The battle over gender affirmative medicine in Australia has intensified with a call to arms by two experienced psychiatrists for their fellow doctors to resist the pressure of activism driving treatment.
Monash Medical Centre child and adolescent psychiatrist George Halasz and Andrew Amos, an academic psychiatrist with a training role with Queensland’s health department, went as far as to remind doctors of their obligation to observe the Hippocratic oath in questioning the evidence base of affirmative medicine.
In an article in the journal Australasian Psychiatry, They urged doctors to examine the ethics of a model in which powerful hormone drugs are prescribed despite a lack of evidence that the affirmation of a child’s perceived gender identity and subsequent medical transition eases teenagers’ mental distress.
But even as the explosive article was published, paediatricians and their colleagues at the Royal Children’s Hospital in Melbourne – home of the nation’s leading experts in gender-affirmative medicine and the self-appointed setters of quasi-national guidelines adopted by most of the country’s children’s hospitals – quietly published an updated version of their standards of care that endorse a radical expansion of the affirmative model.
The new guidelines endorse the prescription of puberty blockers and cross-sex hormones by general practitioners, outside a multidisciplinary model led by specialist children’s hospitals – the model explicitly endorsed as of utmost importance by the Cass Review in the UK.
Professor Halasz, who trained in the UK and was in close contact with doctors who watched the Tavistock scandal unfold, described the rise of gender-affirming medicine as taking place within a radical form of social activism. “It was a culture of intimidation, silence, and I think threat,” the professor said. “And I just thought ‘this is so outside of my understanding of what medicine is about’.”
He said it has been very difficult to get psychiatrists to make public statements about gender dysphoria even though the majority appeared to share a more moderate, exploratory approach. Doctors were afraid for their professional reputations.