By Michael Bachelard and Mike Foley
Australia’s treatment of transgender children and adolescents will be put through the scrutiny of a thorough medical assessment after the federal government announced a landmark review on Friday.
Health Minister Mark Butler said that interim advice on the use of one part of that treatment, puberty blockers, will be completed in the middle of next year. That treatment was banned last year in the United Kingdom after a review found there was little scientific evidence to support it.
Health Minister Mark Butler announced the review into transgender treatment on Friday.Credit: Alex Ellinghausen
Butler has appointed Australia’s peak medical research body, the National Health and Medical Research Council, to develop new national guidelines in place of state guidelines that have seen an explosion in the number of young people transitioning gender.
The number of young people in gender care in Australia has increased approximately tenfold in a decade, in line with increases across the Western world.
The review will examine the prescription of both puberty blockers, which stop young adolescents from developing secondary sex features, and also so-called “cross-sex” hormones used to transition young people so their appearance matches their gender identity.
Much of this work has been done in specialised gender clinics based at state children’s hospitals.
The research council was not in a position on Friday to announce who would conduct the inquiry, or its timing, but would update on Monday.
The announcement of the review was initially welcomed by both sides of an often-intense debate about gender medicine. Assistant Health Minister Ged Kearney took to Twitter late on Friday and said the review was called at the request of practitioners who deliver what’s known as “gender-affirming” medicine, and it would listen carefully to them as well as people with lived experience.
“This is not a political football – this is about ensuring the best practice of care for trans and gender diverse children and adolescents,” Kearney said.
Butler’s review follows an announcement by the Queensland government on Tuesday that they were pausing the prescription of gender transition drugs, including puberty blockers, for young people. Queensland ordered public health facilities to cease offering such interventions to new patients, the first state in Australia to do so.
Butler sought advice from the research council and the Therapeutic Goods Administration before launching the federal review and said it was imperative that “highly vulnerable children and adolescents” receive treatment based on the best available evidence.
“We want young people and their families to receive the best health care … and wrap-around support,” he said. “It is imperative there is community confidence that Australian children, adolescents and their families are receiving the most appropriate care.”
The review will scrutinise the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents.
National approach
Butler said his review was prompted by the announcement made by Queensland Health Minister Tim Nicholls on Tuesday.
“I’ve indicated to Minister Nicholls that I don’t think it would be appropriate for Queensland to continue with their stated intention to undertake an evidence review in this area of care,” Butler said. “These issues should be nationally consistent, and in my view, should be driven by the pre-eminent authority.”
The review will develop new national guidelines for the treatment of young transgender people.Credit: iStock
When announcing the Queensland review, Nicholls said there was “widely contested international evidence” around the use of puberty blockers for young people with gender dysphoria. Britain has banned such treatment after a landmark review by pediatrician Hilary Cass.
Butler said much of the public commentary about trans and gender-diverse treatment was damaging to the mental health of young people and their families, which is why he has turned to the research council.
Opposition health spokeswoman Anne Ruston backed Butler’s commitment to evidence-based treatment, but praised recent moves by Queensland and Western Australia, which have said they intend to bar puberty blockers.
“We have always said that decisions affecting the health and wellbeing of children and young people should be informed by empirical evidence and by our health experts,” Ruston said.
Victoria’s gender clinic at the Royal Children’s Hospital is the largest and busiest in the country, and the state has been a major proponent of pro-affirmation care. NSW’s Westmead clinic went through a number of controversies, producing a report questioning affirming care, before the new Labor government reversed that position.
Greens LGBTIQA+ spokesperson Stephen Bates also cautiously welcomed the review and stressed the need for access to treatment for trans and gender-diverse children.
“Gender-affirming care is healthcare and every person in this country is entitled to access the healthcare they need,” Bates said.
Community reaction
LGBTI groups and transgender medicine practitioners have “cautiously welcomed” the review, but insisted it be led by experts and “remain free of political interference and not block continued care across the country”.
Nicky Bath, the chief executive of LGBTIQ+ Health Australia, said it was an opportunity to end reviews by individual states that threaten to “disrupt best practice treatments as we have seen in Queensland”.
“While it will be challenging to see this occurring, now is the time to ensure that we contribute to the process, hold it to account,” Bath said, adding that treatment should continue while the review is under way.
Professor Ashleigh Lin, the president of the Australian Professional Association for Trans Health, said the organisation acknowledged the need to update the standards of care.
Equality Australia CEO Anna Brown warned against the issue becoming “an ideological debate or a political football”.
“Politicians should not be in the business of making medical decisions for young people and families they have never met and whose experience of life are unimaginable to most of them,” Brown said.
Judith Hunter, spokesperson for Genspect, an organisation that opposes gender-affirming care, said it was “a step in the right direction”.
“I just hope they get the right people on the committee,” Hunter said.
“Unfortunately the history of this is that it’s the people who are lobbyists, who are pushing for these interventions for young people, rather than proper evidence-based analysis.”
Treatment in Australia
Treatment delivered in Australia, known as “gender-affirming care”, starts from the premise that a child’s statements about their gender identity should be taken seriously and acted upon.
Puberty blockers are often given to children at the early stages of adolescence – when breasts and testes are developing. Gender clinics insist the effects are reversible, though that’s disputed.
The next step is cross-sex hormones – oestrogen and testosterone. At each stage, says Family Court of Australia rulings, clinics must obtain the consent of both the child’s parents as well as clinicians. The third stage, “top surgery” to remove breasts, is very rare for adolescents, and “bottom surgery” to change genitals is only available to adults.
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