Psychiatrists’ college emphasises need for ‘comprehensive assessment’ of those experiencing gender dysphoria

Psychiatrists’ college emphasises need for ‘comprehensive assessment’ of those experiencing gender dysphoria

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has released its first position statement on gender dysphoria, titled “Recognising and addressing the mental health needs of people experiencing gender dysphoria/gender incongruence”.

We have written previously about the growing international caution amongst medical professionals when it comes to following the ‘gender affirmative approach’ in treating young people with gender identity issues. It is encouraging to see that RANZCP too, appears to be moving away from endorsing this problematic approach.

RANZCP’s president, Associate Professor Vinay Lakra, says the intention of the college was “not to put barriers in place” for trans people but rather to practise evidence-based medicine. He says that without this, we “run the risk of approaching an issue without due diligence”.

The statement explains that a gender affirmative approach is one that accepts rather than questions a child’s statements regarding their gender identity. However, it states that “evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate”.

It also emphasises the lack of evidence in relation to outcomes for those presenting with gender dysphoria, particularly for children and young people, and notes its support for further research into “the long-term effects of medical and surgical affirming treatment in all age groups”.

In terms of approach, RANZCP stresses that “comprehensive assessment is crucial”:

“Assessment and treatment should be evidence-informed, fully explore the patient’s gender identity, the context in which this has arisen, other features of mental illness and a thorough assessment of personal and family history. This should lead to a formulation. The assessment will be always responsive to and supportive of the person’s needs.”

The approach takes into account “evidence that people who experience incongruence between their gender identity and assigned gender have higher levels of mental illness than the general population”. It also recognises the worldwide increase in people seeking help for gender identity issues, particularly young women.

As we and others have argued already, this in itself provides cause for pause in applying the ‘gender affirmative approach’, as we stop to consider why there has been such a surge in teenage girls wanting to transition. Author and journalist Abigail Shrier has concluded that peer pressure, social contagion and media hype are major factors in this trend.

Peer influence and exposure to trans influencers on social media play an outsized role in their desire to escape womanhood… these young women almost always suffer from severe anxiety and depression or other significant mental health problems — and those problems are often overlooked or ignored.”

Her view on this was recently supported by two prominent US gender medical providers who spoke out about the reckless treatment of children by gender healthcare providers.

Psychiatrist Roberto D’Angelo, the president of the Society for Evidence-Based Gender Medicine, says the position statement “doesn’t really give anybody any clear direction” but is an improvement because “it reflects the state of the literature and research more accurately and it also reflects the diversity of opinion within the psychiatric profession about gender dysphoria”. He says that the research on outcomes for young people is extremely limited and that clinicians should be honest about that.

“It’s not an ideological position about whether people, young people should have gender-affirming treatments or not, it’s really about ‘do we know whether they work and whether the benefits are durable in the long run?’”

The College’s statement is indeed a positive development in this highly controversial area of medical ‘treatment’. We hope that other medical professional bodies in Australia will follow RANZCP’s lead in this much-needed return to comprehensive, evidence-based medicine.