Australia’s children’s hospitals are increasingly being left as international outliers as Britain’s National Health Service (NHS) moves to ban the routine prescription of puberty blockers in children, raising questions over the safety and clinical effectiveness of the hormone drugs that are given to children experiencing gender dysphoria. The NHS released a statement saying, “we have concluded that there is not enough evidence to support the safety or clinical effectiveness of puberty blockers to make the treatment routinely available at this time” and announced the drugs will only be able to be prescribed as part of clinical trials. The decision is in line with a central recommendation of pediatrician Hillary Cass following an extensive examination of the care being provided to children at London’s Tavistock clinic in the wake of clinical governance concerns raised by doctors and patients. While Australian gender-affirming doctors continue to maintain puberty blockers simply “pause” sexual development while confused children weigh up whether to progress to transition, the Cass review found that an ideologically-driven approach at the Tavistock had essentially transplanted usual clinical governance practice and usual practices of comprehensive assessment and care, and that children were being rushed onto the drugs and placed on a medical pathway that almost invariably progressed to the later prescription of cross-sex hormones and sometimes surgery.
International evidence has mounted since the interim findings of the esteemed pediatrician were handed down in Britain, with several progressive countries that had wholly embraced gender-affirming care instituting greater restrictions and safeguards and launching reviews into the model’s evidence base. Some of the original Dutch researchers who published the first papers on puberty blockers in the treatment of gender-questioning children – that provided the evidence upon which the gender-affirming model is based, including in Australia – have now questioned their own findings, prompting the Netherlands parliament to commission fresh research. There are concerns around the drugs’ impact on children’s brain development, bone mineral density, and potentially their future fertility and sexual function especially when the patients progress onto cross-sex hormones. Last year Norway’s independent healthcare investigator, the Norwegian Healthcare Investigation Board, published a report pronouncing that little was known about the long-term effects of puberty blockers and side effects of treatment with hormone drugs and issuing a recommendation that “puberty blockers and hormonal and surgical gender-confirmation treatment for children and young people be defined as experimental treatment”.
The world’s leading clinicians in gender-affirming care appear to accept that the model is experimental, with the president of the World Professional Association for Transgender Health openly admitting in comments from a discussion forum recently leaked to US journalist Michael Shellenberger and published by his think-tank Environmental Progress, that there was no research whatsoever as to the consequences on the future fertility for children placed on puberty blockers, and that boys given the drugs at a pre-pubescent stage were later unable to orgasm. The files also revealed deep uncertainty among clinicians at the ability of young people to provide informed consent to hormone treatment. Shellenberger, who is aligned with gender-critical activists Genspect, has taken a strong stance in opposition to gender-affirming care and has not revealed the source of the leak. Australia’s leading physicians in gender-affirming care – who have authored guidelines of care adopted as quasi-national standards in the absence of medical colleges stepping into the field – have also acknowledged their practices are somewhat of a work in progress.
In a response to the interim findings of the Cass review authored by Royal Children’s Hospital Melbourne doctors Ken Peng and Michelle Telfer, co-authored by trans activist Jeremy Wiggins and published in the British Medical Journal, the physicians argued Dr Cass had ignored international consensus around the prescription of puberty blockers and that seeking to craft a policy based on “the middle ground” consensus by taking into account “those who view gender diversity as inherently pathological” was “a fallacy”. The editorial piece said that while long-term data was “undoubtedly needed”, taking a cautious approach to the prescription of the drugs “ignores more than two decades of clinical experience in this area as well as existing evidence showing the benefits of these hormonal interventions on the mental health and quality of life of gender diverse young people”. The article noted that “it will take many years to obtain these long-term data” and that it was legitimate to proceed on the basis of “professional consensus”.
However, despite the presentation of consensus by gender-affirming care advocates, medical consensus is far from assured in Australia, with the foremost experts in children’s hormone treatment, pediatric endocrinologists, opposing the prescription of puberty blockers to children during consultation by the Royal College of Physicians two years ago. Their dissenting view was suppressed by the RACP in its published position reporting on its consultations. Psychiatrists have also put forward an increasingly cautious view, as have the clinicians in charge at Sydney’s flagship children’s hospital at Westmead. Despite the call for more data, RCH clinicians have published very little data on the outcomes of their patients, which have swelled in number to about 1000 from very small numbers a decade ago. Despite the oft-pronounced extreme suicide risk for transgender young people, Westmead’s published research has questioned whether the gender-affirming care pathway results in better mental health outcomes for those who progress to transition at all.
This is in line with the world’s most robust study to date on the issue, published in the journal BMJ Mental Health last month by Finnish researchers. The study analysed the mental health outcomes of all of the 2083 young people referred to its gender service between 1996 and 2019. It found that although the proportion of suicides was higher in the gender-referred group of young people versus a control group, after specialist-level psychiatric treatment was allowed for, neither all-cause nor suicide mortality differed between the two groups. The paper concluded: “clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for”.
Source: The Australian
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