Response to recent media reporting in The Australian newspaper regarding health care for transgender children and adolescents:
The Australian Professional Association for Trans Health (AusPATH) was established in 2009 and is Australia’s peak body for professionals involved in the health, rights and well-being of trans, including gender diverse and non-binary (TGDNB) people. The AusPATH membership comprises approximately 250 experienced professionals working across Australia. Our organisation is concerned that the recent reporting in The Australian newspaper regarding health care provided to TGDNB children and adolescents is biased, emotive and is not based on fact. The reporting ignores available scientific evidence which strongly endorses supporting TGDNB children through social and medical transition to improve their mental health outcomes.
A study of the mental health of TGDNB young people living in Australia (Trans Pathways 2017) found very high rates of ever being diagnosed with depression (75%), anxiety (72%) and self-harm (80%), with 48% of these young people under the age of 24 years ever attempting suicide. It is well recognised that these poor mental health outcomes are not inherent to being TGDNB but are due to these individuals experiencing high levels of stigma, discrimination, social exclusion, family rejection, bullying, harassment and assaults.
The evidence for an affirmative model of care has been publicly scrutinised in Australia through both academic and legal processes at the highest level and is currently standard clinical practice not only in Australia but in New Zealand, USA, Europe and across many other countries and regions across the globe.
1. Academic scrutiny of the evidence for social and medical intervention in TGDNB young people
In 2017, AusPATH endorsed the Australian Standards of Care and Treatment Guidelines for Transgender and Gender Diverse Children and Adolescents. This guideline is a collaboration of approximately 50 clinicians and researchers across Australia and NZ and is based on empirical scientific evidence and expert clinical consensus. This was peer-reviewed and published in the Medical Journal of Australia in June 2018. Later that month it was again reviewed and endorsed through an editorial in The Lancet, which stated that;
“children and adolescents with gender dysphoria often experience stigma, bullying, and abuse, resulting in high rates of mental illness, including depression, anxiety, and self-harm. But with supportive, gender-affirming management, as laid out by the Australian guidelines, these consequences can be minimised.”
2. Legal scrutiny of the evidence for medical and surgical intervention in TGDNB young people
The Full Bench of the Family Court of Australia has twice reviewed the academic and clinical evidence for medical intervention in TGDNB adolescents through Re Jamie (2013) and Re Kelvin (2017). In Re Kelvin, evidence was submitted to the Full Bench of the Family Court from clinicians supporting the care for TGDNB children and adolescents as well as from those who oppose medical intervention. Overwhelmingly, the scientific evidence submitted to the Court and taken into evidence demonstrated that medical intervention not only improves mental health outcomes, but saves lives by reducing suicide. The Full Court decision removed the legal process from medical decisions to assist with improved access to affirming care, thereby improving mental health outcomes.
The Royal Commission into Victorian Mental Health Services undertaken in July 2019 also heard expert evidence through cross examination and written submissions from current AusPATH members. It is clear that the facts related to the gender-affirming care of TGDNB people have had ample opportunity for public scrutiny.
Whilst the evidence for affirming practice demonstrates improvements in mental health outcomes, there is also extensive evidence that psychological practices, such as conversion or reparative therapies which deny social and medical interventions, lack efficacy, are considered unethical and cause significant harm to the health and well-being of TGDNB people, and their families.
For those who work clinically with TGDNB children and adolescents, we see the benefits supportive care can provide. We also see the harm that inaccurate and biased reporting in the media can have on these young people and their families. Ignoring the facts in the reporting on this issue is irresponsible and, most importantly, not in the best interest of these young people due to the significant harm it causes.
Board of Directors, The Australian Professional Association for Trans Health (AusPATH)
Associate Professor Michelle Telfer, Paediatrician and Adolescent Medicine Physician
Dr Jaco Erasmus, Psychiatrist
Dr Belinda Chaplin, University Lecturer in Nursing
Mr Andrew Ives, Plastic Surgeon
Dr Fiona Bisshop, General Practitioner
Mr Rainer Jardin, Clinical Psychologist