Why medical care for trans kids is so controversial

Melissa Clarke: Hi, I’m Melissa Clarke coming to you from Gadigal land. This is ABC News Daily. Music The waiting lists for care for transgender children in Australia are growing. At the same time, public debate over medical intervention is becoming increasingly toxic. Today, ABC’s Patricia Karvelason the battle over the bodies of trans kids and whether Australia’s approach is the right one. Music PK, you’ve been speaking to lots of kids and their families about gender dysphoria. Can you explain to me what gender dysphoria is?

Patricia Karvelas: Yeah, well, look, gender dysphoria, and that’s not a new concept, it refers to the psychological distress experienced by those whose gender identity, the way they understand their gender, doesn’t match the sex they were assigned at birth.

Melissa Clarke: So, we know that increasingly this seems to be something that more young people are experiencing or identifying with or able to recognize symptoms of it, but what is life like for kids who are experiencing gender dysphoria?

Patricia Karvelas: Hard. I did meet a couple of young people going through the process of getting officially diagnosed with gender dysphoria and the medical intervention process that they can follow. One of the kids I met was a lovely trans girl called Brock.

Brock Wilcocks: I’m Brock Wilcocks. I’m a 14-year-old trans girl and I live in the western part of Sydney.

Patricia Karvelas: She has been officially diagnosed with gender dysphoria. A psychiatrist did that. First, she thought she was perhaps gay because she didn’t have the language for what it is to be transgender.

Brock Wilcocks: I started realizing that I was different mainly in primary school.

Patricia Karvelas: But then she realized that it was a much more profound feeling, which was very different from just sexuality, and that she felt like she was a girl.

Brock Wilcocks: I always, like, imagined myself, like, having long hair and putting on make-up and, like, wearing dresses and I would always be like, oh, I wish I was a girl. But I would be disappointed to find out, oh, you’re a boy, you have to stay like this.

Patricia Karvelas: Brock’s mum Renee noticed she was drawn to things typically associated with girls, although let’s not just stick to sexist stereotypes. Girls can do lots of things and I think that’s important. But Brock’s mum always noticed that Brock was different.

Renee Wilcocks: In preschool, I’d come and pick her up and she’d be a princess dressed up and pushing a pram and wearing the fake high heels. Then

Patricia Karvelas: Brock started changing. Wasn’t bubbly, wasn’t outgoing anymore at the end of primary school, and started seeming quite depressed.

Brock Wilcocks: I tried going to therapy to try and explain this and try to be like, why do I feel like this?

Patricia Karvelas: So Brock’s mum sought help eventually after Brock came out to her as transgender and that was a really brave moment. Then was referred to Maple Leaf House in Newcastle where she started receiving gender-affirming care.

Melissa Clarke: Okay, and PK, we hear this term a lot but what exactly is gender-affirming care?

Patricia Karvelas: Yeah, look, I think it’s misunderstood, to be honest in my exploration of what it is. It’s about meeting the person where they are. Before you even get a medical diagnosis of gender dysphoria, it involves psychiatrists and psychologists figuring out if that’s what’s going on. If they are then diagnosed with gender dysphoria, it can lead to gender-affirming medical intervention and that’s contentious. Now in Brock’s case, she was prescribed puberty blockers. They essentially stop you from developing the hormones of the sex you were assigned at birth. But puberty blockers have become quite contentious around the world. They have side effects. They can include reduced bone density. Now Brock’s mum Renee was informed about these risks and said that she decided with her child Brock that this was the right decision for Brock.

Renee Wilcocks: Obviously, you wouldn’t want to rush into treatment when you’re just finding out that your child is transgender. For us, it made sense. The fact that Brock had been going to a psychologist for quite a while was reassuring to know that it’s not a phase so to speak.

Melissa Clarke: So PK, the debate both here and overseas has been pretty polarised. That’s a fair characterization.

Patricia Karvelas: Oh yeah, I think it’s a good way to describe it. Look, it’s incredibly polarised and I think it’s a really important discussion to have. There are some genuinely good and important questions here about medical intervention, its risks, and its benefits. All of that needs to be discussed, I think, really thoroughly. But if you look at the political dimensions of this, it has become a culture war. In the United States, for instance, at least 20 states are moving to ban or restrict gender-affirming care for young people. In the UK, the NHS has restricted puberty blockers to children saying there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment. To be clear, that doesn’t mean they won’t be available. You’ll just have to be part of a clinical evaluation or research to be part of it.

Melissa Clarke: And in Australia, what about here?

Patricia Karvelas: Well, good question, because Australia is where our story is. Now in Australia, it has put more pressure, I believe, on Australian gender clinics to show that the treatments that they are offering are evidence-based. And that is a reasonable question to ask. I spoke to Dr. Stephen Stathis from the Gender Service at Queensland Children’s Hospital. Last year, for instance, they had more than 900 active patients. He said that most research into this kind of treatment, gender-affirming care, is fresh. He said in the last decade, most of this has come out. And his clinic, he says, is constantly adapting to new recommendations as they happen.

Dr. Stephen Stathis: It doesn’t mean that we are locked into treating a young person with puberty blockers or hormones. It doesn’t mean that we are stuck in some ideology. What it does mean is that we’re curious and we’re keen to explore the reasons why they’ve presented.

Melissa Clarke: Now, Dr. Stathis’ clinic has stood down a senior psychiatrist earlier this year following a complaint from a young transgender patient. Can you run me through what happened in that circumstance?

Patricia Karvelas: Look, what we know is what’s already on the public record, which is that there has been a complaint and that it’s being investigated. It is a complaint that the doctor, Dr. Gillian Spencer, is contesting. But she was stood down because of this incident. But actually, something else too. She’s also been accused by the hospital of breaking their code of conduct as a public servant because she attended and spoke at two rallies, one in Canberra and one in Brisbane. She did stand up and spoke out against gender-affirming care.

Dr. Jillian Spencer: There are massive health risks from these experimental medications and surgeries. We must speak out about the harm we see being done.

Melissa Clarke: OK, so it’s clear Dr. Spencer has concerns about the approach of Dr. Stathis’ clinic. And we know she’s complained to the Queensland Human Rights Commission saying doctors like her should have the right to object to the affirmation model for children. So what’s the approach that she thinks the clinic should be taking in these situations?

Patricia Karvelas: Yeah, well, look, Dr. Spencer prefers the approach she describes as watchful waiting. She thinks that the current approach embraced not only by the hospital where she works but also across our country, is harmful.

Dr. Jillian Spencer: Watchful waiting is a medical term to describe taking time to see if a problem resolves before intervening. That would involve engaging with them, treating mental health comorbidities, engaging them in therapy, and trying to get them connected to peers and activities that help them to feel good about who they are. I think the vast majority of child and adolescent psychiatrists have serious concerns about the affirmation model.

Patricia Karvelas: I spoke to Professor Ian Hickie. He’s well-known in the mental health space. He says that there is no evidence that simple psychological therapy alone is a legitimate alternative to what’s being offered through most of the specialist clinics in Australia.

Professor Ian Hickie: Expiratory psychological therapies, family therapies instead, and watchful waiting is not evidence-based. They are the sets of intrinsic beliefs of different professional groups.

Patricia Karvelas: He does say that watchful waiting carries risks for young people because some of them are in incredible distress, Mel. They are really, and some of them are at risk.

Melissa Clarke: When it comes to gender-affirming care, there are often concerns raised that it’s not reversible or that it might lead to decisions, medical decisions being made that lock people into a decision that can’t be changed. And how can we do that with young people? I know in your investigations, you’ve spoken to someone who has been through a gender transition and who has regretted it. Can you tell me about this case?

Patricia Karvelas: Yeah, so you are right. Detransitioners, as is the sort of language used, have become a really big part of this discussion. And I think an important part of this discussion because you need to hear everyone’s stories. They have, though, been weaponized by people who are against affirming care to really, really talk up the risks of medical transition. Now, they are still a small proportion of the people who transition. We spoke to Courtney Coulson. She transitioned to become a trans man in her early 20s. I think it’s important because our story is really about young people. She did decide as a young adult, not as a child. She says she had a lot of issues going on. And she says that she decided that life would be easier as a man, that she’d always been interested in gender play and wanted to become a man.

Courtney Coulson: I think you can be pushed so far into a belief that these things start to become real. I just went right through the trans production line there and I stayed living as a man for five years.

Patricia Karvelas: She said she found it too easy to get diagnosed with gender dysphoria, and too easy to get testosterone.

Courtney Coulson: Whatever I was going through when I wanted to transition, I seemed to have outgrown it, gotten over it. Before you commit to this thing for the rest of your life, don’t you want to see every perspective? I should have been able to do that and I didn’t.

Melissa Clarke: PK, you came to this story wanting to know if medical interventions and the battleground that’s become, whether that process is the right one. What conclusion did you come to? Is Australia getting the approach right?

Patricia Karvelas: Look, I don’t see myself as the ultimate judge on whether this should continue or not continue. Do I think there should be a mass closure of our gender clinics? I don’t think the case has been made for a mass closure, but I think what has been established is that we need research, research, research. We need funding and we need to support young people as much as we can. Stigmatizing them doesn’t help. Stigmatizing their families doesn’t help. And having ugly, ugly debates where they are kicked around rather than centered in the storytelling is a really dangerous way to go. What I found was that for young people who are desperate for assistance, people like Brock, this is helping them right now.

Brock Wilcocks: I didn’t choose to be born in this body and then want to be born in another. Like I didn’t wake up one day and be like, yeah, I’m trans. It was years of dysphoria, and self-hate, that it took me to find out you’re not in the right body.

Melissa Clarke: Patricia Karvelas reported this story for Four Corners. You can catch her full report on iView. This episode was produced by Veronica Apap, Flint Duxfield, and Sam Dunn, who also did the mix. The supervising producer is David Coady. I’m Melissa Clarke. ABC News Daily will be back again tomorrow. You can find all of our episodes of the podcast on the ABC Listen app. Thanks for listening.