Australian Doctor Australian Doctor 24th November 2017 | Page 11

News Review
TOO
YOUNG
TO CHOOSE?
A looming Family Court ruling on gender affirming hormone treatment for
adolescents has elevated the debate over how doctors treat transgender youth.
K
RACHEL WORSLEY
KELVIN was born female but has
identified as a male since he was nine
years old. At 13, he told his father.
He then took the contraceptive pill
to cease his periods. He swapped
schools and, on his first day, arrived
to class dressed as a boy.
Yet aged 16, he had to hire law-
yers and go to court. He wanted his
doctors to prescribe testosterone, the
hormone treatment that would mark
the first irreversible step towards his
true gender identity.
While he had the full support of
his parents and his treating team,
like dozens of adolescents before
him, Kelvin had to seek the approval
of the Family Court of Australia.
The prescription of testosterone
or oestrogen to develop characteris-
tics of the opposite sex — the stage
2 treatment that occurs usually after
the administration of puberty block-
ers — is deemed a “special medical
procedure”, a procedure that the
court has defined as non-therapeutic
and non-reversible.
As such, the consequences of
getting the judgement wrong have
meant that the court believes it has
a role beyond the bounds of parental
responsibility.
A costly exercise
Kelvin and his family won the
court’s support because he was able
to show that he had the capacity to
make an informed decision about
the treatment. However, getting that
support took two months and cost
thousands of dollars in legal bills.
There is wider interest in Kel-
vin’s case because his family has
launched a legal appeal arguing the
court should not be involved in these
decisions at all, except in extreme
circumstances. They want treatment
decisions left to doctors and the
patients themselves.
Australia’s main transgender
groups say this fight is significant.
They argue that the court process
is emotionally arduous and often
results in treatment delays that could
make or break the success of transi-
tioning.
A final point they make is that the
decisions of the court tend to go one
with chemicals and its brain has
been denied the orientating effects of
gonadal hormones?”
AUSTRALIA’S MAIN TRANSGENDER GROUPS
SAY THIS FIGHT IS SIGNIFICANT. THEY ARGUE
THAT THE COURT PROCESS IS EMOTIONALLY
ARDUOUS AND OFTEN RESULTS IN TREATMENT
DELAYS THAT COULD MAKE OR BREAK THE
SUCCESS OF TRANSITIONING.
way — between 2013 and 2017 it
dealt with close to 50 cases involving
applications for stage 2 treatment
and approved them all.
Child abuse?
But this is where the arguments
begin. As the judges deliberate the
appeal, gender transitioning contin-
ues to sit at the heart of a fraught
ideological debate about the exist-
ence and nature of gender fluidity.
Critics have attempted to link
gender transitioning to the rise of
political correctness. A fringe, right-
wing clinician group calling itself the
American College of Paediatricians
has gone so far as to equate gender
transitioning with child abuse, stat-
www.australiandoctor.com.au
ing that children are being condi-
tioned into “believing a lifetime of
chemical and surgical impersonation
of the opposite sex is normal and
healthful”.
In Australia, Professor John
Whitehall, a professor of paediatrics
at the University of Western Sydney,
is one of the most strident opponents
of gender transitioning in the young.
“Gender idealogues argue that
puberty suppression is necessary to
give confused children time to con-
sider their future gender identity,” he
has written.
“But what child in puberty can
be expected to foresee with clarity
its gender and procreative future if
its limbic system has been wounded
Blown out of proportion
For Professor Whitehall, who fea-
tures regularly in the conservative
media, gender dysphoria is a legiti-
mate issue for some children. But
the prevalence of gender dysphoria
has been “blown to epidemic pro-
portions by a sensationalist media”,
certain “gender-friendly” websites
and even the much-maligned Safe
Schools program, which discusses
gender and sexual diversity in high
schools around Australia.
Family Court cases involving
approval for stage 2 treatment, he
adds, are often for children with
anxiety, depression, psychosis or
autistic traits that existed long before
they were identified as experiencing
gender dysphoria.
He argues it is therefore illogical
that treating gender dysphoria alone
by advocating medical transitioning
would solve the broader psychologi-
cal distress experienced by patients.
As for the argument that transi-
tioning is essential for the long-term
mental health of children distressed
with gender dysphoria, Professor
Whitehall says the evidence doesn’t
stack up.
“While there may be many happy
cont’d next page
24 November 2017
|
Australian Doctor
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11