Doctors treating children and teens with gender dysphoria have opened up about feeling pressured to prescribe puberty blockers and cross-sex hormones before non-medical interventions, such as psychotherapy, have been explored.In the first Australian study of its kind, clinicians at The Children’s Hospital at Westmead in Sydney say the emergence of a “conveyor belt” mentality to treating the condition has forced them to compromise their own ethical standards.The treatment of gender dysphoria in children and adolescents remains contentious. A group of Sydney clinicians is concerned that families are pinning hopes on pills rather than broader psychosocial therapies.
The Sydney doctors, including paediatric endocrinologist Professor Geoffrey Ambler and psychiatrist Dr Kasia Kozlowska, said many children equated gender affirmation with medical intervention and believed their distress “would be completely alleviated if they pursued the pathway of medical treatment”.
Both the patients and their families arrived at the clinic with strongly entrenched beliefs, and the doctors’ efforts to discuss psychological, social or family issues “fell on deaf ears”.
Another challenging aspect of their work was the increased pressure to prescribe cross-sex hormones to children aged 16 and over following a 2017 ruling by the Family Court of Australia.
The ruling essentially removed the requirement for court approval to access stage 2 treatment — cross-sex hormones — and put this responsibility into the hands of doctors.
“In the wake of [this] … some families presented to the clinic with the expectation that a child nearing the age of 16 could attend the gender service, see the mental health team for a one-off consultation, collect a diagnosis of gender dysphoria, and move to another service to obtain stage 2 treatment … with no engagement in a therapeutic process.”