Psychiatry Body’s Radical Challenge to Transgender Care

The peak psychiatry college has become the first medical body in the country to acknowledge shifting international evidence on transgender healthcare and puberty blockers in a major position statement challenging the approach of children’s hospitals. The Royal Australian and New Zealand College of Psychiatrists (RANZP) declined to endorse gender affirming care as the key intervention for children who believe they may be transgender, highlighting an increasingly cautious approach in some European countries amid a lack of evidence for the medical pathway. It acknowledged the plight of detransitioners, who it noted had reported being harmed by medical transition. The college has also issued an unambiguous statement defining sex as a biological characteristic – a statement in opposition to the notion put forward by trans activists that sex is a concept related to identity rather than a binary state. “Sex refers to the biological characteristics that define humans as female or male,” the position statement says.

The statement went on “While these sets of biological characteristics are not mutually exclusive, as there are individuals who possess both, they differentiate humans as males and females in the vast majority of people.” The RANZCP position statement, drafted by a committee of senior psychiatrists, for the first time acknowledges a range of professional opinions over the best approach to treating children with gender distress, and references the fallout from the Cass review in Britain which was called to examine concerns of clinical governance and lack of appropriate comprehensive healthcare at the Tavistock clinic in London, where thousands of children were rushed on to hormone treatments.  “Professional opinions differ about some aspects of the most appropriate care for adolescents requesting treatment,” the position statement says. “A range of interventions (including psychological, social, and medical) may be considered for adolescents presenting with distress related to their gender.

“There is a range of recommendations regarding the care of children and adolescents with gender incongruence/gender dysphoria. These include caution on the use of hormonal and surgical treatment, screening for potential coexisting conditions (autism spectrum disorder and ADHD), arranging appropriate service provision for these conditions, and offering psychosocial support to explore gender identity during diagnostic assessment. “Some TGD young people, supported by their family, wish for and commence gender-­affirming puberty suppression/sex hormone treatment, and report they experience it as beneficial. While several major professional organisations support the use of puberty suppressants and cross sex hormones for adolescents, health authorities in some European countries recommend restrictions be placed on their use. Australian and New Zealand paediatric services continue to provide multidisciplinary gender-affirming care.”

Gender-affirming care is a medical approach in which a child’s perceived gender is unquestioningly endorsed by doctors. It sometimes results in the prescription of puberty blockers to “pause” development, and later cross-sex hormones to transition sex. The position statement notes that “distress associated with gender may in some situations be related to a range of psycho­social issues or mental health conditions” and emphasises the importance of psychotherapy and psychosocial support that may “provide an opportunity for reflection and exploration”. It notes “childhood and adolescence are times of rapid … brain development and development of personal identity” and “gender expansive and nonconforming behaviour and preferences … should not necessarily be a cause for concern or require attention”. “For some people, gender identity and/or gender expression can change over time,” the statement says. “It is not known how many individuals who detransition experience regret, and how many are satisfied with the changes they have made. While regret appears to be infrequent, the true regret rate is unclear.

“Individuals who detransition have been reported to experience mental health concerns including depressive and anxiety disorders and may have difficulty accessing healthcare services. Some report they have been harmed by gender-affirming care and some have launched legal proceedings.” Leading psychiatrists who have questioned the role of trans-activism in affirmative healthcare and raised concerns as to its evidence base welcomed the new guidelines as a “totally radical and new” contribution to an issue that was increasingly prompting a “civil war within medicine”. “In my opinion, it is unconscionable that gender-affirming medical-based care has grown rapidly across Australia in the last decade despite the reality that we simply don’t know how many kids change their minds,” said Andrew Amos, an academic psychiatrist at the James Cook University. “This is particularly damaging because medical/surgical transition require lifelong care, with potentially catastrophic ­effects of detransitioning later in life.”

Source: Compiled by APN from media reports

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