As more girls and young women present to gender clinics with gender dysphoria, serious legal questions are being raised about their treatment. And It seems that Australian doctors could find themselves in hot water if they follow the “affirmative model” of care favoured by trans advocates. As international trends veer away from this model and as “de-transitioners” − many of them women − come forward willing to sue for misdiagnosis, Australian doctors now have legal, as well as medical, dilemmas to resolve.
Until the last decade or so, gender dysphoria was typically associated with pre-pubertal boys, so the recent uptick in adolescent girls presenting to gender clinics marks a break with the previous pattern. Researching this phenomenon for her 2020 book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, Abigail Shrier interviewed transitioning girls, their parents, counsellors and doctors as well as “de-transitioners” who bitterly regret their decision to medically “affirm” a transgender identity and concludes that social contagion and media hype are major drivers of the new phenomenon now placing a generation of girls at risk:
Unsuspecting parents are awakening to find their daughters in thrall to hip trans YouTube stars and “gender-affirming” educators and therapists who push life-changing interventions on young girls—including medically unnecessary double mastectomies and puberty blockers that can cause permanent infertility.
The treatment of gender dysphoria appears to be a polarising issue dividing the medical and mental health professions into ideologically entrenched camps. One group supports “affirmation” through medical intervention and condemns delay as harmful. The other argues that these interventions are both unnecessary and harmful and points instead to the importance of careful psychological assessment of co-morbidities and psychotherapeutic interventions as the first step.
Internationally, caution about the medical affirmation model appears to be trending upwards. In June 2020, Finland issued new guidelines for the treatment of minors, which emphasise the importance of psychotherapy as the first line of treatment for gender-dysphoric youth. The state of Arkansas in the USA followed suit in April 2021 and other US states look set to follow. In May 2021, Sweden’s Astrid Lindgren Children’s Hospital also stopped prescribing puberty blockers and cross-sex hormones to children under 18-years-old.
If the claims of the affirmative therapists were already disputed among the health professions, the UK’s High Court in December 2020 in the case of Bell v Tavistock subjected these claims to legal scrutiny and found them wanting. The conclusion that has sent shock waves around the world was the court finding that no child, however well supplied with age-appropriate information they might be, could be considered competent to give informed consent to the consequences of medical transition.
This finding and the potential for future liability that it raises has understandably given at least one Australian gender clinic cause to pause treatments for new clients until the legal situation is clarified.
A recent article co-authored by Professors Patrick Parkinson and Philip Morris issued a warning that doctors who rely on the guidance published as recently as June 2020 in the Australian Journal of General Practice and the TransHub website are being misinformed about the realities of their legal position.
These sources suggest that gender-affirming hormones can be prescribed for over 16s and monitored in a primary-care setting, without the need for a formal mental health diagnosis or advice from an endocrinologist. The Australian Standards of Care inaccurately state that parental consent is desirable but not imperative:
“informed consent for this treatment must be obtained from the adolescent and ideally, but not necessarily, consent should be also obtained from their parents, carers or guardians.”
TransHub provides a list of “gender-affirming” GPs on its website.
Only time will tell whether the affirmation model they favour will emerge heroic on “the right side of history” or whether it will join lobotomies and electric shock therapy in modern medicine's hall of shame.
Until the broader question is decided, doctors who were previously undecided on the merits or otherwise of the affirmative model of care, will need also to consider their own legal position. In many cases, this consideration can be expected to weigh the scales on the side of medical caution.