Is this the beginning of the end in Australia for the experiment of using puberty blockers for gender-incongruent children?
It began as a compassionate solution to the difficulties that trans people had in being accepted as the sex with which they identify.
A Dutch doctor came up with a solution to block puberty, so a male’s voice would not drop, nor would he develop male facial hair. A few years later, after high quantities of synthetic oestrogen (which would have to be maintained for the rest of his life) and his appearance would feminise. Puberty blockers could work for girls too, preventing them from developing breasts. Puberty had to be blocked early, before normal pubertal development began to be obvious. That might mean commencing blockade in a girl as young as 11.
Puberty blockers were known to be safe and fully reversible in children who experience very early onset of puberty. For gender-dysphoric children, they were promoted as giving kids time to think about whether to go on to take cross-sex hormones and have surgeries. Initially, the Family Court took a cautious approach, insisting on court approval as a safeguard. However, in re Kelvin (2017), it decided it didn’t need to be involved at all, if both parents agreed to the treatment.
Since then, the movement to normalise the treatment of gender-dysphoric children and adolescents with life-changing drugs has unravelled. It always had one major flaw. For decades, most children seen at specialist gender clinics in Amsterdam, Toronto and elsewhere had resolved their gender issues before, or while going through, puberty, usually growing up to be gay or lesbian.
Could blocking puberty actually prevent the very natural processes that would help these children resolve their gender issues?
The notion that puberty blockers were both safe and fully reversible has now been called into question. Safe? Yes, except for significant impacts upon bone density, and concerns that they interrupt a crucial developmental stage in adolescent cognitive development.
About 95-98 per cent of children on puberty blockers go on to take cross-sex hormones. So it would seem that they operate as a platform to get on to a trans train that hurtles inexorably to its destination – irreversible transformation of the body that some will later regret. A boy commenced early on puberty blockers who goes on to take oestrogen may never obtain adult sexual function and capacity for pleasure.
Furthermore, systematic reviews of the evidence conducted in several countries have all reached the same conclusion – the evidence of mental health benefits from these treatments is very weak, and some studies show no such benefits at all.
Re Devin, the decision of Justice Strum of the Federal Circuit and Family Court this week, is a further hammer blow. It must be emphasised that this is a judgment about one 12-year-old boy. It is not necessarily a precedent. Judges are not qualified to resolve great medical controversies. However, they have to be aware of the medical evidence to make decisions about individual children. Strum rejected the diagnosis of the gender clinic that the boy was suffering from gender dysphoria.
He was highly critical of its failure to conduct proper clinical assessments even though its clinical staff had been seeing the boy since he was six. Strum refused to authorise the boy to receive puberty blockers or cross-sex hormones and banned either parent from taking the child back to the gender clinic unless they both agreed. He removed the child from living with his mother. The boy will live from now on with the father.
The judgment is carefully and powerfully reasoned. Strum is withering in his criticisms of the hospital’s expert witnesses, especially “Assoc. Prof. L”, who argued that the landmark Cass Report, which has led to an almost complete ban on the use of puberty blockers for gender dysphoria in England, forms part of a “third wave of transgender oppression” commencing with the Nazis. Strum also rejected the very foundations of “gender-affirming care”, expressing concern about the gender clinic’s apparent policy “to affirm unreservedly those who present with concerns regarding their gender, brooking no questioning thereof” – even if it is a young child. He also rejected the notion that gender identity is innate and immutable.
If it is changeable, especially in a child, what can be the justification for irreversible treatments? Strum regarded the risks of puberty blockers as “unacceptable”, accepting the view of the Cass Review in Britain.
Is this the beginning of the end in Australia for the experiment of using puberty blockers for gender-incongruent children? The gender clinics and clinicians in private practice are fighting hard, with powerful political support from LGBTQ+ advocacy organisations. The professional medical colleges have been reluctant to take a stand; but if no one else will act, the courts will.
Strum’s judgment offers several bases upon which a negligence lawsuit could succeed against the gender clinic concerned in Devin’s case. It also reveals much about what is really going on in at least one children’s hospital.
Patrick Parkinson is an emeritus professor of law at the University of Queensland and formerly a chair of the Family Law Council.
Source: The Australian