Doctors treating children at a major public hospital gender clinic have questioned the basis of the “gender-affirming” approach in medicine, highlighting sparse evidence justifying the use of puberty blockers, instances of serious side-effects from the drugs, ongoing mental distress following transition and the significant potential for later regret among patients. Senior physicians at the NSW Children’s Hospital Westmead’s (CHW) gender clinic have studied the physical and mental health of 79 patients in a rare academic study of the outcomes of children who presented with gender distress and gender dysphoria. The findings cast doubt on the scientific basis of the gender-affirming approach followed by the nation’s other children’s hospitals. In an open access academic paper, CHW psychiatrists, endocrinologists and other physicians, and a senior medical ethics expert, called for a “much more nuanced and complex approach.”
Analysis has revealed 88% of children presenting at Westmead’s gender clinic had at least one co-morbid mental health condition, with more than 50% diagnosed with behavioural disorders or autism. One in five children who consulted the clinic with gender-related distress later had these feelings resolved, and almost one in 10 with a formal diagnosis of gender dysphoria, some who had taken puberty blockers and cross-sex hormones, later discontinued transitioning. Given this, the adoption of a “neutral therapeutic stance” and provision of “a much more diverse range of treatment options and pathways as an alternative to medical gender transition was necessary”, the doctors concluded. One of the central justifications for gender-affirming medicine – that it alleviated psychological distress – was not borne out in the experience of the young people studied.
Some 44 out of 50 patients diagnosed with gender dysphoria reporting ongoing mental health concerns 4 to 9 years after presentation at the gender clinic, many after transitioning. Parents of children with gender distress are often told their child is at high risk of suicide if the gender-affirming path is not followed. “An unanswered question in the paediatric literature is whether gender-affirming medical treatment improves or does not improve mental health outcomes and quality of life,” said CHW doctors, including paediatric psychiatrist Kasia Kozlowska, paediatric endocrinologists Geoffrey Ambler and Ann Maguire and physician Joseph Elkadi. “In the era of evidence-based medicine, the evidence base pertaining to the gender-affirming medical pathway is sparse and, for the young people who may regret their choice of pathway at a future point in time, the risks for potential harm are significant,” the authors said.
The study comes as doctors practising gender-affirming medicine come under scrutiny in court, as parents seeking to block prescription of puberty blockers to their children call expert witnesses to challenge the evidence. One recent Family Court case initiated by a parent seeking to halt their child being prescribed puberty blockers was settled midway through evidence as doctors from a children’s hospital gender clinic called as witnesses came under scrutiny. Solicitor Bill Kordos, who acted for the parent, said: “What became apparent running the case is that the science and the evidence didn’t seem to support the recommendations of the gender clinic. The unravelling of the science and the medicine was so telling that I became alarmed that, if this is one case, and there are hundreds of children being put on a conveyor belt, and young children are being told they have gender dysphoria without the whole picture being addressed, I felt it was a form of child abuse.
“I also formed the view that they appeared to have politicised healthcare, which directly threatens the welfare of children. An inquiry should be held as to how these clinics are operating. I think they’re exposing themselves to a massive class action.” The Australian litigation comes as senior doctors from the UK’s Tavistock Clinic spoke out in a new book by British journalist Hannah Barnes at their growing concerns the gender-affirming approach they were following ”wasn’t actually safe” and may amount to a medical scandal. The Cass Review in the UK, which led to the shutdown of Tavistock, has said it was now examining gender-affirming medicine guidelines set by the World Professional Association for Transgender Health. The gender-affirming approach has been championed in Australia by paediatrician Michelle Telfer and colleagues at the Melbourne Royal Children’s Hospital.
Dr Telfer helped author the Australian Standards of Care and Treatment Guidelines for trans and gender-diverse children and adolescents, following The Netherlands model and based heavily on World Professional Association for Transgender Health guidelines. Australian Professional Association for Trans Health standards are followed by most doctors treating patients with gender dysphoria in Australia, from major children’s hospital clinics to general practitioners. Gender-affirming care is designed to support and affirm an individual’s perceived gender identity, including the prescription of puberty blockers and hormone treatments to medically affirm the patient’s perceived gender. The guidelines stipulate decision-making, including relating to medical intervention and social transitioning, “should be driven by the child or adolescent wherever possible”.
The CHW doctors have raised concerns that “many unknowns remain” regarding the long-term effects of puberty blockers, which are described by the Royal Children’s Hospital Melbourne as “reversible in their effects”. International evidence is in fact casting greater doubt on whether the effects of these medications are reversible. Endocrine reviews of the CHW patient cohort documented side-effects in 23 of the 49 young people prescribed puberty blockers, including low bone density, hot flushes, weight gain and anxiety. The CHW doctors raised concerns about long-term effects on patients’ sexual function in adulthood. Within the 9% cohort of patients with a diagnosis of gender dysphoria who had discontinued the transgender pathway 4-9 years after consulting the gender clinic – three had undergone puberty suppression beginning at the average age of 12. Three had taken cross-sex hormones not prescribed by CHW.
Transgender activists claim rates of transition are in the order of less than 1%. But the CHW doctors say the “emerging voices of de-transitioners are identifying important issues”, and remain concerned many young people may regret their transition. The hospital said it appeared many young people were accessing cross-sex hormones from unregulated sources as 51 of the cohort they studied had commenced treatment outside the institution, 20 of whom were under 16. Six young people studied had undergone gender-affirming surgery such as mastectomy. The CHW doctors also identified concerns around the increasing prevalence of predominantly female patients with “late rapid-onset or adolescent-onset gender dysphoria” with no prior history of gender distress. “The absence of prior history raised questions that this particular group of adolescents were being drawn to the construct of gender dysphoria because of some evolving social process,” the doctors said.
Source: Compiled by APN from media reports
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