In Australia, as elsewhere in the developed world, doctors and parents are perplexed about an epidemic of young people, mostly teenage girls, who want to change gender. Back in August the Federal Health Minister, Greg Hunt, asked the The Royal Australasian College of Physicians (RACP) for advice on how to treat gender dysphoria in children and adolescents.
The RACP’s answer, released last week, is baffling. It responded that (a) this is a very complex issue about which we doctors know very little and (b) we mustn’t tell the public to know how ignorant we are.
Of course, it wasn’t quite so candid as that, but that is a bare bones summary.
First, the RACP candidly confesses that “evidence on health and wellbeing outcomes of clinical care is limited”. In other words, it is not in a position to give definitive advice about treatment. Why? Because there is very little unimpeachable evidence — because of “the relatively small number of studies, the small sizes of study populations, the absence of long-term follow up and the ethical challenges of robust evaluation when control (no treatment) is not acceptable”.
This is a sound comment. It’s great that the RACP has acknowledged the rudimentary nature of the medical profession’s understanding of transgender issues.
It gives a much needed corrective to heavily slanted media coverage. Last week, the government-funded ABC ran a feature on non-binary children on Four Corners, its flagship investigative program. Only two doctors were interviewed, both very supportive.
One, a child psychiatrist, Dr Georgie Swift, told viewers:
There are definitely strong critics to this area who would argue that the work I do is child abuse in allowing young gender diverse people and non-binary people to socially transition, to medically transition.
In fact, not allowing someone to socially transition or to medically transition, not supporting them in their gender identity is a high, high chance of them having significant mental health problems including high rates of deliberate self-harm, high rates of suicidality and suicide attempts. That to me is much more abusive than supporting someone in their affirmed gender.
Four Corners failed to convey to viewers that Dr Swift’s warning was based on limited “evidence on health and wellbeing outcomes of clinical care” and that many health professionals, both in Australia and overseas, dispute them.
Clearly, the RACP’s honesty is a breath of fresh air.
But then it slips into the kind of cognitive dissonance that psychologists see in heavy smokers or people who text while driving.
The RACP’s second point was to say that notwithstanding the dearth of evidence, existing guidelines should still be followed. These were written by the gender clinic at the Royal Children’s Hospital Melbourne and have been hailed as “the world’s most progressive”. They advise that children with gender dysphoria should be treated medically rather than with a cautious “wait and see” policy. This includes double mastectomies for 16-year-old girls (page 25).
And third, astonishingly, despite the lack of unassailable evidence and despite questions raised by many doctors and psychologists, the RACP demands that proposals for a national inquiry should be rejected. Why? It would “further harm vulnerable patients and their families through increased media and public attention”.
Says who? This is not medical science. Why should anxious parents believe doctors who admit that “evidence on health and wellbeing outcomes of clinical care [for their children] is limited”? It is white-coated bullying. It is saying to the public: “you are just a parent; you know nothing; trust us; we are doctors”.
In any case, it is just plain wrong to say that there is a consensus.
By way of example, Professor John Whitehall, of Western Sydney University, questioned the RACP’s advice. “The RACP boasts of interest in public health and that usually involves full and frank discussion of all side-effects as part of preventing harm,” he told The Australian. “Here, it is essentially (saying), ‘Be quiet and accept the experimentation’.”
In his letter, RACP president Mark Lane told the Minister that gender dysphoric children experienced “self-harm, attempted suicide and suicide”. This is disputed by other doctors and he did not respond when questioned by The Australian newspaper.
“If you are depressed, your suicidality risk is going to be elevated, but you see that in kids who are depressed but don’t have gender dysphoria,” Dr Zucker said last year. “The idea that adolescents with gender dysphoria are at a higher risk of suicide per se is dogma — and I think it’s wrong.”
The controversy over the RACP’s advice coincided with the launch of the Society for Evidence Based Gender Medicine (SEGM). Its members – an international group of nearly 100 clinicians and researchers — contend that “in view of the current dearth of evidence, the application of the model to children, adolescents, and young adults is unjustified outside of research settings”.
If anything calls for a public inquiry, it is transgender medicine. The risks of using “existing guidelines” must be opened to public scrutiny. The Australian government should ignore the RACP’s contradictory and politically correct advice.
Michael Cook is the editor of MercatorNet
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