This is a brief update on the gender affirmative model of treatment of children and vulnerable young people with gender distress, to help protect you and your patients from harm:
- The 4-year UK NHS Cass review found no clear evidence base for gender affirmation interventions, i.e. puberty blockers and cross-sex hormones.
- There are proven medical harms from these interventions including sterility, sexual dysfunction, osteoporosis, mood disorders, cognitive impairment, cardiovascular disease, meningioma, and blood clots. The effects of more than brief use of puberty blockers and cross-sex hormones and any surgery are not fully reversible.
- Increasing numbers of countries—particularly the UK, the Nordic nations and the USA—as well as Queensland, are now restricting use of puberty blockers, cross-sex hormones and surgery for minors.
- Australian treatment guidelines reviewed by the Cass investigators scored 19/100 for rigour of development and were judged “untrustworthy” by Prof Gordon Guyatt a pioneer of evidence-based medicine.
- Both the Cass review and the National Association of Practising Psychiatrists (Australia) recommend individualised psychosocial support as first line treatment for young people with gender dysphoria.
Australian medical organisations and institutions are continuing to use guidelines that do not reflect the current evidence base.
There are increasing numbers of legal cases arising due to the harms patients are experiencing from these interventions.
One Australian indemnity company has already withdrawn cover for privately practising doctors who initiate hormone treatment in children and adolescents with gender dysphoria.
We are concerned about the harms being done to children and the medicolegal risk to doctors.
To protect yourself we would advise that for children and adolescents up to18 years of age you:
- not prescribe puberty blockers and cross sex hormones;
- not refer for gender surgery;
- not refer to gender clinics as they offer treatment that is not evidence-based and causes bodily harm; and
- not refer patients on for private gender affirmative psychological treatment that will cement a child’s likely transient identity.
Standard psychological therapies do not constitute conversion and are allowed under state legislation. Children and adolescents with gender confusion may benefit from referral to a therapist who will provide holistic care with psychological therapies under the precautionary principle of “first do no harm”.
There also needs to be consideration given to protection of vulnerable adults up to the age of 25.
We suggest that you contact your medical college to request that for children and adolescents up to 18yrs of age they:
- follow the international evidence and recommend banning of puberty-blockers, cross sex hormones and gender affirming surgery; and
- remove recommendations for use of these therapies from their guidelines, journals, newsletters and educational material.
If you would like further information, the Australian Doctors Federation has two podcasts relating to this issue on its “Let’s Talk Medicine” podcast at https://ausdoctorsfederation.org.au/lets-talk-medicine/ or http://www.youtube.com/@AusDoctorsFederation. If you would like to speak to us or be part of any joint letters regarding this issue, please contact the Australian Doctors Federation via the contact us tab on the home page of this site.
