Informative and practical steps for medical practitioners

The Australian Doctors Federation has issued a stern warning about affirmation pathways in Australia. The organisation was established to protect the independence of the doctor-patient relationship. The warning was issued to stop unnecessary harm on both sides. 

The following facts were listed as considerations for doctors dealing with gender confused children.

• • The 4-year UK NHS Cass review found no clear evidence base for gender affirmation interventions, i.e. puberty blockers and cross-sex hormones.

• • There are proven medical harms from these interventions including sterility, sexual dysfunction, osteoporosis, mood disorders, cognitive impairment, cardiovascular disease, meningioma, and blood clots. The effects of more than brief use of puberty blockers and cross-sex hormones and any surgery are not fully reversible.

• • Increasing numbers of countries—particularly the UK, the Nordic nations and the USA—as well as Queensland, are now restricting use of puberty blockers, cross-sex hormones and surgery for minors.

• • Australian treatment guidelines reviewed by the Cass investigators scored 19/100 for rigour of development and were judged “untrustworthy” by Prof Gordon Guyatt a pioneer of evidence-based medicine.

• • Both the Cass review and the National Association of Practising Psychiatrists (Australia) recommend individualised psychosocial support as first line treatment for young people with gender dysphoria.

The federation highlighted the fact Australian guidelines are not in line with international guidelines and the risk of lawsuits are increasing. They also noted one insurance company has already withdrawn from the gender space for this reason. Additionally, they issued sound advice for doctors on how to navigate gender confusion.

To protect yourself we would advise that for children and adolescents up to 18 years of age you:

• • not prescribe puberty blockers and cross sex hormones;

• • not refer for gender surgery;

• • not refer to gender clinics as they offer treatment that is not evidence-based and causes bodily harm; and

• • not refer patients on for private gender affirmative psychological treatment that will cement a child’s likely transient identity.

Standard psychological therapies do not constitute conversion and are allowed under state legislation. Children and adolescents with gender confusion may benefit from referral to a therapist who will provide holistic care with psychological therapies under the precautionary principle of “first do no harm”.

This is a great resource to share with your own GP and medical practitioners. Children should never be subjected to experimental pathways or drugs being used off label. 

Australian politicians refuse to heed the warnings from overseas and they have all but criminalised medical practices that oppose or ignore the harmful Australian guidelines.

It is time for medical experts to intervene for the sake and well being of our nation's youth.