal Health Minister Greg Hunt is urging his state counterparts to make sure controversial transgender treatments in their children’s hospitals are consistently high standard and involve counselling, safeguards and long-term tracking of outcomes.

Mr Hunt, who opposes a federal government inquiry into youth gender clinics, wrote on Friday to COAG’s Australian Health Ministers’ Advisory Council, asking it to come up with a nationwide approach to treating under-18s with gender dysphoria, the feeling of being “born in the wrong body”.

There is global debate about an exponential surge in often troubled teenagers, chiefly girls, seeking hormone drug treatment and surgery, such as mastectomies. The British government has foreshadowed changes to the law to protect trans-identifying ­minors from making irreversible changes to their bodies.

Earlier this month, Mr Hunt was reported in The Age as ruling out a national inquiry because it might “harm” vulnerable trans youth, echoing an unsupported claim by the Royal Australasian College of Physicians which warns against more “media and public attention”.

However, Mr Hunt has not ­repeated that claim about the danger of an inquiry, and it is understood the federal government regards a national inquiry as counterproductive because it would take the heat off the states, which are responsible for their children’s hospital gender clinics.

Professor of paediatrics John Whitehall last year asked Mr Hunt to set up a federal parliamentary inquiry into the safety and ethics of “gender affirmative” hormonal and surgical treatments, a call backed by a petition of 200-plus doctors as well as overseas clinicians.

On Friday Dr Whitehall said he doubted state governments ­already committed to affirmative gender clinics would allow a thorough review. “If they didn’t raise ethical questions before, they’re not going to raise ethical questions now,” he said.

John Whitehall

“(Any inquiry) has to be public, and it has to have people who are independent, otherwise there will be no public confidence in it, it will just be rubber-stamping.”

A new international watchdog, the Society for Evidence Based Gender Medicine, which includes clinicians with expertise in gender dysphoria, welcomed a review but said it was essential to look at the full range of treatment ­options and not just the dominant affirmative model spearheaded in Australia by the Royal Children’s Hospital in Melbourne.

A spokesman for SEGM, ­Sydney psychiatrist Roberto D’Angelo, said the group did not believe these affirmative treatments were “sufficiently sup­ported by robust evidence”.

“A review which consults only with clinicians supportive of the gender-affirming paradigm will not achieve what it should do, namely to determine which treatments are ethical, evidence-based and without untoward risks of causing serious, irreversible harms,” he said.

In March the RACP told Mr Hunt the evidence for these treatments suffered from “limitations” and “gaps”, and suggested a “national framework” to underpin consistent, high quality care across the country.

Not up to gold standard?

The college defended controversial “Australian standards” for affirmative treatment issued by the gender clinic at RCH, saying it might not be “feasible” for a gender dysphoria guideline to measure up to the “gold standard” set by the National Health and Medical Research Council.

The college had previously lobbied to extend affirmative treatments with more public funding and less judicial supervision.

Mr Hunt’s letter to the health ministers’ body cites the college idea of a national framework and says this could bring consistent quality “and in particular ensure strong and balanced counselling and safeguards, workforce standards, monitoring of practices, and monitoring of long term health and wellbeing outcomes”.

Advocates for the “affirmative” treatment approach sometimes play down the necessity for counselling or a diagnosis of gender dysphoria before trans youth are given access to medical interventions.

Comment was sought from RCH.