Calls to review transgender treatment for kids after British Tavistock Clinic is closed

Australian gender clinics are under fresh scrutiny after a leading British clinic was closed down over safety concerns.

Queensland paediatrician Dylan Wilson says the closing of Tavistock should now see Australian authorities reconsider the treatment of children experiencing gender dysphoria.

Australian gender clinics are under fresh scrutiny and face calls for an independent review of their prescription of puberty blockers to teenagers after a leading British clinic was closed down over safety concerns.

The ordered close of the Tavistock Clinic – the model for treating trans people around the world – on Thursday followed concerns raised by doctors that young ­patients were being referred on to a gender transitioning path too quickly and that there was insufficient evidence as to the long-term cognitive and physical impacts of puberty blockers.

With several major Australian gender clinics based at children’s hospitals having been strongly influenced by the Tavistock Clinic, some doctors say the findings of the British review by Dr Hilary Cass are likely to apply equally in Australia amid a dominance of a “gender affirming” approach to treating gender dysphoria.

Some of the nation’s leading trans clinics, including the centre at the Royal Melbourne’s Children Hospital, defended their methods on Friday and said they followed best Australian practice.

Queensland paediatrician Dylan Wilson said the closing of Tavistock should lead to Australian authorities reconsidering the treatment of children experiencing gender dysphoria.

“The concerns that have been raised with the UK Tavistock Clinic translate directly to the same concerns that can be applied to gender clinics here in Australia,” Dr Wilson said.

“The fact that Dr Cass noted that there is insufficient evidence to recommend puberty blockers but they have been used by gender clinics in Australia is of huge concern.

“They are now only going to be used in the UK as part of research trials with significant ethical oversight which is the same pathway that Sweden has followed, but the gender clinics in Australia continue unabated to prescribe them on a regular basis without any oversight or scrutiny whatsoever.

“The concern is that children are, as the Cass report found, instantly socially and medically ­affirmed without any exploration of any other diagnoses or contributing factors to their gender identity being considered, which means as soon as they are ­affirmed as children that are transgender, they are placed along a pathway which leads them to medical treatment, and medical treatment pathway leads them to lifelong medicalisation.”

The National Association of Practising Psychiatrists – which has adopted a cautious, psychotherapy-first approach to treating gender dysphoria – is also calling for a review of gender clinics in Australia.

“The longer-term studies of what happens to children and ­adolescents when they’re treated with puberty blockers is not known. The evidence base is lacking,” said association president Philip Morris.

Public gender clinics in Australia all say puberty blockers and hormone therapy is prescribed only after comprehensive clinical assessment.

The Royal Melbourne Hospital’s gender clinic led by Michelle Telfer, head of the hospital’s ­Department of Adolescent Medicine and director of the RCH Gender Service, developed the Australian standards of care for the treatment of gender dysphoria.

The hospital says the clinic’s service “is underpinned by research methodology to monitor outcomes that will continuously inform best practice”. Critics say published research on the long-term outcomes of hormone treatment of children is non-existent.

“We will continue to closely monitor how services nationally and internationally develop and evolve, and welcome all actions that ensure that trans children and young people continue to ­receive the highest possible quality of care, regardless of where they live,” a hospital spokesman said.

The Children’s Hospital at Westmead in Sydney, which has a trans and gender diverse service, said all patients referred to the clinic underwent a specialised and comprehensive assessment involving consultation with specialists in psychological medicine, adolescent medicine and endocrinology.

“Children are only ever considered for stage 1 treatment (puberty blockers) once this assessment has taken place and in close consultation with the patient, parents and treating medical teams. This treatment is reversible,” a hospital spokesperson said.

Transcend Australia, an organisation that supports trans, gender diverse and non-binary children, rejected the calls for a review and said Australian standards of care had been developed by best practice.

Transcend Australia chief executive Jeremy Wiggins said treatment often gave young ­people a chance to consider their identify for longer and said the ­effects of puberty blockers were reversible.

“The treatment is highly considered and given to people who demonstrate that they meet the criteria for gender dysphoria. It is considered for them to be lifesaving treatment so they can continue and get on with their lives,” he said.

“I’d be concerned for any government in any country to remove access to treatment for a highly vulnerable population.”

The close of the Tavistock Clinic comes as Dr Cass recommends a shift to a more “holistic” mode of care amid concerns that other clinical presentations including mental health issues were “overshadowed” when gender was raised by children referred to the clinic.

Puberty blockers will now only be able to be prescribed in the UK as part of a clinical trial that follows children until adulthood.

“Puberty blockers, rather than acting as a “pause button” allowing children time to explore their identity, seem to lock them into a medicalised treatment pathway,” Dr Cass’s interim report said.