Talking trans: Adolescence, gender transitions and the conversations we have to have

In suburbs and towns across Australia, and throughout the Western world, households are talking intensely about gender as families grapple with something that feels entirely new, and big. Starting in about 2012, a surge of people – many of them children and adolescents – began coming forward to say their gender was incongruent with their birth sex.

Some of these young people are content to dress ambiguously and perhaps change their name, to identify as non-binary or by one of a panoply of different genders, and ask for different pronouns. Some live like this for a time, then revert to their birth gender. A proportion, though, seek medical treatment.

The numbers tell the story. In 2011, eight young people sought medical care at the gender clinic, at the Royal Children’s Hospital (RCH) in Melbourne, that treats eight- to 16-year-olds. By 2021, that number was 100 times higher at 820. The fastest growth has been among adolescent girls. A publicly funded clinic for over-16s at Monash Health also saw a steep rise – a phenomenon also reflected overseas. But Victorian government figures show numbers at both the Royal Children’s and Monash have fallen markedly in the past two years, to 634 at the children’s hospital last year and just 327 to the end of October.

The state health department did not offer an explanation for the recent decrease, just as nobody can explain with confidence what caused the increases. Some research postulates that the huge rise might be partly due to an increase in trans visibility in the media and a reduction in the stigma involved in being transgender. Sceptics argue there might be an element of “social contagion”, particularly among teenage girls, an argument the trans community vehemently rejects.

There are publicly funded gender clinics in all of Australia’s mainland capital cities, but the clinic at Melbourne’s RCH is the biggest and, under its former long-time head, former Olympic gymnast Dr Michelle Telfer, led the national response. In 2018, a team led by Telfer published standards for the treatment of gender incongruence and dysphoria in children and adolescents which guide clinics around Australia. Recognised globally, they’re based in large part on material including influential reports emerging from pioneering Dutch gender clinics in the 2000s, as well as on guidelines from the World Professional Association for Transgender Health. The model is known as gender-affirming care.

In the United Kingdom, London’s Tavistock children’s gender identity clinic will close down next year after an official review questioned its methods. Britain’s National Health Service responded by saying its gender services would only prescribe puberty blockers as part of formal research studies. Public clinics in parts of Europe are becoming manifestly more conservative too, and the clinic at Sydney’s Westmead hospital in 2021 produced a controversial study of 79 patients that declared many of the young people it was treating “did not have the cognitive, psychological, or emotional capacity to understand the decisions they were making” in the context of the potential impact on their fertility, sexual function and brain development.

[I]nternationally, and among some doctors and scientists in Australia, the reassurances that affirming care is the best possible treatment are not being taken at face value. The Royal Australian and New Zealand College of Psychiatrists is revising its position statement after disquiet from some professionals, and one medical insurer has withdrawn GP cover for some treatments. A small number of legal challenges is finding its way into the courts, and groups, led by politicians and a number of vocal doctors and lawyers, are agitating publicly for a rethink.

I meet a group of parents who are desperate to have a more open discussion about what they see as the tragedies happening in their lives.

They ask to remain anonymous because they fear being publicly labelled anti-trans, or transphobic, their jobs even threatened.

These parents believe their children have arrived at their new gender identities with no forewarning and based on a trend. They see most of the media as complicit and the law in Victoria as threatening. Under Victoria’s 2021 Change or Suppression (Conversion) Practices Prohibition Act, taking active steps to stand in the way of any person’s desire – even a child’s – to affirm their new gender is an illegal conversion practice (subject to up to 10 years in jail for cases of serious injury). By contrast, facilitating their transition is, according to the Victorian Human Rights and Equal Opportunity Commission, “completely legal – and encouraged”. The ACT has a broadly similar law and NSW is contemplating one. Queensland only holds medical professionals liable for prosecution in gender-suppression cases.

These parents call the legislation the “anti-therapy law” – they say it’s spooked mental health professionals into believing that when a child mentions gender, they must affirm it or risk prosecution. Finding a “neutral” therapist for their troubled, anxious, loner children to deliver “exploratory” or “watchful waiting” therapy is now a minefield.

The course of Mel Jefferies’ life is precisely what frightens these parents. Born female, and living with a number of mental health issues, from age 16, she was affirmed as a trans man by doctors, the trans community and mental health professionals. For years, on and off, she took testosterone, she’s had a double mastectomy and now at 32, she bears the physical scars of regret.

Mel says she’s been questioning her gender and sexuality for half her life but now describes herself as a “detransitioner”. When she looks in the mirror, for the first time she sees herself as a cis-het woman. And she’s angry. “I thought transitioning was a panacea for all my problems, but it’s compounded them.”

I speak to a handful of detransitioners for this story – two of whom are either suing or considering suing their medical practitioners – but it’s true that few have come forward publicly in Australia. Sceptics of affirming care say it might take 10 years for people to admit to regrets but that we will see more – and more lawsuits. One large medical insurer is already taking precautions. In July, MDA National, one of the biggest providers of medical indemnity insurance in the country, stopped covering practitioners who assess or treat people under 18 for gender reassignment. Its president, Dr Michael Gannon, said, “We don’t think we can accurately and fairly price the risk of regret.”

In 2013, she publicly described herself for the first time (on SBS’s Insight program) as a detransitioner. Later, though, reassured by friends in the trans and gender-diverse community that feeling unsure was normal, she started testosterone again. She said it was hard to speak up about doubts within the community because of the danger of being labelled transphobic.

At 26, still struggling with body image issues and rage at her female form, Mel had her breasts removed. Immediately, her focus turned to her thighs and stomach, and to the desire for more surgery, including a full hysterectomy. “It’s like chasing the dragon. You get a real high from it and then you start to feel bad and you need to have more.” She did not go through with that procedure but the mental health problems persisted, compounded now by phantom pain from the double mastectomy, scars, and what she describes as “zipper tits” and a “pepperoni nipple”. She is on a disability support pension and struggling to afford the electrolysis to remove the hair that grew on her “face, back and chest, my stomach and butt” as a result of testosterone.

I ask Mel how her life feels. The question catches her at a vulnerable moment. “It feels like I’m dunked into the ocean and can’t figure out which way is up. I can’t get air. And people are laughing at me because I don’t know how to swim.”

Source: Talking trans: Adolescence, gender transitions and the conversations we have to have