Australian Transgender Healthcare Guidelines ‘Lack Rigour and Independence’

Australia’s guidelines on gender affirmative medicine lack rigour and independence and fail to recommend formal assessment processes that screen for body image problems, autism spectrum disorder, sexual orientation, or physical health conditions, according to international researchers commissioned by the UK Cass review. University of York researchers conducted a study analysing international standards of care in gender-affirming medicine. The Royal Children’s Hospital Melbourne (RCH) guidelines, which are followed by all Australia’s children’s hospitals, were examined. The review found all guidelines around the world, including Australia’s, recommend a multidisciplinary approach to assessment, but few provide specific detail or clarity on the purposes of assessment. For instance, very few guidelines recommend formal measures or clinical tools to assess gender dysphoria. Royal Children’s Hospital Melbourne guidelines in Australia were found to contain no recommendations for the discussion of body image, neurodiversity or autism spectrum disorder, sexuality, sexual functioning or sexual orientation, or physical health or conditions.

A past president of the Royal College of Paediatrics and Child Health, Hillary Cass was commissioned to carry out a review of London’s Gender Identity Development Service following patient and clinician concern over an activist-driven approach adopted at the flagship Tavistock clinic that was deemed to have unduly overridden clinical governance and decision making, risking harms to children who were routinely rushed on to puberty blocker medication. The review’s recommendations reflect a culmination of four years of investigation and consultation, as well as eight independent systemic reviews of the global research literature found a lack of reliable evidence for the key gender interventions used in the gender affirming model of care, including social transition, puberty blockers and cross-sex hormones. The review also examined international evidence and gender-affirming medicine guidelines, including in Australia where RCH guidelines were first published in 2018 in the Medical Journal of Australia. Written by gender-affirming clinicians at RCH, they became known as the Australian Standards of Care and Treatment Guidelines.

These guidelines are endorsed by the Australian Professional Association for Trans Health and in turn have been modelled on the World PATH endorsed standards of care. In the University of York’s examination of international guidelines, the RCH Standards of Care ranked very poorly. Australia’s guidelines were given a very low score of 19 per cent on “rigour of development” and 14 per cent on “editorial independence”. The Cass report found that various national guidelines tended to reference each other in a “circular” fashion to back up their methods despite objectively poor evidence underpinning the gender-affirming medical approach. The RCH did not respond to the criticism when approached. Queensland child psychiatrist Jillian Spencer, who was stood down from her job in a children’s hospital over her opposition to gender-affirming medicine, said she believed that since the release of the Cass review, “the College of Psychiatry appears to be defending a gender-affirmative approach for children”.

Despite the mantra that Australian gender clinics are multi­disciplinary and holistic, she said we could not be sure, as the same was once said of the Tavistock. “Such similarities indicate the need for an inquiry to investigate how Australian gender clinics are actually functioning on the ground,” Dr Spencer said. “Concerns are reinforced by Freedom of Information data showing Australian paediatric gender clinics continue to prescribe puberty blockers and cross-sex hormones at high rates. “I am concerned Australian gender clinics are providing a standard of care significantly worse than the Tavistock clinic on several measures.” For children approaching puberty, Australian clinics offer a three- to four-session assessment phase before referral for hormones, whereas the Tavistock clinic was criticised as “rushing” children into hormonal interventions using a four to six-session assessment phase. The UK gender clinic prescribed cross-sex hormones from “around the time of the child’s 16th birthday”, whereas Australian clinics routinely prescribe cross-sex hormones to children aged 14.

While the Cass review did not comment on gender surgeries, which are not provided to minors in Britain, in 2018 the Australian Family Court gave the green light for adolescents with decision-making capacity to undergo gender surgeries. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is facing ongoing calls to release a statement acknowledging the findings of the Cass review. There is also growing concern at the dearth of information on the outcomes of the children who have been treated at public hospital gender clinics around the country, which have published very little data or outcomes based on patient research. The college re-released a statement it gave two weeks ago. “The RANZCP is reviewing the findings of the Cass Review,” a spokesperson said.

Source: Compiled by APN from media reports

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