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

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.

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.

Advocates of these treatments say the science is settled: they prevent suicides and self-harm, and to delay or withhold them is unethical.

In the United Kingdom, London’s Tavistock children’s gender identity clinic will close down next year after an official review questioned its methods.

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.Internal divisions at Westmead subsequently slowed the clinic’s work to a crawl, and the report and its authors came under significant public pressure.

Professor Ashleigh Lin, the president of AusPATH, said it was now under new leadership and back on an affirming-care track. As for the more cautious approach being taken by UK and some European clinics, Lin, a youth mental health researcher, insists they came under the sway of an “anti-child and -adolescent-affirming lobby”.

But internationally, 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.

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.

In another lounge room, in a cosy apartment in the heart of progressive, metropolitan Melbourne, 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. There are about 15 people here – representative of a wider support group of 30 – and all their children are expressing gender incongruence.

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.

Retired clinical psychologist and sex therapist Sandra Pertot, who has almost 50 years’ experience, argues that minimising the experience of detransitioners is precisely the wrong approach: “These people should help us develop a safer diagnostic process … I don’t care how small a percentage they are … it’s straight science.”

Much is contested, but what’s not is that young people with gender incongruence and dysphoria are multiple times more likely to be autistic than the general population. They also have mental health issues on a broader scale. .

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

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