This episode of Let’s Talk Medicine discusses the confronting and challenging topic of gender dysphoria in children.

This podcast is the result of months of consideration and preparation by the Australian Doctors Federation.

We have assembled a list of experts in the field to discuss the topic with our Chairman in a considered and scientific manner, emphasising the situation in Australia.

  • Dr Helen Joyce PhD, is an internationally renowned author who has written extensively on the topic
  • Dr Jillian Spencer is an Australian psychiatrist
  • Dr Andrew Amos is an Australian psychiatrist
  • Professor John Whitehall is an Australian paediatrician

This podcast is primarily intended for members of the Australian Doctors Federation in the medical profession, but it can also be of benefit to policy makers and the general public who are interested in this topic.

As the podcast is long, over 2 hours, the show notes below will help viewers find what is most relevant to them.

Whilst 4 of the participants are practising Australian medical practitioners, the contents of the podcast should in no way be interpreted as medical advice directed at any individual patient.

References:

Professor John Whitehall:

Puberty Blockers: A Blight on the Brain https://quadrant.org.au/magazine/2024/01/puberty-blockers-a-blight-on-the-brain/
https://quadrant.org.au/magazine/2023/04/life-altering-decisions-and-the-adolescent-brain/

Dr Helen Joyce
Trans: Gender Identity and the New Battle for Women’s Rights, ONEWorld Publications, 2022

Highlights:

  • 00:00:00 Introductions
  • 00:02:01 Definitions – Gender v. Sex
  • 00:04:27 Sexual orientation and gender identity
  • 00:06:22 Trans terminology and importance of comprehensibility
  • 00:09:31 History of these issues in Paediatrics
  • 00:13:45 What is gender dysphoria?
  • 00:15:02 Higher prevalence of Gender dysphoria and gender non-conforming in children destined to be gay
  • 00:16:08 Diagnostic criteria – Gender dysphoria and Gender Incongruence
  • 00:16:23 Political purpose of criteria for Gender dysphoria / Incongruence
  • 00:17:43 Concept of social contagion
  • 00:18:17 Exploitation of normal adolescent confusion
  • 00:19:28 Importance of how doctors talk about gender dysphoria
  • 00:20:43 Development of the definition of gender dysphoria v. other psychiatric diagnoses and lack of scientific basis
  • 00:22:11 Statistics – Royal Children’s Hospital gender clinic 2003 v. present
  • 00:24:11 Epidemiology – prevalence of Gender dysphoria
  • 00:25:35 Labelling of normal human experience as a disorder
  • 00:26:34 A Western social contagion
  • 00:27:36 Trans people are not a disease vector
  • 00:28:13 Presence of clinics feeding contagion
  • 00:29:04 Power of a medical diagnosis
  • 00:30:31 An example of anorexia mis-diagnosed as Gender dysphoria
  • Contagion of anorexic behaviours
  • 00:32:11 Commercialisation of a treatment pathway
  • 00:33:11 How do paediatric patients present?
  • 00:35:23 Self -diagnosis
  • 00:36:01 GP and psychologist networks funneling patients to public gender clinics
  • 00:36:29 Lack of data re number of patients in gender clinics and how they are referred
  • 00:37:11 Victorian Informed Consent Model – GP diagnosis and initiation of hormone treatment without psychiatric assessment
  • 00:38:25 Lack of reliable epidemiological figures, prevalence among different age cohorts
  • 00:39:48 Medical students encouraged to bring up gender issues when taking medical history
  • 00:41:05 How Gender Affirming Care traps distressed teens, social reinforcement
  • 00:41:57 How does psychiatry distinguish gender dysphoria from delusion, imagination etc.
  • 00:43:35 Dysphoria as an over-valued pre-occupying idea
  • 00:43:55 Unique presentations
  • 00:44:46 Feedback loop between medical profession and legal policy/educational institutions
  • 00:45:39 How a diagnosis impacts on the rest of a community (eg schools, employers), ignoring other’s rights
  • 00:47:13 Gender Affirming Care (GAC) does not require diagnosis, purpose is not to treat gender dysphoria
  • 00:47:19 Clinical guidelines for Gender dysphoria do not have measurable medical outcomes
  • 00:48:45 Goal of GAC is to affirm self-reported gender identity
  • 00:49:36 UK experience of gender distress in school environments and infringement of human rights
  • 00:51:57 Differentiating gender dysphoria and delusion
  • 00:52:56 Pressure on politicians who raise concerns, distraction of Brexit in the UK, gender self-identification legislation and conversion therapy bans
  • 00:56:52 Cass Review of Tavistock gender clinic in UK
  • 00:58:49 No evidence base for Gender Affirming Care
  • 00:59:17 NICE review, Cochrane review, failure of institutions
  • 01:00:36 Ideology has overtaken scientific method
  • 01:01:36 What are puberty blockers?
  • 01:02:54 Effects of puberty blockers on neuronal cells and limbic system
  • 01:08:30 Is the effect of puberty blockers reversible?
  • 01:09:18 GnRH role in brain development
  • 01:12:12 Possible side effects not being mentioned
  • 01:14:29 Effects of cross-sex hormones
  • 01:18:02 Complications of sex change surgery
  • 01:21:46 Books promoted to children feeding social contagion, over-simplifying
  • 01:24:00 Surgery from top to bottom other effects and claims of reversibility
  • 01:25:59 The pathway in children leading to surgery, no one decision-maker, lack of information given
  • 01:27:57 Story of a 9 year old boy at the Tavistock Clinic
  • 01:30:41 Surgery is legal for under 18s in Australia
  • 01:31:17 Psychologically avoiding something that makes you anxious is not treating anxiety
  • 01:31:53 Psychological impact of puberty blockers on integration of what puberty means
  • 01:32:51 Gender affirmation, conflation of psychotherapy and conversion therapy
  • 01:35:18 Avoidance of puberty stops normal exploration/play behaviour
  • 01:36:18 Cass Report – Puberty blockers do not treat suicidality
  • 01:36:34 The harm v. risk equation does not add up, emotional use of suicide risk argument
  • 01:38:17 Refusal of RANZCP to discuss the Cass research
  • 01:39:59 medical profession’s fear of being targeted, jeopardising career for speaking out
  • 01:42:35 Meaningful consent in children
  • 01:44:33 Can children give consent to lose sexual function, reproductive ability? Kira Bell case.
  • 01:48:40 The Tavistock clinic’s Gender Identity Development Clinic and the Cass Review
  • 01:50:20 World Professional Association for Transgender Health (WPATH) is a member association (not a professional or medical one)
  • 01:51:23 WPATH ‘standards of care’ and leaked files
  • 01:55:30 Mastectomies on girls under 18
  • 01:55:59 Feminism, gender role stereotypes and gender medicine
  • 01:59:11 The role of the judiciary and the ripple effect
  • 02:00:39 The lie that flips all systems upside down
  • 02:01:57 The medical profession’s responsibility
  • 02:02:38 Hilary Cass’s position
  • 02:04:18 Concluding remarks