Medical experts in Australia are calling for a halt and reexamination of ‘unproven’ gender-affirming treatments which have been heavily influenced by trans activist groups whose lobbying was aggressive and intimidatory.
Gender-affirming treatments include a range of controversial medical interventions “designed to affirm an individual’s gender identity” when it conflicts with their biological sex at birth. These interventions include puberty blockers, hormone replacement, and surgical procedures. Most treatments given to teens are unproven and irreversible. This is nothing short of a dangerous medical experiment involving children.
In a recent article published in the journal Australasian Psychiatry, authors Prof. George Halasz and Dr. Andrew Amos urged doctors to examine the ethics of prescribing powerful hormone drugs despite a lack of evidence that the affirmation of a child’s perceived gender identity and subsequent medical transition actually eases teenagers’ mental distress. They cite “concerning lapses of clinical governance influenced by activists and linked to patient harm”.
Furthermore, they call on the medical profession to resist the pressure of activism that has triggered the widespread “subordination of clinical governance to social and political goals” in the rush to affirm distressed children’s chosen gender.
Professor Halasz is a consultant child and adolescent psychiatrist and Adjunct Senior Lecturer at Monash University. Dr. Amos is Director of Training – Psychiatry at Queensland Health.
Halasz and Amos urge the medical profession to heed the “cautionary tale” posed by the healthcare scandal that unfolded at London’s Tavistock clinic and in British compensation cases they say are directly relevant to Australia. A review of the Tavistock clinic by Dr. Hilary Cass OBE. triggered the institution’s closure. It confirmed a “limited evidence base for gender-affirming care, systemic failures of clinical governance, and unjustifiable risks of harms to children and families”. Refer to cass.independent-review.uk for more information on the review.
“The Tavistock case shows this drive has risked patients’ health and family wellbeing on clinical frameworks unbacked by evidence. As the Cass Review makes clear, the certainty associated with gender affirming care is not backed by any strong evidence about the natural history of gender dysphoria or the efficacy/sequelae of the treatment alternatives, particularly over the long term.”
Not only has the UK National Health Service closed the Tavistock clinic, puberty blockers are now only able to be prescribed in the context of a clinical trial in England.
Halasz and Amos’ article has certainly intensified the battle over gender-affirming medicine in Australia, and how it’s being managed by the medical profession:
“I think there’s been a failure of leadership across medicine. Individual practitioners have been able to have huge influence because medical colleges have not stepped in to provide guidance.”
Halasz and Amos go on to say… “The natural history of gender dysphoria suggests two critical ethical questions: first, is the ‘transition pathway’ – social, medical or surgical – in the best interest of the child? and second, is that pathway consistent with the principle ‘first, do no harm’? … There is no compelling evidence that affirmation decreases the risk of suicide. The dilemma in which distressed parents are challenged to imagine choosing between a dead child and a trans-child appears to use parents’ caring instinct and trust in experts’ knowledge/ethics to force them to suppress the impulse to question any aspect of gender affirming care.”
Source: Gender dysphoria: Reconsidering ethical and iatrogenic factors in clinical practice
Despite this, the Royal Children’s Hospital in Melbourne – home of Australia’s self-appointed setters of quasi-national guidelines – published an updated version of their standards of care that endorse a radical expansion of the affirmative model. The new guidelines endorse the prescription of puberty blockers and cross-sex hormones by general practitioners!
“Clinicians pushing for clinical accountability and transparency said they were stunned that the new guidelines fail to consider any of the newly emerging evidence or systematic reviews post-2020 that have dismantled the credibility of the original model that underpins gender-affirmative medicine and also cast doubt on the efficacy of the approach.”
Professor Halasz and Dr Amos say there are “major risks associated with gender-affirming care”. Yet the new version of Australia’s guidelines “reads as if there is simply no controversy”.
“I think it’s wise that any hospital that has been following what’s happened to the Tavistock to start to distance itself as much as possible, as urgently as possible, lest they suffer the same fate,” Prof. Halasz said.
“And where is the data on the number of surgical interventions that follow after the Royal Children’s Hospital care is finished and these patients transition over to adult services? Where is the data? Or the follow-up to document detransitioners? Where is the evidence?”
The psychiatrists said the rise of gender-affirmative medicine had been heavily influenced by trans activist groups whose lobbying was aggressive and intimidatory. And that culture had flowed through into medical training. “As someone involved in the education of training psychiatrists, I am particularly concerned at how effective trans advocacy has been in training young doctors to reflexively reject any evidence that there might be negative consequences to gender-affirming care,” Dr Amos said. “Trainees appear to believe that simply acknowledging there are alternative approaches to gender dysphoria actually threatens harm to the transgender community. I would describe that as magical thinking.”
“I think there’s been a failure of leadership across medicine. Individual practitioners have been able to have huge influence because medical colleges have not stepped in to provide guidance.”
Professor Halasz, described the rise of gender-affirming medicine as taking place within a radical form of social activism. “It was a culture of intimidation, silence, and I think threat,” the professor said. “And I just thought ‘this is so outside of my understanding of what medicine is about’.”
The psychiatrists said they were also concerned by the suspension of Queensland specialist child psychiatrist Jillian Spencer, who we recently interviewed for Family Matters (see the full interview below). Dr Spencer, a vocal critic of gender affirmative care, has been stood down from her role as a senior staff specialist at a public children’s hospital in Queensland. She has been open about preferring a cautious and holistic approach to the treatment of gender dysphoria cases, rather than an automatic affirmation-only approach.
It is very difficult to get psychiatrists to make public statements about gender dysphoria even though the majority appeared to share a more conservative approach. Doctors are afraid for their professional reputations.
“The major reason for this fear is that trans advocates appear to be both aggressive in their rhetoric, and unwilling to engage in any discussion that does not adopt their basic viewpoint,” Dr Amos said. “While I do not know the specific details, the protracted suspension of child psychiatrist Jillian Spencer for expressing an alternative view of the approach to gender dysphoria appears to have confirmed the real threat behind such fears.”
And the overriding of parents’ frequent gut instinct for caution over affirmation had damaged psychiatry as a profession, according to Professor Halasz.
“Our profession is entrusted by parents to do what’s in the best interest of their child,” he said. “The trust that we have built up with families over years, I believe, actually has been absolutely shredded by this process.”