Critique of The RCH Gender Clinic document:

“Australian Standards of Care and Treatment Guidelines For Trans and Gender Diverse Children and Adolescents“.

The gender clinics acknowledge that they have no way of determining which children, as they mature, will remain gender dysphoric and which will desist. [1]  Further, reports from the clinics indicate that virtually 100% of children put on puberty blockers and which are socially affirmed become transgender. This means that these therapies are being used for the MAJORITY of children despite NO evidence that they are needed by this majority. The concern should be obvious: children are being transitioned who should not be. It would appear that there are no safeguards to protect these children.

The DSM-5, the foremost medical manual used to diagnose psychological conditions, indicates that that attendances of adults at gender clinics range from 0.005 to 0.014 percent of adult males who consider themselves females and 0.002 to 0.003 percent of women who identify as men. [6] Therefore, averaging those figures based on an Australian population of 20 million people, the total number of adult transgender people across the Australian adult population, should at its extreme be around 1200. (The 2016 Census registered 1260 non binary adults of which only 340 registered as specifically transgender.)

Associate Professor Michelle Telfer MBBS who is the Director of the Victorian Royal Children’s Hospital Gender Services, who has the full support of the Labor governments, has been instrumental in formulating the Australian Standards of Care and Treatment Guidelines For Trans and Gender Diverse Children and Adolescents. [2]  (We will refer to this as the Aust Standards of Trans Care for the rest of this article.)

Please note that as inferred by the name, it is considered that this document should be viewed as the standard treatment of such care for all of Australia.

We have a number of concerns at the accuracy of the data used in these ‘standards’ and the way it is being applied:

  • RCH Gender Clinic Transgender Numbers Projections, As Opposed to the 2016 Census.

This document on page 2 states and accepts a NZ study that concludes that 1.2% of adolescents identify as transgender.

On a further link according to the RCH  1.2% of adolescents  = 45,000 adolescents ( 10 – 19 yo)  in Australia consider themselves transgender. [3]. This is despite the fact that 2016 Census showed only 340 adults identifying as transgender

Assessing the RCH Aust Standards of Trans Care 45,000 adolescent transgenders and comparing it with the DSM-5’s projected 1200 Australians who will continue as adult transgenders means that 97.3% or 43,800 of those 45,000 adolescents, if properly supported, ( not transitioned) will grow out of their gender dysphoria.

  •  RCH Gender Clinic Policy On Gender Affirming Treatment.

In light of those figures, what does the Aust Standards of Trans Care say on page 5? Withholding of gender affirming treatment is not considered a neutral option,

The document goes on to say, “In the past, psychological practices attempting to change a person’s gender identity to be more aligned with their sex assigned at birth were used. Such practices, typically known as conversion or reparative therapies, lack efficacy, are considered unethical and may cause lasting damage to a child or adolescent’s social and emotional health and wellbeing.“

The document provides no clear evidence to support these claims of being ‘unethical’ or ‘harmful’ and we see clear evidence from the DSM-5 that there is up to a 97.3% chance a child will desist. Despite this, the RCH policy is not only to affirm every child they deem gender dysphoric, but allowing a parent to seek balanced medical and psychological advice for their child should not be allowed because it MAY (in their opinion) damage the child.

  • Gender Affirming Treatment Regulation.

Page 7 Current law allows the adolescent’s clinicians to determine their capacity to provide informed consent for treatment. Court authorisation prior to commencement of hormone treatment is no longer required.

Therefore, whereas previously there had been court oversight of the treatment of gender dysphoric children, this no longer exists. Now the doctors who promote this ideology are also controlling the operations of the gender clinics without allowing any alternative approaches. This is not consistent with good medical care that should carefully consider all the alternatives in a balanced fashion. We are calling for balance to be brought back to the discussion.

  • Psychological Counseling of Transitioning Gender Dysphoric Children.

On Page 9 is this statement.  Trans or gender diverse children with good health and wellbeing who are supported and affirmed by their family, community, and educational environments may not require any additional psychological support beyond occasional and intermittent contact with relevant professionals in the child’s life, such as the family’s general practitioner or school supports.“

Any reasonable thinking mind would look at the above statement and then come up with two pertinent questions.

First, aren’t we being assured that children go through years of intensive counseling before, during and after the transgender processes? Where is the evidence that this actually occurs.

Secondly, how does any reasonable mind accept that a child, who is biologically a particular sex but is living believing they are the opposite sex, only requires occasional and intermittent psychological support? What standards do the clinics use to determine what is “occasional” and what is “intermittent”? The Aust Standards of Trans Care provides no guiding standard.

Is it because of this the approach that there are so many youth on the Reditt r/detrans social media page, young transgenders (18,000 members) who want out of their transgender lives, claiming that they had very little psychological support and that their other mental issues weren’t explored? Numerous other detransition websites and social media pages are also being created with similar claims.

  • Gender affixing declaration.

The Aust Standards of Trans Care (Page 9) states Developing a shared understanding allows the child to feel genuinely supported and affirmed in who they are“.  The question has to be asked, exactly who are these children and what are they really? Because the gender clinics openly admit that they have no idea which children will remain transgender and which will desist. Despite this the gender clinics persist in transitioning them.

  • Ignorance of Detransistioning Numbers Admission.

The Aust Standards of Trans Care makes the unbelievable “scientific“ admission on Page 9. “The number of children in Australia who later socially transition back to their gender assigned at birth is not known, but anecdotally appears to be low and no current evidence of harm in doing so exists.“

Thus we have clear evidence that the clinics are embarking on therapy that alters the fundamental anatomy and physiology of a CHILD with no real evidence for the success or failure of such treatment. The only accurate way to explain this approach is ‘experimental’. We do not want our children subjected to such an experiment.

  • The Harms of the Transgendering Process.

The Aust Standards of Trans Care admits that there is permanent sterility for natal males after the use of hormones and no way of collecting sperm if hormone blockers start before puberty. (Page 14) “For trans females, there is evidence that oestrogen impairs sperm production, although whether these effects are permanent remain unknown.“

“ Should a trans female adolescent be commencing puberty suppression in early adolescence (Tanner stage 2-3) collection of mature sperm will usually not be possible since mature sperm are produced from mid puberty“

  • No Existing Standards of When to Start Hormone Blockers.

Incredibly the Aust Standards of Trans Care admits that there is no empirical evidence when hormone blockers should start. (Page 17)

 “There is no empirical evidence to provide objective recommendations for the appropriate age for introduction of stage 2 treatment“  (Tanner stage 2 pubertal status has been achieved. This can be confirmed via clinical examination with presence of breast buds or increased testicular volume (>4 mL) and elevation of luteinizing hormone to ≥0.5 IU/L.)

Again, the only accurate way to explain this approach is as a matter of experimentation with a young person’s life.

  • Acknowledged Negative effects of Hormone Blockers.

While the clinics want to claim that hormone blockers are safe and fully reversible, clearly there are known negative effects from blockers. The Aust Standards of Trans Care states. (Page 15.) “ The main concern with use of puberty suppression from early puberty is the impact it has on bone mineral density due to the absence of effect of oestrogen or testosterone on bone mineralisation during this time. “

“ Reduction in the duration of use of puberty suppression by earlier commencement of stage 2 treatment must be considered in adolescents with reduced bone density to minimize negative impacts. “

Worse on Page 15. but the long term impact of puberty suppression on bone mineralisation is currently unknown.“

Rebuilding bone density is difficult if not impossible.

There are other effects of blockers not acknowledged here that Prof John Whitehall showed evidence of. Not forgetting that if a child is put on blockers for any period of time, that child’s physical and social development is that far behind its peers.

  • Acknowledged Negative effects of Cross-sex Hormones.

The Aust Standards of Trans Care goes on to say on page 16.  “Gender affirming hormones oestrogen and testosterone are used to either feminise or masculinise a person’s appearance by inducing onset of secondary sexual characteristics of the desired gender.  Some of the effects of these medications are irreversible, whilst others have a degree of expected reversibility that is likely, unlikely or unknown. “

The paper then has two tables on the effects of cross-sex hormones which states that the results of which for natal boys, “Decreased testicular volume, Decreased sperm production,“ for natal girls “Clitoral enlargement, Vaginal atrophy“ are unknown.

Yet cross-sex hormones have been used for decades. How could any reputable gender clinic claim to not know the results of hormone treatments on such obvious physiological changes? Worse, state that the degree of reversibility is unknown but continue to prescribe them? Yet there are myriads of available scientific papers that report on the results of using Hormone Blockers and Cross-sex hormones.

  • Transgender Regret Acknowledged.

The Australian Standards of Care, having earlier said that transgender regret is “anecdotally” low, later in the document admits that transgender regret exists and should be minimized. (Page 17)

“Whilst later commencement of hormone treatment during adolescence provides time for further emotional maturation and potentially lessens the risk that the adolescent will regret their decision,“

But how do the gender clinics “lessen the risk” if the number of, and hence the reasons for, regret and detransitioning is unknow? It may well explain why so many youth on the Reditt r/detrans social media page, complain that they received little forewarning of the effects of hormone treatments and that there is no-one available to help them detransition.

The obvious question is “what is an acceptable level of transgender regret”? On what basis should it be calculated? At what point are the clinics justified in using the threats of impending suicides, on parents and guardians resisting the transitioning of their adolescents, using them as a cudgel to enforce transitioning?

  • Admission of The Adverse Effects of Hormone Treatment & Surgery.

The Aust Standards of Trans Care outlines the roles of the various doctors. (Page 19)  Monitoring of physical and mental health during medical transition. This includes identification and monitoring for both desired physical and psychological changes and adverse effects from treatment.“

Provision of information and education to the adolescent and their parents/carers regarding options for medical transitioning including risks and benefits of puberty suppression and gender affirming hormones.

Counselling of birth assigned male adolescents and their parents/caregivers on the impact medical treatment such as puberty suppression may have on future surgical procedures, including creation of the neovagina. Counselling on the potential for altered sensation relating to orgasm as a consequence of this surgery is also necessary.

 The above excerpts demonstrate that the clinics know full well the results of the transitioning has “adverse effects” on their patients. Despite this, NO consideration is given to any alternative approaches other than affirmation. This is not consistent with good medical care.

  • Gender Clinics Harnessing the Law To Enforce Parental & Carer Compliance.

The Aust Standards of Trans Care refers to the roles of the bioethicist and legal practitioners (Page 22.)

Legal advice may be sought when young people or their families experience discrimination or in the case of an objecting parent or legal guardian who initiates legal proceedings with the aim of preventing commencement or continuation of treatment.

This advises that the law may be used to force parents or guardians to comply with the transgendering of their children, even if they object to it. This confirms the ‘parental rights’ concerns we discussed earlier.

  •  Gender Surgeries.

The Aust Standards of Trans Care discusses medical interventions are appropriate starting at age 16. (Page 25.)

Chest reconstructive surgery (also known as top surgery) may be appropriate in the care of trans males during adolescence. In alignment with the recommendations of WPATH SOC version 7 chest reconstructive surgery is regularly performed across the world in countries where the age of majority for medical procedures is 16 years of age.“ In Australia, before the family court removed itself from the process, there are records of girls having mastectomies at 15 years of age.

The article, Adolescent Maturity and the Brain: The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy. [4] should raise serious concerns about transgendering our youth.

This article outlines that adolescents brain development at puberty is such that they take increased risks. This risky type of behavior does not dramatically reduce till the adolescent reaches their early to mid 20’s.

For this reason teens aren’t allowed to drive or purchase alcohol till age 18. Particular note should be taken that insurance companies have high insurance premiums for the under 25’s because it is well know that the brain is not sufficiently developed to fully understand risk till around that age. But here we have doctors approving irreversible surgeries 9 years earlier, pharmaceutical drugs 15 years earlier.

Professor John Whitehall further explains that the effects of puberty blockers impairs the executive function of the brain to make informed decisions. He can be viewed speaking in the video titled, “Hormone Blockers and the Limbic System.” [7]

  • The Basis of the Australian Standards of Care and Treatment Guidelines For Trans and Gender Diverse Children and Adolescents.

Lastly on Page 27 the following stunning admission: As mentioned above, the recommendations made in this document are based primarily on clinician consensus, along with previously published standards of care from the World Professional Association for Transgender Health (WPATH), 12 treatment guidelines and position statements,13-19 and findings from a limited number of non-randomised clinical studies and observational studies.8-11,20-26 It is clear that further research is warranted across all domains of care for trans and gender diverse children and adolescents, the findings of which are likely to influence future recommendations.“

In the statement the RCH gender clinic admits much of the basis of these treatments is a limited number of studies which were “non-randomized” i.e. they are based on biased studies and the opinions of pro-transgendering clinicians. It then goes on to admit further research and studies need to be done but doesn’t explain why or in what specific areas. It leaves us with the clear understanding that the children of Australia who are suffering from gender dysphoria are being drawn into a huge experiment.

Long-Term Projection Of The Number Of Australia Transgenders Using RCH Figures and Policies.

Based on the RCH Gender Clinic figures and policies, with the expectation that all transgender adolescents remain transgender into adulthood, the following is a projection of the adult transgender population in Australia.

  1. The RCH claims that there are at any one time 45,000 Australian transgender adolescents between the ages 10 to age 19 (a 9 year period) [3]
  2. Taking the average age of death to be 75, and presuming that number of adolescents has stayed consistent, then every 9 years an additional 45,000 transgender children will have added to the adult figures till age 75, when they will pass away.

 To illustrate, if we were to start with zero adult transgenders in 2020, by 2029 we would have 45,000 and in 2038 we would have 90,000 (45,000+45,000) adult transgenders.

This projection of the RCH gender clinic figures should seriously concern all

 

Summary of the RCH gender Clinic Policies.

  • The clinic policy is that all children presenting as transgender should have affirming treatments.
  • The RCH Gender Clinics make it clear that their policy is that no-one should be able to offer a child any other than affirmative treatment.
  • The clinic, are using the courts to cajole parents and guardians into compliance, stating their want to make such treatments enforceable by law for all children presenting with diagnosed gender dysphoria.
  • The statistics and statements from the RCH website clearly demonstrate that in our gender clinics we have doctors who believe that at any one time there are 45,000 adolescent transgenders who should by law be forced into adulthood without any alternative recourse, which translates to an adult transgender population of around 270,000. This contrary to all historical records
  • As opposed to other medical interventions, these treatments are being applied to perfectly healthy bodies. Treatments involving social affirmation, lifelong dependence on pharmacological agents and irreversible surgeries.
  • The Australian Standards of Care openly admits that many of these children have comorbid psychological conditions and that others are on the autism spectrum. It admits that the exact interplay between these conditions is as yet unknown. Yet they are quite prepared to transition children without addressing these issues first.
  • Despite assurances from the clinics that children are given years of counselling the clinic admits that there are children they decide only need minimal counselling for what is major non-reversible, life-long treatments.
  • The clinics have decided that the gender confusion that children suffer determines “who they are.” History records that many children as they mature are no longer transgender, clearly showing the “who they are” statement to be false.
  • The clinic admits that the right time to start blockers is
  • The clinic admits that hormone blockers damage bone density. They admit that the long-term effects of hormone blockers are unknown.
  • On the long-term effects of cross-sex hormones, the clinic says these also are unknown.
  • The clinics admit that these are irreversible treatments that sterilize children. We would assert at a time when they are too young to understand the consequences and so are incapable of making such decisions.
  • The policy is to allow 16 year old girls to remove their breast so destroying their ability to breast feed any children they may have.
  • The clinic admits that sexual pleasure may well be reduced.
  • The clinic advises that is knows the treatments have adverse effects yet proceed with treatments.
  • The Australian Standards of Care admits that the gender clinics only have anecdotal statistics” of their failures, which therefore is an admission that the success” rates of these treatments are
  • In addition, we have the clinics admitting that the risks are unknown and admitting a lack of consensus among doctors as to what the correct treatments should be. Despite this they are prescribing hormones known to do permanent damage to organs and bones and admitting that there are children who they considered to only need minimal psychological support. These interventions leave them permanently sterile, often sexually incompetent, with urological issues and many times does not relieving the gender dysphoria that these treatments were supposed to cure”.
  • Whereas there used to be court oversight over the transgendering that is no longer the case. As a result there is a serious conflict of interest as the very doctors who are profiting from transgendering children are the ones deciding that they should be transgendered.

 Recent Precedents of Universally Accepted Medical (Mal)Practice.

Simply because representative groups advise that the current processes are safe and adequate, does not mean it is so. One only needs look at the lessons learnt from relatively recent history.

  • Homosexuals were lobotomized and given electro-shock treatments to “cure” them in the 1940’s to 1970’s because this treatment was the overwhelmingly supported medical procedure at the time.
  • Thalidomide, used in the 1950, & 60’s, FDA approved, was accepted as totally safe and widely prescribed for morning sickness. Yet it genetically damaged thousands of babies.
  • In the 1960’s and 70’s Chelmsford Clinic in Sydney was killing and damaging patients with what was known as deep sleep therapy despite other doctors raising serious concerns.
  • In the late 1980’s breast implant companies such as Dow Corning were producing reports that their products were safe with plastic surgeons overwhelmingly supporting their claims. In the end Dow Corning paying injured women many millions of dollars in compensation.

In each case it has only been because of the voices of small groups who stood up for right, unfortunately having to resort to the court systems for justice, that these institutions and companies were called to account. In the meantime, all these practices resulted in lives of innocent people being damaged or lost.

Despite such lessons from recent history, in the face of a rising number of medical voices raising concerns about the activities of the gender clinics, and with an increasing number of people, particularly the young, detransistioning, the affirming behaviors of the gender clinics continue unabated.

These treatments are being driven by ideologies, with opinion pieces tendered as scientific expose’s, but not by solid medical data. As can be seen above, by their own acknowledged deficiencies, while the gender clinics claim to have peer reviewed data, none of the studies are definitive, nor is any peer who has a contrary view permitted to examine or input data into these studies, so biasing every study towards affirming the gender transitioning.

The gender clinics are not recording, or if they are, not releasing the statistics of those who regret transgendering. Contrary to the assertions of the Australian Standards of Care there an increasing number of those who are detransitioning. These are beginning to speak up, claiming they weren’t properly diagnosed or properly informed. Worse, when they wanted out of their transgender lives there was no support from the doctors.

Nor are the numbers of those whose surgeries do not meet expectations being readily released. One should not presume that these surgeries all go well, they are complex and many have complications.

A growing number of doctors and other professionals across the world, practicing in various fields, are voicing their concern over this phenomenon. The Tavistock Gender Clinic in the UK had 35 clinicians resign in protest at the fast-tracking of children towards being transitioned as recommended by the Australian Standards of Care. There are similar concerns voiced by doctors in other clinics.  Subsequently the full bench of the UK High Court have ruled that the Tavististock clinic was giving children puberty blockers at an age where they were too young to be able to give consent. Worse, the clinic could not provide evidence of efficient follow up of their patients to show whether the treatments were beneficial or not. [8]

Therefore, we have treatments with unknown success rates conducted on individuals whose ability to fully comprehend the risk is unknown, using drugs and medical procedures with unknown side-effects and unknown outcomes. The clinics admit that they are using biased studies to draw on for their data and openly state that further research needs to be done.

The concern should be obvious: children are being transitioned who should not be. It would appear that there are no expected safeguards in place to protect these children.

  • Kiera Bell V’s the UK Tavistock Gender Clinic in the High Court.

Subsequent to writing this article in the Keira Bell Vs the UK Tavistock gender clinic case, heard before three  High Court judges, the court was scathing that the clinic had not kept, or could not product, proper records of follow up of their patients. Further, the High Court rules that children were not capable of giving informed consent. The Tavistock clinic has ceased prescribing puberty blockers to children.

  • Australia’s Westmead Hospital Doctors Lodge Report Castigating the Treatment of Gender Dysphoric Children.

Doctors treating children and teens with gender dysphoria have opened up about feeling pressured to prescribe puberty blockers and cross-sex hormones before non-medical interventions, such as psychotherapy, have been explored.

Professor Geoffrey Ambler.

In the first Australian study of its kind, clinicians at The Children’s Hospital at Westmead in Sydney say the emergence of a “conveyor belt” mentality to treating the condition has forced them to compromise their own ethical standards.

Bookmarks

[1] https://www.nbcbayarea.com/news/local/transgender-kids-eligible-for-earlier-medical-intervention-under-new-guidelines/19909/

Transgender Kids Could Get Hormone Therapy at Earlier Ages

[2]  Aust Standards of Care and Treatment Guidelines for Trans and Gender Diverse and Adolescents pdf

https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf

[3]  Kids Health Info, The Royal Children’s Hospital, Melbourne

https://www.rch.org.au/kidsinfo/fact_sheets/Gender_dysphoria/

[4] Adolescent Maturity and the Brain: The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy. By  Sara B. Johnson, Ph.D., M.P.H,a,* Robert W. Blum, M.D., Ph.D,b and Jay N. Giedd, M.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892678/

[5] 10,000% Increase In Male to Female Sex Changes In Utah.

https://www.thenewamerican.com/culture/education/item/35538-utah-sees-10-000-increase-in-girls-getting-sex-change?fbclid=IwAR39o-lnqvvd1UgAb_KttqY25HediY53eG7ldLgsf8TF_fBYJltOMgrLtTM

[6] The DSM-5 Can Be Purchased Here.

[7]  https://www.stopsafeschools.com/prof-john-whitehall-childhood-gender-dysphoria-videos/

[8]  https://www.theguardian.com/society/2020/oct/07/court-hears-children-cannot-consent-to-puberty-blockers

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