Health Analysis

Children casualties in war over gender transition

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The fight to protect the rights of trans kids marches on (Screenshot via YouTube)

Activists and the media are turning trans issues into controversy instead of helping to find ways to treat gender dysphoria in children, writes Dr Jennifer Wilson.

AT THE CENTRE of the recent Four Corners program, Blocked, is research conducted at Sydney's Westmead Children’s Hospital on the treatment of children presenting with gender dysphoria. This is defined as ‘the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related characteristics’.

The Westmead research can be read here and here.

The Westmead team, along with researchers in Sweden, Finland and the United Kingdom (all countries where the use of puberty blockers has been wound back) argues for a trauma-informed biopsychosocial model of treatment for gender dysphoria, prior to or instead of the gender affirmative model which offers puberty blockers, cross-sex hormone therapy and gender-affirming surgery, depending on the age of the child.

Also known as “watch and wait”, the biopsychosocial model is a form of care that offers children psychotherapy-based support for gender dysphoria and any comorbidities, prior to making decisions on drug and/or surgical intervention.

While puberty blockers are regarded as reversible, there are concerns about their adverse effects on bone density and cardiovascular health. Their effect on neurodevelopment is also unknown, as is their effect on sexual function in adulthood.

Some effects of cross-sex hormones are not reversible.

The two models have become the battleground for what presenter Patricia Karvelas describes as a “bitter war over young people's bodies”.

The decision to embark on medical intervention is a serious one and a heavy burden for a child and their family to bear. It is difficult to understand why anyone is opposed to giving them time and a supportive environment in which their gender dysphoria can be explored before embarking on medical intervention. 

However, opponents of the watch-and-wait option claim it only prolongs the child's distress and can equate to rejection and shame.

While their approach puts Westmead in step with international thinking, in Australia, where the gender-affirming model is still regarded as best practice, the team is viewed as an outlier and has come under heavy criticism, including a thinly-veiled critique of their ethics.

The Westmead researchers recorded ‘high rates of adverse childhood experiences’ (A.C.E.) with 68.5% reporting family conflict, parental mental illness (63.3%) loss of important figures via separation (59.5%) bullying (54.4%) and history of maltreatment (39.2%).

The team did not draw a causal link between A.C.E. and gender dysphoria.

Nonetheless, one of the criticisms is that a causal link is “implied”. One parent in the study felt the data suggested that “children are trans because of dysfunction in the home”.

Transgender woman, Dr Anja Ravine, a genetic pathologist, told Four Corners:

“The implicit messaging that I read in this, which actually wasn’t said directly but it was implicitly there and quite powerful is that these children, trans-ness and presentation with associated distress is really something that’s emerged out of a background of early childhood traumas, poor parenting practices, associated impaired parent/child attachment patterns.”

I saw no such implications in the study. It is clear that some of the children also had other serious challenges to navigate and assistance with those challenges offered by a trauma-informed approach could be of considerable benefit to their overall well-being.

There is, however, a baffling error in the Westmead report, relating to the concept of "desistance". This is defined as the ‘disappearance of gender-related distress’  that brought the young person to the clinic. The researchers claim that the distress eventually disappeared for 22% of those they studied.

That figure includes children who are assessed and considered not to meet the diagnostic criteria, so were never eligible for puberty blockers in the first place. The actual number of children diagnosed as eligible for treatment who changed their minds is 9.1%.

This is important as desistance is used as an argument against gender-affirming care.

As this controversy rages, one of Australia’s leading medical insurers, MDA National, recently announced that it will no longer cover private doctors such as general practitioners from legal claims arising from the assessment of patients under 18 as suitable for gender transition treatment, such as cross-sex hormones and gender affirmation surgeries.

This decision was arrived at after what MDA National described as ‘growing criticism globally of the research that underpins medical and surgical transition of children in response to gender dysphoria’.

In the Wall Street Journal, 21 leading experts on paediatric gender medicine from eight countries have written a letter disputing the efficacy of gender-affirmative treatment, calling instead for the psychotherapeutic model to be used.

It is beyond unfortunate that children have been caught up in a much broader ideological war between trans rights activists and gender-critical feminists, as Four Corners demonstrated.

What should be the only concern is ensuring children with gender dysphoria are offered the best available options for their distress.

Conflating their situation with adult hostilities acted out in an atmosphere of toxic warfare will do nothing for their well-being.

Dr Jennifer Wilson is an IA columnist, a psychotherapist and an academic. You can follow Jennifer on Twitter @NoPlaceForSheep.

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