Senior psychiatrists have gone public with ethical and scientific concerns about Australia’s first long-term treatment study of transgender-identifying teenagers and children.  The Trans20 study at the Royal Children’s Hospital (RCH) in Melbourne involves a projected 600 patients aged 3-17 given pro-trans “gender affirming” care, including potentially sterilising hormonal treatment for gender dysphoria, or distress about one’s body.  “There’s a kind of assumption that the gender affirming treatment being provided is the gold-standard, appropriate treatment,” Sydney psychiatrist Roberto D’Angelo said.

Dr D’Angelo is one of six psychiatrists to put their names to a letter in the journal BMJ Open.  “Are families actually told, ‘we’re still not sure this affirmative model treatment is the best way to treat gender dysphoria’?”  There is concern about possible social contagion in rapidly increasing numbers of teenagers, chiefly girls, declaring trans identity with no childhood hint of gender confusion, and undergoing novel treatments with puberty blocker drugs, cross-sex hormones and sometimes surgery.  Critics say the evidence for these treatments is low-quality, short-term, flawed or missing.

At the RCH youth gender clinic, the number of female-born new referrals in 2018 was 2600% higher than in 2012 when there were just seven, according to data obtained under FOI legislation.  Clinic director Michelle Telfer, a paediatrician, has appealed for more public money so RCH can begin “gender affirming surgery” (double mastectomies) for post-pubertal “transmasculine” patients.  RCH says its gender service is a world leader and follows “strict clinical governance standards”.  In its journal letter, the group of six psychiatrists says it has “grave reservations about the ethical underpinnings and methodology” of the RCH Trans20 study based on what’s been made public.

They call for the release of details showing that informed consent for participation in the study takes account of mounting concerns about the safety and ethics of the affirmative model and life-altering medical interventions. Trans20 researcher Ken Pang said there was a response coming to the psychiatrists’ questions.  Meanwhile, in a sign of international networking by critics of the affirmative model, seven Swedish physicians, including adolescent and child psychiatrist Sven Roman, have written to Scott Morrison, backing local calls for an independent inquiry.  A medical college is already reviewing standards of care.

The Swedish doctors cite the high rate of psychological and other disorders in the mostly teenage girls now diagnosed with dysphoria by gender clinics.  “There is a possibility that the majority of patients in the new group have autism or autism-like conditions,” they say.  “In their teens, people with autism have even more concerns about their body and identity than other adolescents.”  They say these patients often suffer from self-harming, eating disorders, mental trauma, depression and emotional instability, which along with autism may be the main underlying problems.

Like similar projects overseas, the Melbourne study lacks a comparison group of patients getting rival treatment, casting doubt over what the results mean.  “If the kids seem better after a year or two, we won’t know whether it’s because of, or despite, the gender affirmative intervention, or because they got a lot of attention,” Dr D’Angelo said.  Before the 2000s, gender dysphoria typically appeared in preschool boys, and in most cases resolved itself as children matured, with many emerging as young gay or bisexual adults at peace with their biological sex.  The psychiatrists’ letter warns that the affirmative-only approach may “lock” young people into gender dysphoria.

Source: Compiled by APN from media reports

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