Urgent concerns raised by the UK Cass report have been roundly dismissed by Australian gender clinicians. After almost four years of work, Dr Cass’s report reflects a meticulous analysis of all relevant international research including systematic reviews of the weak evidence base for treatment of gender-distressed young people. Yet the best response that gender clinicians in Australia can muster is an eerily identical chorus that “Australia is not the UK” and a hollow refrain that gender dysphoria management is “complex and evolving.” The acknowledgement of this uncertainty does not appear to cause restraint or circumspection as gender clinicians continue to initiate radical hormonal regimes in children; regimes which are, by design, required for the remainder of the child’s life.
Gender clinicians are eager to reassure the Australian public that international research is not relevant to their practice. Somehow, the echoed reassurance of “multidisciplinary teams” is supposed to assuage mounting concerns by Australian doctors, young people, parents, journalists, politicians, academics and the legal profession. This emphasis on multidisciplinary care is tactical. The public is not being told that Australia’s general practitioner doctors (GPs in primary care) are increasingly starting lifelong cross-sex hormones for 16- to 17-year-olds independently of specialists such as endocrinologists or psychiatrists. These GPs are celebrated by the Royal Australian College of General Practitioners as a “Special Interest Group”.
What Australia’s gender clinicians have not done is respond, in any way, to the specific concerns raised by the Cass report, much of which is directly applicable to unacceptable practice in Australia. It is arguable that Australian gender clinics have some of the most egregious examples of substandard care and malpractice in the world. This is why parents and detransitioners, burdened with regret about past medical interventions recommended by trusted clinicians, are starting to bring claims to court.
Simply claiming that Australia’s “gender-affirming care” is holistic doesn’t make it true. Even if a patient’s history is carefully noted and a multidisciplinary team is involved, it falls short of holistic care when a gender clinic offers only a narrow pathway of hormonal intervention. Genuine holistic care would mean best practice management of all relevant conditions, not just the gender distress presented as the key problem.
Do Australia’s health ministers know the clinical reality that lies behind the slogan of “holistic gender-affirming care”? Consider the case of Maple Leaf House, a gender clinic in NSW’s Hunter region which takes young people under the age of 25. This clinic has a growing reputation for internal staff problems, hauling the reluctant parent in a family before a court to force treatment of the child, and allowing ideological presuppositions to override clinical discretion.
On the surface, Maple Leaf House can be viewed as a success, with 986 young people seen in the past year, more than 12 full-time staff and a very large number of patients initiated on puberty blockers and “gender-affirming” hormones. While 91 otherwise pubescent children were receiving puberty blockers as at September 24 last year, Maple Leaf House is understood to have refused to report the number of young people prescribed cross-sex hormone treatments, despite clear Freedom of Information requests.
Clinicians in the Hunter region have noted that Maple Leaf House fails to engage with the complexities present in a young person’s life. Serious medical and mental health issues are documented in letters from referring doctors, but then ignored or dismissed by Maple Leaf House as unrelated to gender distress or inexplicably unimportant. Issues such as autism spectrum disorder, attention-deficit/hyperactivity disorder, major depression, anxiety, a history of sexual violence, other childhood trauma and family issues appear to go unaddressed by Maple Leaf House, despite their staff including a paediatrician, child and