
Michelle Telfer was a young paediatrician at The Royal Children’s Hospital Melbourne in 2012 when she was asked to make what would become a life-changing decision.
A colleague heading into retirement approached her to take on his small number of young transgender patients requiring support for medical transition. It was a tempting offer to work in this developing branch of medicine. “I really didn’t have much experience working with trans and gender diverse young people. I didn’t have any actually,’’ Telfer, a Perth-born former Olympic gymnast and Commonwealth Games medallist, told the Emerging Minds podcast in 2019.
Back in 2012, the service received just 18 referrals and Telfer was advised these patients would be a small part of her clinical practice. How wrong that prediction would prove.
Each year since 2012, referrals have rapidly grown (to 473 by 2020) and the cause of trans and gender diverse young people has “actually taken over my life’’, Telfer, now one of Australia’s foremost child gender medicine experts, told The Lancet Child and Adolescent Health.
Telfer’s advocacy led to young people gaining access to hormone and surgical treatment without approval from the Family Court and as her profile soared, she was hailed as a lifesaving advocate for trans youth and profiled on the ABC’s Australian Story and on the cover of Nine’s Good Weekend magazine.
In those stories, her work and courage were supported by a number of patients, their families, colleagues and the Victorian government, and any questions or criticism around the direction of child gender affirming treatment were largely downplayed.
The court case before Justice Strum centred on a biologically male child. The mother believed the child to be gender dysphoric and, as a result, should have access to puberty blockers. The father wanted to hold off on treatment and “let the child be the child”.
Justice Strum said that according to the evidence from Telfer and another doctor, the gender clinic had a “single approach”. Gender dysphoria was treated with puberty blockers. “No alternative treatment options are offered by the CHGS for gender dysphoria diagnosed there,” he said.
Justice Strum said the mother’s case, supported by the evidence of Telfer and another expert was that gender identity was internal and immutable and not open to external influence.
“However, neither of those experts was able to point to any empirical or substantive basis for their opinion, but, rather, only to anecdotal reports from transgender adults about their experience of gender identity,” he said.
Justice Strum voiced concern that the child’s mother, along with Telfer and the expert for the mother’s case, seemed to dismiss the possible relevance of other factors, such as maternal influence or underlying neurodivergence playing any part in the child’s presentation. “I consider that prudence would have dictated that such an investigation be undertaken … and certainly before puberty blockers were contemplated, given the gravity of the issue,’’ he said.
While noting the diversity of views on best practice healthcare for transgender or gender diverse children and adolescents, Justice Strum said there was limited evidence on the long-term effects of some of the healthcare options promoted by Telfer, the Children’s Hospital and its Gender Service.
He said the evidence of the mother’s experts were, in many respects, at odds with the UK Cass report, which was tendered to the court by the mother’s team.
Notwithstanding that she was called as an expert witness for the mother, Justice Strum noted that an expert’s duty to provide objective and unbiased opinion to the court prevailed over obligations to the party that engaged them.
He then listed the occasions when Telfer described herself as or agreed she was an advocate for transgender healthcare who was involved in the push to remove the legal requirement for trans and gender diverse adolescents to obtain court authorisation to access gender affirming hormone treatment. “Advocacy in a court is for lawyers, not witnesses, neither lay nor expert,’’ he said.
Telfer was the first author of the inaugural Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents and approved the final draft.
However Justice Strum said he approached her evidence in this regard “with caution”.
“As I observed during the hearing … she is akin to being the proverbial ‘judge, jury and executioner.’ Indeed, in cross-examination [she] conceded that her opinion that the ASCTG is best practice was essentially tantamount to her agreeing with herself,’’ he said.
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