Professor Dianna Kenny featured on a recent 4 Corners episode called “Blocked.”
It was a woeful attempt to sell “affirmation-only” pathways that deny the harmful reality of ignoring other underlying issues and the irreversible nature of drugs and surgery.
Professor Kenny has spoken out to specifically address the shortfalls of the ABC program.
Her expertise, compassion and knowledge in this area is essential.
Watch the video here.
View the PowerPoint presentation here.
Read Professor Kenny’s accompanying notes here:
RESPONSE TO FOUR CORNERS “BLOCKED” ABC 10 JULY 20231
Dianna T Kenny PhD
On 10 July the ABC Four Corners presented a program entitled, “BLOCKED”2 about gender dysphoria and its treatment in young people.
I was so concerned by the coverage that I felt it incumbent upon me to provide a more balanced account of the current state of research in the care of gender dysphoric young people internationally.
It was disappointing that the alternative view to GAT was awarded only 14% of the total air time of the program.
Before I present my concerns with the Four Corners program, I make the following statements with which the international scientific community working in the area now agree.
- Young people with gender dysphoria almost always have psychological, psychiatric, and psychosocial comorbidities that predate the onset of gender dysphoria.
- Social transition and puberty blockade are not neutral interventions. Puberty blockade interrupts the progression of normal development which may not be reversible after prolonged use. Both social transition and puberty blockade facilitate progression to cross sex hormones.
- Medications aimed at halting puberty also pose health risks and prevent children from resolving their gender confusion. They have no positive benefits on mental health or suicide prevention.
- Cross sex hormones have not been proven to result in long-term positive health benefits or the resolution of identity confusion. These interventions do not decrease suicide ideation or suicide. The suicide rate after (but not before) medicalised transition is higher than population norms.
- Medical and surgical interventions carry high risk for lifelong mental and physical health problems, including serious surgical complications and chronic pain, loss of sexual function, and infertility.
- Children do not have the maturity or the capacity to consent to social and medical intervention in respect of their gender identity. That is, they are unable to give informed consent to life altering interventions.
I turn now to the key, but by no means, all of issues with the program:
1. The failure to propagate available research that is critical of the gender affirming model.
Three examples will suffice
(i) The decision to close the Tavistock gender clinic was treated in a cavalier and shallow way by Ian Hickie. There was no mention of the findings of the Cass Review and two systematic reviews that found the perceived benefits of gender affirming treatment was based on very weak evidence. No other medical condition would be implemented with such a poor quality evidence base. The Tavistock's own longitudinal research also found no benefit - a shocking finding in view of the fact that this gender service continued to prescribe puberty blockers and cross-sex hormones knowing that they bestowed no positive health benefits to young people.
(ii) There was no mention of developments in other countries that have now greatly restricted the prescription of puberty blockade and cross sex hormones to minors, mandating the use of psychotherapy as the first line of treatment. This is the case in the UK, Finland, Norway, Sweden, France, and Spain, and 20 states of the USA have passed anti-gender affirming treatment legislation (although this is currently being challenged in the courts).
(iii) One of the most important omissions in the story and in gender-affirming interventions is the failure to appreciate that gender dysphoria is almost always secondary to other comorbidities. The NHS Interim Service Specification explicitly noted the issue stating that underlying issues may need careful psychotherapeutic intervention even to access and once identified, painstaking work to resolve. Gender affirming care advocates vehemently deny the presence or importance of other psychopathologies in this group of young people, despite a vast trove of research indicating its high prevalence.
2. The attack on the Westmead researchers. The results of their published studies make it difficult to continue the denial that comorbid psychological and psychiatric conditions predate declarations of gender dysphoria and regularly remain untreated by health professionals in gender clinics.
Developmental pathway choices of young people presenting to a gender service with gender distress: A prospective follow-up study
Joseph Elkadi, Catherine Chudleigh, Ann M. Maguire, Geoffrey R. Ambler, Stephen Scher and Kasia Kozlowska (6 authors)
Karvelas’s treatment of the two published studies from the Children’s Hospital at Westmead was confusing and unbalanced. She set out to discredit it. The relentless agitation by activists to have adverse research findings amended, retracted, or denigrated is a familiar strategy. They did the same with the Lisa Littman studies.
Accusations were made about some form of sleight of hand in reporting desistance rates in the sample of 79 young people. The opposite is in fact the case. The authors could not have been more transparent about the outcomes for the two subgroups in their study, which they clearly defined as:
Desistance in the cohort as a whole: In the cohort as a whole, desistance refers to the resolution/disappearance of the gender-related distress that was the foundation for the young person to present to the service.
Desistance in the Gender Dysphoria subgroup: In the subgroup with a formal diagnosis of Gender Dysphoria (DSM-5), desistance refers to discontinuation of transition once commenced. This included cessation of social transition, puberty blockers, or cross-sex hormones, or a combination of these elements.
-All had puberty staging and a formal DSM-5 based diagnostic assessment.
-66 met criteria, 13 did not but two later obtained a GD diagnosis.
-68 young people (68/79; 86%) with formal diagnosis of GD were deemed eligible for gender-affirming medical interventions and 11 young people (11/79; 14%) were not.
-Followed up November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow- up), six had desisted (desistance rate of 9%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 91%; 60/66).
-Within the cohort as a whole, overall persistence rate was 78% (60/77), and overall desistance rate for gender-related distress was 22% (17/77).
Conclusion: Even in highly screened samples of GD young people outcome pathways follow a diverse range of possibilities.
Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service
Kasia Kozlowska, Georgia McClure, Catherine Chudleigh, Ann M Maguire, Danielle Gessler
Stephen Scher, Geoffrey R Ambler (7 authors)
Same sample of 79 young people.
Same mental health profile as reported in other paediatric clinics providing gender services: --high levels of distress (including dysphoria about gender), suicidal ideation (41.8%), self-harm (16.3%), and suicide attempts (10.1%);
-high frequency of mental health conditions: anxiety (63%), depression (62%), behavioural disorders (35%), and autism (14%).
-high rates of adverse childhood experiences, with family conflict (66%), parental mental illness (63%), loss of important figures via separation (60%), and bullying (54%), history of maltreatment (39%).
Key challenges faced by the clinicians:
-increasingly dominant, polarized discourses on daily clinical practice
-patient and clinician safety (including pressures to abandon the holistic model);
-difficulties of untangling gender dysphoria from comorbid factors such as anxiety, depression, and sexual abuse
-factual uncertainties regarding longitudinal outcomes of GAT.
Recommendation: a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria, addressing unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.
Instead of a rational discussion of the ubiquitous comorbid presentations and adverse events in the lives of young people presenting to gender clinics, we saw on Four Corners the rebuttal of this careful and important work overturned by a 14-year-old declaring that his GD could never be fixed by going to therapy.
3. The failure to point out any of the adverse consequences to young people of taking puberty blockade and cross sex hormones
Adverse effects of puberty blockade
Potential long-term effects on
- future fertility
- bone growth and density, and growth spurts
- weight gain
- hot flushes
- pseudotumor cerebri, or high-pressure build-up in the brain that can cause progressive and permanent loss of vision if unaddressed.
- brain development and by implication, cognitive development
- long term use places the child into a permanent state of childhood
Deleterious effects of testosterone on women
- Suppression of menses (within two to three cycles from commencement of testosterone) due to the gonadotropin production and ovarian function are suppressed.
- Permanent infertility – ovarian and uterine atrophy
- Clitoral discomfort and vaginal atrophy (atrophic vaginitis)
- Increase in clitoral size (after 3-4 months of use) – but not sufficient to allow penetrative sexual intercourse
- Increase in ovarian stromal tissue and cyst formation identical to changes seen in polycystic ovarian syndrome
- Pelvic pain
- Polycythemia (too many red blood cells)
- Increase cardiac risk (dyslipidemia) and stroke
- Redistribution of body fat, increased muscle definition, decreased waist-to-hip ratio
- Weight gain
- Coarsening of skin texture
- Acne/oilier skin
- Abnormal levels of cholesterol and other lipids – decrease in HDL and increase in LDL
- Hypertension (high blood pressure)
- Type 2 diabetes/decrease body’s sensitivity to insulin
- Deep vein thrombosis/pulmonary embolism/venous thromboembolism
- Higher risk of oestrogen-dependent cancers (endometrial, breast, ovarian, uterine cancer)
- Irreversible lowering of voice pitch
- Male pattern facial and body hair
- Male pattern baldness (temporal thinning and crown hair loss)
- Increased irritability, frustration, and anger
- Mood swings
Adverse effects of Oestrogen on Males
- A blood clot in a deep vein (deep vein thrombosis) or in a lung (pulmonary embolism)
- High triglycerides, a type of fat (lipid) in your blood
- Weight gain
- High potassium (hyperkalemia)
- High blood pressure (hypertension)
- Type 2 diabetes
- Cardiovascular disease
- Excessive prolactin in your blood (hyperprolactinemia)
- Nipple discharge
- Increased risk of breast cancer compared to cisgender men
- Poorer mental health outcomes, including higher suicide rates
So adverse are some of the outcomes of GAT and so unhappy are some of its recipients that a major medical insurer, the Medical Defence Association (MDA) has advised its members has informed all insured private medical practitioners that it:
… view of the high risk of claims arising from irreversible treatments provided to those who medically and surgically transition as children and adolescents, MDA National is restricting cover for practitioners in private practice. From 1 July 2023, MDA National excludes cover for claims against medical practitioners that involve (i) assessment that a patient under the age of 18 years is suitable for gender transition; and (ii) initiating prescribing of gender affirming hormones for any patient under the age of 18 years.
They stated: We consider it appropriate that the assessment and initial prescribing for patients transitioning under the age of 18 years occurs with the support and management of a multi-disciplinary team, in a hospital setting.
This is one of the first significant systemic gestures of caution in Australia regarding the GA treatment of young people under 18 years.
4. The shameful declaration that suicide is likely to follow a failure to provide gender affirming interventions to young people
This is perhaps the biggest flaw and the most damaging mistruth transmitted by the program. It is likely to cause panic and confusion among parents dealing with children in this situation. It is difficult to believe that Karvelas and her team were not aware of the information I am about to tell you.
From 2010 to 2020, at UK Gender Identity Development Service (GIDS), four patients were known or suspected to have died by suicide, out of about 15,000 patients attending and also including those on the waiting list.
The Royal Children’s Hospital in Melbourne conducted their own 10-year audit of their clinic patients and found no suicides.
Further, RCH standards of transgender care warn that withholding treatment is not “a neutral option” and doing so may increase suicide risk. These are scandalous mistruths. Puberty blockade has been shown repeatedly to convey no benefit in reducing suicide (Biggs, 2022).
Despite this, the donation-seeking foundation of RCH use suicide risk statistics to attract sympathy and money. The foundation website states:
“Australian data shows 48% of transgender young people attempt suicide before the age of 24.”
For Four Corners to give centre stage to the tragic death of a young person with the message that failure to provide gender affirming care was the one and only cause of this suicide is unconscionable and risks causing fear among parents and to amplify copycat suicides among gender dysphoric young people.
This segment of the program is likely to be in violation of the standards of reporting required of responsible journalism. There is the misguided focus on suicide that breaches clause 7.6 (content which may lead to dangerous imitation) of the ABC code of practice as well as clause 2 (accuracy).3 To quote, unquestioned, an inexperienced intern psychologist who stated that failure to provide GAT leads to higher suicide risk is irresponsible and misleading. This intern was given more air time than experts. She conveyed no meaningful message at the expense of time that could have been devoted to the true suicide statistics and alternative models of care.
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