May 5th 2018

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Articles from this issue:

COVER STORY HECS: hastening our demographic winter

EDITORIAL Liddell is the 'fly in the ointment' of the NEG

AFRICAN AFFAIRS African Continental Free Trade Area ... in the spirit of GATT

CANBERRA OBSERVED Bernardi foray looks to be fading out of view

ENVIRONMENT Is a prolonged freeze on the way for the earth?

MEDICINE NaProTechnology: an ethical alternative in reproductive health

MEDICAL ETHICS Grounds for objection: a declaration on freedom of conscience

OPINION What a republic would really mean for Australia

LAW AND FREEDOM 'Rule of law' does not support exemptions: a reply to Robin Speed

INTERNATIONAL AFFAIRS Saudi Crown Prince challenges Wahhabists

HIGHER EDUCATION Undoing the dis-education of Millennials

GENDER POLITICS Why are patients being denied freedom of choice?

ASIAN HISTORY Jinmen: the forgotten crisis that brought the world to the brink


MUSIC Grammy salute to Elton John: Revealing revisit to the 1970s

CINEMA The Isle of Dogs: Man's best friend in exile

BOOK REVIEW Australia, we need to talk about China

BOOK REVIEW Novelised life a vivid drama of survival



NATIONAL AFFAIRS Committal hearing dismisses main charges against Cardinal Pell

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Why are patients being denied freedom of choice?

by Terri M. Kelleher

News Weekly, May 5, 2018

People should have freedom of choice in the counselling or medical advice or treatment they seek. In relation to same-sex attraction or gender identity or gender transitioning, as with any other medical or health issues, all options should be open to them, including counselling out of same-sex attraction or gender transitioning if they so choose. Decisions around medical treatment should be patient centred.

Federal Labor policy is to “amend laws to deal with any psychological treatments to discourage gender questioning,” saying “[c]urrent laws regulating false and misleading conduct in trade or commerce, or professional misconduct in the health professions, are inadequate to deal with perpetrators who can evade health regulation by not being registered, and evade consumer protection laws by claiming to be conducting religious activities.”

Labor policy is that “conversion therapies” to “cure” gender questioning young people is to be regarded as “serious psychological abuse” and that “harms” suffered by such children in families will be treated “as domestic violence against the child”.

The Victorian Labor Government’s Health Complaints Act effectively rules out the option of exploring counselling out of same-sex attraction or counselling towards being comfortable with one’s birth sex rather than gender transitioning. Medical and health professionals and counsellors at present cannot offer such options without risk of complaint merely for doing so.

Recently Victorian Leader of the Opposition Matthew Guy is reported to have said “there was 'absolutely no chance' he would support or allow any form of gay conversion therapy". Why should counselling out of same-sex attraction not be allowed for a person who requests it? It is not about forcing 'gay conversion therapy' or denying gender transitioning to anyone. Rather it is about patients being denied the freedom to explore all options, including counselling out of same-sex attraction or to being comfortable with their birth sex, if they so choose.

There are good reasons for exploring all the options in relation to these complex issues.

In relation to counselling away from same-sex attraction, sexual orientation is very fluid for a particular group of people. Around three-quarters of those who identify as gay or lesbian in their mid 20s identify as heterosexual by their mid 50s, according to three surveys by Morgan Research of 180,000 Australians between 2006 and 2014. These people should have a right to seek counselling as they see fit.

In relation to gender transitioning, it is not possible to identify with any certainty which children will continue as transsexual beyond puberty and which will not. The desistance rates for children with gender dysphoria who do not transition are very high. Therefore caution in moving towards gender transitioning for these children is advised and all options for treatment should be explored.

A study by Korte et al., “Gender Identity Disorders in Childhood and Adolescence”, found: “Gender identity disorders of childhood (ICD-10 F64.2, DSM-IV 302.6) are only rarely the initial manifestation of a transsexual development (in 2.5 per cent to 20 per cent of cases).” That is, 80 to 97.5 per cent of children presenting with gender dysphoria do not go on to be transsexual in adulthood.

Even social transitioning (such as dressing as and using the toilets of the gender identified as) is advised against. It leads almost inevitably to medical transitioning: A 2011 study by Steensma et al. concluded: “Parents and caregivers should fully realise the unpredictability of their child’s psychosexual outcome. They may help the child to handle their gender variance in a supportive way, but without taking social steps long before puberty, which are hard to reverse.”

The American Endocrine Society, which actively promotes puberty blockers and cross-sex hormones for pubescent children, counselled against social transition in its practice guidelines: “Given the high rate of remission of Gender Identity Disorder after the onset of puberty, we recommend against a complete social role change and hormone treatment in prepubertal children with GID.”

Then there are the dangers of puberty blockers and cross-sex hormones. A report by Hruz et al. in the Spring 2017 edition of The New Atlantis cited a Dutch study that found that puberty suppression “has a significant negative effect on the height growth rates of both male-to-female and female-to-male patients”. And that “the development of normal bone-mineral density is another concern for children and adolescents treated with puberty-suppressing hormones”.

Hruz et al. point out that, in the United States, the treatment of gender dysphoria is not yet an FDA-approved use for GnRH analogue drugs. “This means that puberty suppression relies on the ‘off-label’ prescription of GnRH analogue treatments; doctors are permitted to use these drugs in treating children with gender dysphoria, but the lack of FDA approval means that pharmaceutical companies selling the drugs cannot market them for treating gender dysphoria. Off-label status reflects that the use has not been proven in clinical trials to be safe and effective.”

Hruz et al. also found that the claim that puberty-blocking treatments are fully reversible makes them appear less drastic, but this claim is not supported by scientific evidence.

Big unknowns

It remains unknown whether or not ordinary sex-typical puberty will resume following the suppression of puberty in patients with gender dysphoria. It is also unclear whether children would be able to develop normal reproductive functions if they were to withdraw from puberty suppression.

It likewise remains unclear whether bone and muscle development will proceed normally for these children if they resume puberty as their biological sex. Furthermore, we do not fully understand the psychological consequences of using puberty suppression to treat young people with gender dysphoria.

The extent of “transitioning regret” should also be of concern. A detransitioned woman recently conducted a survey of detransitioners, Female detransition and re-identification. Though it was only open for two weeks, more than 200 women completed it. Clearly, there are more than just a handful of people who are coming to re-identify as female.

The survey results are compelling:

• 92.5 per cent of those who responded said that their dysphoria was the same or better after detransitioning than during transition.

• Only 8 per cent of respondents felt somewhat or completely positive towards their own transition, whereas 60.2 per cent felt somewhat or completely negative towards it.

Then there is the research that shows significantly higher suicide rates after gender reassignment surgery. A 2011 Swedish study at the Karolinska Institute, a long-term study – up to 30 years – followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the patients began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable non-transgender population.

The main author of the study, Cecilia Dhejne, said that trans people as a group experience significant social oppression in the form of bullying, abuse, rape and hate crimes. Medical transition alone won’t resolve the effects of crushing social oppression: social anxiety, depression and posttraumatic stress. But Sweden is one of the most LGBT tolerant societies, the culture is strongly supportive of transgender people – and all the subjects of the study were from Sweden.

Any patient who wishes to seek assistance from medical or health professionals or counsellors in relation to same-sex attraction or gender identity issues or gender transitioning should be able to access such help and explore all options, including counselling out of same-sex attraction or out of gender transitioning. Medical professionals should not be at risk of complaint and professional discipline, possibly de-registration, for offering counselling out of same-sex attraction or gender transitioning for a patient who requests it. Adequate laws and systems should be put in place to ensure that parents and young people are all given full information about the psychological harms of social, medical and surgical gender transitioning.

The Victorian Health Complaints Act should be amended to ensure that medical and health practitioners and counsellors explore all options when they have patients who request counselling out of same-sex attraction or gender transitioning without risk of complaint and possible de-registration.

As with all other medical decisions, decisions around counselling in relation to same-sex attraction or gender transitioning should be patient centred and the law should not close off options that would otherwise be open to the patient should he or she so choose.

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April 4, 2018, 6:45 pm