Trans kids hit the headlines again

Get ready for a week of contradictory media reports surrounding gender-affirming care.

---

Two of the biggest mastheads in Australia are running conflicting stories on gender-affirming care this week, meaning GPs might need to brace for renewed interest in the topic.

Tuesday update: The NSW government has announced a review into the delivery of gender-affirming care, following last night’s Four Corners on Westmead Children’s Hospital’s gender clinic.

Arguments about how best to treat transgender patients – particularly young people – have been reaching a fever pitch over the last several years.

It’s an area of medicine and medical ethics that’s highly emotionally and politically charged, and it’s no stranger to dodgy science.

Most medical colleges and associations, including the RACGP and AMA, now support gender-affirming care, an approach to treatment that seeks to help patients align their outward traits with their gender identity.

On Monday night, the ABC will air a Four Corners episode examining the challenges faced by children and families attempting to access gender services at Sydney’s Westmead Children’s Hospital.

The central focus of the episode will be on how Westmead’s internal policies, as well as recent research that came out of the hospital – but was not done by frontline gender clinic workers – has affected both the workforce and patients of its gender service.

The 2021 research article suggested a high rate of desistance among young people presenting for gender-affirming care and referred to the gender service’s affirmative model of care as a “conveyor belt” and a “tick the box” mentality.

It’s understood that some staff left the clinic following the publication of the research, with at least one former staff member citing a lack of support from hospital hierarchy to provide gender-affirming care.

According to the former staff member, the controversial paper created distress among the clinic’s existing patients, who were worried that frontline staff were involved in the writing of it.

Unlike other gender services across Australia, the ABC reports, Westmead’s waitlist deprioritises patients who have reached or completed puberty.

Whether it’s due to this waitlisting system or a staff shortage, the clinic only has 145 patients on its books.

The gender clinic at Melbourne’s Royal Children’s Hospital, meanwhile, has more than 1000 patients and the gender service at the Queensland Children’s Hospital has around 900 patients.

The Four Corners report will also examine the patient journey of two transgender teenagers who were allegedly deprioritised for care at the Westmead clinic because they had already entered puberty.

One child went to another NSW Health gender clinic, where she was accepted for treatment.

The other died by suicide while waiting for an appointment.

The Australian, meanwhile, has published three articles in the last week relating to transgender teenagers, the thrust of which is that concerns around gender-affirming care have been suppressed.

One article contends that 2019 advice from the medical affairs committee of the Endocrine Society of Australia was not given due weight by the Royal Australasian College of Physicians in a letter advising then-health minister Greg Hunt that there was no need for a national review of gender-affirming medicine.

At the time, the endocrine society’s position was that there was a lack of evidence for the gender-affirming protocol as followed at the Royal Children’s Hospital, particularly in regard to puberty blockers.

Its position has since changed in keeping with current evidence, and the society now supports gender-affirming care in line with international and Australian guidelines.

The RACP’s 2019 letter to Mr Hunt did acknowledge the small evidence base for gender-affirming care, but did not explicitly state the position of the endocrine society.

Another of the articles in The Australian cites plastic surgeons who believe there should be a minimum age for transgender males or non-binary people to undergo a double mastectomy, sometime referred to as top surgery.

Surgical interventions for transgender young people tend to be limited to those over 16 years of age, but exceptions are made in some circumstances.

This article hinges on the case of a 15-year-old who, with the support of both parents, underwent a double mastectomy at a private day hospital.

Given that any double mastectomies for the purposes of gender-affirming care are either completely private or reimbursed under the same item number as a double mastectomy for cancer purposes, there’s no hard data on whether this surgery is on the rise for young people.

The Australian reported that three breast reconstruction specialists had confirmed anecdotally that the proportion of young people seeking gender-affirming surgery has risen over the last few years.