The debate on ‘gender affirming’ care is long overdue

The debate on ‘gender affirming’ care is long overdue

By Stephanie Bastiaan

Australia's 'gender affirming' model of care for treating patients with gender dysphoria will be tested with a landmark case in the NSW Supreme Court. 

Jay Langadinos was 19 and identifying as a male when she sought professional help for gender dysphoria after searching google for answers concerning her mental health. After one meeting, Dr Toohey approved her to start hormone treatment and two years later approved her to have a bilateral mastectomy followed by the removal of her womb less than seven months later.  

Ten years later, Jay regrets her medical transition and says "she has suffered and continues to suffer from injuries and disabilities" resulting from her transition. 

Jay is suing her physiatrist, Dr Patrick Toohey, for professional negligence. She believes he should have referred her for a second opinion and ensured she received further treatment for social phobia, anxiety and depression before approving irreversible medical procedures to support her living with her male gender identity. 

She is one of the thousands of women globally living with transition regret.

Over the past decade, there has been a significant shift in the demographics of those presenting with gender dysphoria. The number of adolescents presenting with gender dysphoria has been rising rapidly since 2004, and researchers in the UK found an approximately 4,000% increase in teenage girls seeking treatment at a ratio of 7.58 females to 1 male. There is limited statistics in Australia. 

A study published in the Sage Journal on the gender clinic at Westmead Hospital, NSW, in 2021, found that high rates of adolescent patients presenting with gender dysphoria had a history of childhood trauma, family dysfunction and sexual abuse. There were also correlating factors of comorbid mental health issues, including anxiety, depression, behaviour disorders and autism. 

The overwhelming evidence in gender de-transitioning patients is that gender dysphoria can manifest in unresolved mental health issues and disorders. 

The 'gender affirming' model of healthcare failed Jay Langadinos because her psychiatrist did not consider her underlying mental health issues before approving her medical transition in line with her male gender identity. With the treatment of her underlying mental health issues, she has come to regret her medical transition. She is now living with irreversible damage and the lifelong consequences of infertility, a double mastectomy and chronic health conditions, all of which have exasperated her depression and impacted her ability to work. 

With the introduction of state legislation across Australia to ban ‘conversion therapy’, such as the Change or Suppression (Conversion) Practices Prohibition Act 2021 in Victoria, parents and medical professionals have concerns that alternative treatments to 'gender affirmation' care now carry criminal consequences. 

The Victorian legislation is very clear in its intention: 

5 Meaning of change or suppression practice 

In this Act, a change or suppression practice means a practice or conduct directed towards a person, whether with or without the person's consent—

(a) on the basis of the person's sexual orientation or gender identity; and 

(b) for the purpose of—

(i) changing or suppressing the sexual orientation or gender identity of the person; or 

(ii) inducing the person to change or suppress their sexual orientation or gender identity.

In response to concerns raised by the Australian Medical Association, which was not consulted during the drafting of the legislation, the Victorian Liberal Party moved sensible amendments to safeguard the rights of patients, parents and medical professionals. These amendments would have protected parents and medical professionals from criminal prosecution for exploring alternative treatments and therapies to the 'gender-affirming' model. They were voted down.

The theory that gender identity is fluid and interchangeable is at odds with the 'gender affirming' approach to gender dysphoria, given the irreversible consequences of medical transitioning to support a patient's gender identity. This is particularly concerning considering that high rates of patients with gender dysphoria are now adolescents. 

There is very little research on the long-term effects of cross-sex hormones and puberty blockers being administered to adolescents, which can cause irreversible changes to their physical development. 

Discussion on best medical practice, particularly for minors, is limited due to overwhelming and unquestioning support for 'gender affirming' care by academics, politicians and journalists. Anyone who questions it is quickly labelled a bigot or transphobic; if they are a public figure, there is an onslaught of negative media coverage. 

The Victorian Liberal Party experienced this when it was revealed that they were committed to amending the Change or Suppression (Conversion) Practices Prohibition Bill to safeguard medical treatment and freedom should they win the 2022 state election. Buckling to pressure within the media and from self-interested lobby groups aimed at political point scoring, they reneged on their position, saying they were committed to upholding the legislation in its current form. 

It is devastating for women like Jay Langadinos and the claimants against the UK Tavistock children's gender clinic that more robust debate around experimental medical gender transitioning is only now happening in the wake of their court actions for medical negligence. The media and public narrative around trans rights are primarily to blame, along with the introduction of legislation that criminalises doctors, parents and carers for not providing 'gender affirming' medical care.  

The narrative that gender dysphoria is no longer a mental health concern but something to endorse and support needs to be challenged. 

The rising rates of de-transitioners is a testimony that not every patient presenting with gender dysphoria is a person born in the wrong biological body, particularly those who are neurodiverse and those with a history of trauma. 

There needs to be a Royal Commission into the 'gender-affirming’ model of care. Strict medical guidelines must be introduced for assessing and supporting patients with gender dysphoria and whether medical transition is an appropriate response. Given the impressionability of adolescents, education programs in schools that promote and endorse gender dysphoria as the norm should be removed. There should also be an immediate suspension of hormone therapy and surgical treatments for minors altogether, given the irreversible nature and long-term health risks associated with medical transition.

It is just coming to light that misdiagnosis is an increasing problem when it comes to vulnerable patients with gender dysphoria. The consequences are devastating.

There are a lot of difficult questions that should have been answered before the implementation of experimental gender dysphoria treatments.

Gender ideology has politicised health care at the cost of best medical practice.

Stephanie Bastiaan is a Research Fellow with Women's Forum Australia.