Britain looks set to join Finland, Sweden, France and some US states in adopting a more cautious approach to the medical and surgical interventions for gender dysphoria in children, shifting emphasis instead to psychological evaluation and treatment.
Following whistleblower complaints and a high-profile lawsuit against the Gender Identity Development Service (GIDS) clinic in north London, the NHS commissioned Dr Hillary Cass, a retired paediatrician, to conduct a thorough review of the clinic’s operations. Her newly released interim report concluded that the pressure of burgeoning demand had caused this clinic to sidestep the “normal quality controls that are typically applied when new or innovative treatments are introduced” and that the experimental hormone treatments currently on offer are “not a safe or viable long-term option” for children and young people.
GIDS is currently Britain’s only service catering to the needs of gender dysphoric youth. In line with international trends, demand for its services has risen over 3000 per cent, from 50 in 2009 to 2500 in 2020. During the same period, the male/female ratios that previously saw more boys than girls presenting with gender dysphoria were sharply reversed, so that now roughly 3 in every 4 children requesting treatment are female.
Dianna Kenny, formerly a professor of Psychology at the University of Sydney, has observed these same patterns from Australian figures. The number of young people presenting with gender dysphoria is 140 times higher (males) and 350 times higher (females) than estimates of the prevalence of gender dysphoria in the general population. The Australian figures also demonstrate “clustering” in WA and Victoria, states that strongly promote the work of gender clinics. According to Kenny, “these figures cannot be explained by anything other than social contagion phenomenon”.
Social contagion refers to the spread of a harmful idea or practice through close social contacts or networks. Historical examples of social contagion include measurable increases in copy-cat youth suicide rates immediately following a celebrity suicide or the sharp rise in bulimia cases after the inclusion of this diagnosis in the DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition (US)).
The current explosion of cases of “rapid onset gender dysphoria” (ROGD) seems to demonstrate many of the hallmarks of social contagion, including the fact that it disproportionately affects young women, aged 10−29, most especially those with multiple mental health diagnoses or anxiety issues such as autism spectrum disorder, ADHD/ADD, social anxiety disorder, depression, including major depressive disorder, identity confusion, family issues, confusion regarding their sexual orientation, fear that they will never be attractive to men.
Lisa Littman’s protested 2018 report “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports”, also raised the possibility that “social influences and maladaptive coping mechanisms” as well as “parent-child conflict” might feature in the development and duration of gender dysphoria in adolescents and young adults. Like the whistleblower staff at GIDS, the parents surveyed in Littman’s research reported that their child’s announcement of a cross-gender identity was often characterised by formulaic phrases that sounded “rehearsed” – yet another red flag that social contagion is playing a role in these escalating numbers.
The hostile activist response to Littman’s research initially caused Browne University to recall the paper (now re-released) and cost Littman her job as a consultant. GIDS staff privately reported similar intimidation of anyone who questioned the “affirmation only” approach to gender dysphoria favoured by activists.
For those concerned that the climate of intimidation that has discouraged open, impartial investigation of the causes of ROGD − for those who are aware of the rising number of “detransitioners” who regret having followed the “affirmation only” model of care − the UK intention to overhaul the service provision for gender dysphoria in youth comes as a relief. Dr Anna Hutchinson, for example, a clinical psychologist who left GIDS amid concerns that young people were being sent for life-changing hormone treatment without adequate investigation of other factors that might be the cause of their identity crises, welcomed the calls for “better standards of care for gender questions (sic) and trans-identified young people”.
The cautionary approach has yet to affect treatment practices in Australia. The 2018 Australian Standards of Care and Treatment Guidelines for Trans and gender diverse children and adolescents and websites like TransHub recommend the “affirmation only” approach as best practice, excluding the need for comprehensive psychological examination before children are started on puberty blockers and hormones. In a recent interview, Dr Michelle Telfer who was the lead author of these “Standards of Care” and Director of the Gender Service at Melbourne’s Royal Children’s Hospital, mentioned the Victorian government has recently announced a grant of $21 million to see her service expanded across Victoria, so that it might be accessible to more children outside a tertiary hospital setting.
The Guide for Health Practitioners released by the National Association of Practising Psychiatrists reflects the growing international trend for caution, stating that “individualised psychosocial interventions (e.g. psychoeducation, individual therapy, school-home liaison, family therapy) should be first-line treatments for young people with gender dysphoria/incongruence”.
At the same time, however, the ability of mental health professionals to follow this guidance is clearly compromised by the countervailing political pressure to affirm without question. In February, Victoria’s Change or Suppression (Conversion) Practices Prohibition Act 2021, came into effect which threatens clinicians who depart from the “affirmation only” approach with jail time. Given this heavy-handed government support for the safeguard-free medicalisation of children, the informal reports now flowing in from clinicians who simply refuse to risk their careers by consulting with gender dysphoric youth should hardly come as a surprise.
How long before Australia wakes up to the same facts that are causing so many other jurisdictions in the western world to stop their advocacy for gender transition in children?