Making gender guinea pigs of children John Whitehall
“It is important to look more closely at the effects of ‘puberty blockers’ and cross-sex hormones because their use is fundamental to medical intervention in childhood gender dysphoria. Proponents maintain they are ‘safe and entirely reversible’ when they are nothing of the kind.
The Labor government of Victoria is in the process of drafting legislation to ban so-called “conversion therapy”, which it defines as “any practice or treatment that seeks to change, suppress or eliminate an individual’s sexual orientation or gender identity”.
On the face of it, this would appear to be a good thing, given the effect of the so-called “Safe Schools” program, and other initiatives, which, under the camouflage of anti-bullying, have planted seeds of primordial confusion in the minds of many children with their doctrine of gender fluidity, which preaches there is no such binary entity as a boy or a girl. The ideology asserts that everyone is somewhere on the intervening rainbow, depending on their feelings at the time.
The Victorian government could have been applauded had it decided its Education Department was no longer permitted to promote the ideology that has caused hundreds of Victorian children to be submitted to attempts by members of the Health Department to eliminate gender identity determined by chromosomes, and to change bodies to suit mental orientations.
But no: the Andrews government has no intention of stopping the evangelism and practices of the new ideology. To the contrary, with Orwellian Newspeak, it intends to ban any attempt to “convert” or re-orientate a confused child back to a gender identity congruent with its chromosomes.
Failure to comply with the ban will be punished by criminal or civil law, or both, whether committed by omission or commission. Omission will comprise failure of a therapist or teacher to refer a confused child to the Gender Service at the Royal Children’s Hospital in Melbourne where it may undergo “affirmation” of a new gender by means of hormones and surgery. Commission comprises attempts to “make the child comfortable in the skin in which it was born” by means of family and individual psychotherapy: the former mode of therapy that was associated with success, but is now derided as “abhorrent”, and is to be banned as “conversion therapy”.
The first step to the banning of “conversion therapy” in Victoria is found in the Health Complaints Act 2017, whose provisions, according to former Victorian Health Minister, now Attorney-General, Jill Hennessy, will “provide the means to deal with those who profit from the abhorrent practice of gay conversion therapy … which inflicts significant emotional trauma and damages the mental health of young members of our community”.1 Moreover, according to Ms Hennessy, the crime of conversion therapy is so grave it demands “reverse onus” in which “the accused is required to prove matters to establish, or raise evidence to suggest, that he or she is not guilty of an offence”.
The second step was the release in October 2018 of a report titled Preventing Harm, Promoting Justice: Responding to LGBT conversion therapy in Australia2 which was prepared by the Victorian Human Rights Law Centre and the Australian Research Centre in Sex, Health and Society at La Trobe University, with contributions from the Commissioners for Gender and Sexuality, Health Complaints, and Mental Health, and members of the Labor government’s LGBTI task force.3 The Research Centre at La Trobe was largely responsible for the Safe Schools program.
The report called for the Health Complaints Act to be strengthened and to become instructive for the rest of Australia: to consider “legislative and regulatory options to restrict the promotion and provision of conversion therapies and similar practices, including by faith communities and organisations and both registered and unregistered health practitioners”4. It calls for legislation “that categorically outlaws” conversion therapy; “that unequivocally prohibits [it] whether or not an individual complaint is made” and declares the need for “a legislator to intervene to protect children from conversion practices regardless of the setting or level of formality”.
The report demands that therapists of gender-confused children undergo specific accreditation earned by special education that emphasises that attempts to convert a confused child back to a gender identity congruent with chromosomes are “not consistent with their professional obligations” and will invite “disciplinary actions”. Schools must have similar accreditation. Infraction invites de-funding.
The report demands that “public broadcasts” promoting “conversion therapy” also be banned. Given, therefore, this article argues against hormonal and surgical intervention in favour of traditional psychotherapy, it may be the last of its kind in Victoria!
The report coloured its arguments with declarations from fifteen respondents recruited from “various LGBTI, queer and ex-gay survival” and other networks, concluding it had found “overwhelming evidence” of harm from “conversion therapy” practised as “spiritual healing” in various religious institutions. The respondents were aged from eighteen to fifty-nine, nine identified as male and gay, two as transgender, one as female and bisexual, and one as non-binary. Thirteen were from Christian backgrounds, one Jewish and one Buddhist.
Therapy had included individual and group counselling, with theological discussion and prayer, but had failed to influence sexual orientation of the respondents. Worse, it was claimed to have increased misery through intensification of contradictions with traditional theological beliefs. Thus, conversion therapy is futile, harmful, deserves to be banned, and churches, especially Christian Protestant ones, should embrace differing sexual behaviours. Large graphics of crucifixes throughout the report maintain the focus on Christianity.
The story of one of the fifteen, Jamie, requires special attention because, frankly, it beggars belief that such sexual torture could have occurred and not been revealed in these days of publicity of abuse within the church and psychiatric institutions. Abuses in the church are daily fare in the media, and the travesties of “deep sleep” therapy in Chelmsford, and anarchy in Ward 10B in Townsville, must remain known in psychiatric circles: surely someone, somewhere, would have blown a whistle over Jamie.
Jamie’s saga began when she was seventeen, in the late 1980s, after telling her parents she had “fallen in love with a Christian woman”. In response, she was awakened one night and taken to a psychiatric institution where, for over two weeks, she was forced to “sit in a bath full of ice cubes while Bible verses were read over her, to being handcuffed to her bed at night and deprived of sleep, to being interrogated and baited by a man in a dog collar” and to then having been “restrained … having an electrode attached to my labia, and images projected onto the ceiling; a lot of pain from the electrodes and being left there for quite a long time afterwards; exposed and alone”.
The La Trobe report rightly condemns this story and needlessly refers to international obligations against torture. But where is the evidence that the story is true? If it is true, the perpetrators should be in jail. If it is sincerely believed by Jamie, but untrue (as in the “repressed memory” debacle of psychiatry), she needs help. If the Andrews government is not concerned about its truth, the people of Victoria need help because it is part of the argument for major legislative change.
Apart from promoting a story of dubious veracity, there are other weaknesses in the La Trobe report. Given that the Australian Human Rights Commission declares 11 per cent of Australians to be “Lesbian, Gay, Bisexual, Trans and Intersex people”,5 fifteen complainants is not a convincing number, especially in the absence of a denominator: how many people have been helped with unwanted sexual preoccupations by means of “spiritual” counselling? How game would they have to be to go public? Do they and their therapists not have the human right to continue with such therapy if they both agree?
Also, self-selection from the established LGBTI community is not representative. Ironically, a review of experiences of American mothers of teenage daughters with Rapid Onset Gender Dysphoria,6 which concluded they were suffering from a “social contagion” and not a biological disorder, was derided by gender activists, disowned by a university and pulled from a website for its “unscientific” recruitment from social media sites. Yet, based on similar methodology, the La Trobe study is fundamental to major legislative change by the Labor Party.
Lastly, the study extrapolates from adults to children, and from homosexuality to transgendering. It ignores the widely reported assurance that, as they grow, almost all gender-confused children will re-orientate to an identity that accords with their natal sex without the help of hormones and surgery, but with the help of the compassionate counselling Labor is intent on banning.
The next step towards the ban occurred in November 2018 when the Victorian government referred the La Trobe report to the Health Care Complaints Commissioner (HCCC) who quickly concurred with the need for “legislation that clearly and unequivocally denounces conversion practices and prohibits conversion practices from occurring in Victoria”. In February 2019, the Andrews government publicly responded to the La Trobe study and the HCCC report with the announcement that “it will bring in laws to denounce and prohibit LGBTI conversion practices”.
Finally, in October 2019, the Andrews government released a discussion paper titled “Legislative Options to implement a ban of conversion practices” in order “to seek the community’s views on the best way/s to implement a ban of conversion practices”. The discussion paper is not interested in discussion as to whether conversion therapy should be banned: it merely seeks affirmation over something it has already decided to do. Most likely it seeks replies, such as Jamie’s, which can be used for publicity purposes.
The discussion paper wonders if the public would like to banish conversion therapy by criminal or civil law, or both. It suggests criminalisation would “send a clear message about the unacceptability of such behaviour” but warns “criminal offences are investigated by police, [and] this approach is not as reliant as some civil schemes on individuals coming forward with complaints”. Citizens are invited to tick their reply in a drop-down box.
In similar boxes, citizens are asked, “Who do you think should be banned from providing conversion practices? Specific professionals or persons? Or everyone who offers conversion practices?” Don’t waste words, just tick the box.
And they are asked, “Who do you think should be protected [from conversion therapy]? Should protection be limited to children and people experiencing vulnerability? Should protection be available to all members of the community?”
Ominously, citizens are asked, “In what ways do you think the issue of consent is relevant to determining who should be protected?” This little question has major importance that might as yet be unappreciated: it concerns the power of the Orwellian state to over-ride parental objections to the transgendering of children.
In November 2019, the Gender Service at the Melbourne Children’s Hospital published the protocol of a study, named Trans20, which it has been undertaking since February 2017 on “the health outcomes of trans and gender diverse young people”. The study will conclude in February 2020, by which date it expects to have enrolled a massive 600 children.
Why was the study initiated? Because, according to its authors, “specific healthcare for TGD [transgender and gender diverse] children and adolescents—including the use of medical interventions—is relatively new, having commenced only in the past two decades. Consequently, there is a need for more empirical data to inform best practice in important areas such as risk and protective factors and the long-term safety and outcomes of medical interventions.” The authors say “stronger evidence is required” regarding “the natural history of gender diversity” because “not all gender diverse children develop a transgender identity” with literature reporting that “45%–88% of children with gender concerns in childhood go on to identify with their birth-assigned sex in adolescence and adulthood … indicating that only some of these children report a transgender identity when older”.
The Gender Service had revealed details of its regime of medical intervention in guidelines published in 2018, but summarised its stages in the study. First, children are welcomed into the process of “affirmation” towards a gender of their choice, contrary to natal sex. This begins with “social transition” which may “involve adoption of gender-affirming hairstyles, clothing, names and pronouns”.
Then, the child may progress to medical interventions:
First, medications known as GnRH analogues (“puberty blockers”) can help prevent the development of undesired physical changes during puberty, which can trigger and/or exacerbate GD [gender dysphoria]. Second, gender affirming hormones, namely oestrogen and testosterone, can help promote physical changes congruent with the young person’s gender identity. Thirdly, surgical procedures, such as chest reconstructive surgery for transmasculine individuals (“top surgery”), are performed on adolescents in some centres, while genital surgery is generally only advised after the age of majority.
The article does not reveal which centres in Victoria are performing mastectomies on young people, and how many have occurred. But, before the Family Court of Australia abrogated its “gate keeping” role in December 2017, five such procedures had been reported: two in natal girls aged fifteen, one at sixteen, and two at seventeen. Nor does the article clarify the word generally with regard to genital surgery and its inherent castration.
The study will follow the outcome of children treated with hormones and surgery, but will provide no comparison with any alternative form of management. The authors claim it is “not ethically possible to incorporate an untreated control group in the Trans20 study design”, implying that no other form of therapy exists, and, no doubt (because it is a ubiquitous claim), failure to get on with medical intervention will invite self-harm, including suicide.
Whereas few would insist on an “untreated” cohort for comparison, a review of the international literature would insist on comparison with a cohort treated by compassionate, individual and family psychotherapy, as has been shown to be effective in many places, including Australia, in the past.7
The study rejects the protocols for human experimentation which were hammered into various human rights documents after the travesties of “research” in Germany in the Second World War. The Melbourne researchers confess most children will not need the therapy they are going to receive, the researchers must know that therapy is invasive, they admit they do not know whether it will work, or what side-effects may emerge, but, over the years, they think they can work it all out, without consideration of any alternatives which, in any case, will be banned by their supporting government. How did the prestigious Royal Children’s Hospital in Melbourne come to approve of such experimentation? The machinations of its ethics committee should be made public. Who will be liable for litigation?
Normally, many conditions must be fulfilled before live experimentation is approved in Australia, even on rats, let alone children. There must be biological plausibility, an acceptable purpose, supporting review of literature, associated laboratory findings, supporting human experience, a pilot project, a control population, “blinded” intervention, analysis by disinterested assessment, full disclosure of possible side-effects resulting in informed consent, and the opportunity to withdraw at any time.
Trans20 offends at almost every point. The condition it is examining lacks biological plausibility. There is no blood test, X-ray or genetic analysis to suggest a physical basis for the current epidemic of childhood gender dysphoria: the epidemic displays features of a contagious psychological problem to which mentally vulnerable children and some parents seem prone. Even the authors of the study admit, “Serious psychiatric disorders are very common, with rates of self-reported depression and anxiety diagnoses in transgender and gender diverse (TGD) young people in Australia as high as 75% and 72%, respectively, and 80% reporting ever self-harming and 48% ever attempting suicide.” The authors do not mention autism, which is a prominent co-morbidity in many international reviews, and is known for its distorted perceptions.
Proponents for hormonal intervention maintain that the psychiatric co-morbidities result from bullying. They deny the more likely explanation, that gender confusion is a secondary symptom of an underlying disorder. Proponents also argue the need for medical intervention to prevent suicide but there is no evidence, per se, that gender dysphoria leads to suicide. Certainly gender-confused children demand protection because all their associated psychiatric morbidities and family disruptions are associated with increased propensity to self-harm. Given the propensity of transgendered adults to commit suicide, as discussed below, the best way to reduce the rate of suicide in children might be to stop transgendering them.
Mental disturbances in parents include personality disorders and marital disruption. One prominent study in Western Australia found a symbiotic relationship of pathology between unhappy mothers and young boys. The mothers had been mistreated by men, found their little boy more appealing in a dress, and he quickly learned that wearing it would bring a smile to his mother’s face. These days, gender dysphoria appears more common in young, disturbed teenage girls whose parents are shocked by their daughter’s unexpected psychological infection.
Hormonal and surgical management of a psychological problem lacks plausibility, and the study lacks acceptable purpose: the not dissimilar disorder of anorexia nervosa, in which feelings are incongruent with bodily facts, does not receive “affirmation” therapy. The healthy body is not altered to fit the disturbed mind, nor should it be in children confused over gender.
Review of the literature would have advised the researchers of the former rarity of the problem, of successful treatment by psychotherapy, of the widespread physiological role of the hormone they intend to “block”, of the side-effects of that blocking, of the effects on the brain of cross-sex hormones, of the lack of evidence for positive outcome as revealed by the growing number of “detransitioners” and the high rate of suicide after transgendering in adults.
The rejection of a control arm to the study, and the associated evaluation of outcome by its “un-blinded” authors, desirous of seeing good in their work, is an egregious example of “observer bias”. That the authors attest they have no conflicts of interest in the study is challenged by the dependence of reputation, livelihood and medico-legal protection on a desired outcome.
It is important to look more closely at the effects of “puberty blockers” and cross-sex hormones because their use is fundamental to the medical intervention in childhood gender dysphoria but offends medical ethics, especially because proponents maintain the effects of blockers are “safe and entirely reversible” when they are not, and are silent on the cerebral effects of cross-sex hormones.
Puberty is initiated by Gonadotrophic Releasing Hormone (GnRH) released from the hypothalamus to cause the nearby pituitary gland to release gonadotrophic hormones into the bloodstream to stimulate the maturation of the distant gonads and the release of their sex hormones, testosterone and oestrogen, which evoke secondary sex characteristics. Monthly injection of an analogue of GnRH blocks the pituitary from releasing gonadotrophins, causing puberty to stall.
The analogues may be administered at the early signs of puberty: their earliest known administration in Australia was to a natal boy aged ten and a half. Proponents claim delaying puberty provides more time for a child to contemplate its gender identity and procreative future. They also claim it avoids “unwanted” features of the rejected sex, and facilitates future surgery: a breast bud is easier to remove than the developed organ (but an undeveloped scrotum may offer insufficient skin for creation of an ersatz vagina, necessitating the transplantation of a length of intestine to permit receptive intercourse).
The role of GnRH is not, however, limited to the vertical axis from hypothalamus to gonads. GnRH has “horizontal” effects to other parts of the brain, and, perhaps, a widespread role in maintaining the integrity of nerve cells, even in the lining of the bowel.
Of particular importance to gender identity is the role of GnRH in the limbic system, and in sexualising centres in the middle of the brain. The limbic system co-ordinates emotions, cognition, memory and reward into a kind of internal worldview, including identity, which is pursued by “executive function” through ambition, behaviour and decisions.
Such cerebral function has been shown to be reduced in adults administered blockers to reduce the pathological effects of sex hormones, for example, of testosterone in stimulating prostate cancer, or oestrogen stimulating endometriosis in women. Of course, confounders in assessment of the effect of blocking GnRH in those situations include age, disease and treatment, as well as interruption of the normal effects of sex hormones on the brain, but a specific effect of GnRH blockage cannot be excluded.
Such effect was proven in veterinary laboratories in Glasgow and molecular laboratories in Oslo. Given to immature sheep, blockers were found to result in sustained damage to the limbic system, associated with alteration of the function of many of its genes, resulting in sustained reduction of ability in mazes and increase in emotional lability.
A specific role of GnRH in sexualising centres in the middle of the brain was shown by Pfaff et al8 in the 1970s. Stimulated, immature rats respond with sexualised behaviour: the immature female prepares to be mounted, and the male to oblige.
It may be wondered if any child of ten and a half is capable of mature contemplation of gender identity, but more so when sexualisation has been neutered by the interruption of primary centres in the mid-brain, as well as the secondary effects of sex hormones, combined with disruption of the integrating limbic system. It is not plausible to claim that such a child can make a mature decision of such magnitude, and it is not right that someone could make that decision for the child.
Other studies on the effect of blocking GnRH should be mentioned: blockers given to an immature natal boy interfered with normal growth of cerebral white matter which was associated with reduced function. Blockers given to women with endometriosis were associated with increased gastro-intestinal problems and a 50 per cent reduction in intestinal nerve cells, suggesting a widespread role for GnRH in maintenance of neuronal health.
Traditional medical ethics demand full disclosure of possible side-effects: so does the High Court of Australia, which, in Rogers v Whitaker, ruled that even possibilities of side-effects as remote as one chance in thousands must be declared to a patient considering treatment and, by inference, participation in research.
While proponents for the use of blockers in “affirmation” refer to problems with bone growth, there is no evidence of the discussion of effects on the central and peripheral nervous systems. There is only assurance of safety and reversibility.
The use of cross-sex hormones to evoke the sexual characteristics of the desired sex used to be delayed until sixteen years of age, but the Melbourne guidelines have no such advice and the hormones now appear to be given much earlier, in accordance with a certain logic.
The development of the confused child is neutered by blockers while its peers are evolving socially and developing secondary sex characteristics. Thus, Jack believes he is a girl, a conviction fortified by authority figures, including the staff of the Gender Service. But his female peers are behaving as teenage girls and are developing breasts. It is cruel not to give oestrogen to help “her” keep apace.
While proponents of affirmation publicise the bone and cardio-vascular complications of cross-sex hormones, there is no evidence they provide information on the effects of these hormones on the brain. But Hulshoff Pol et al9 have shown that the male brain administered oestrogens shrinks at a rate ten times faster than ageing after only four months. The female brain on testosterone hypertrophies. Thus, the effect of cross-sex hormones on a growing brain, organised before birth in a sex-specific way to await activation by appropriate hormones in puberty, can only be contemplated as deleterious, especially when continued for life. It is implausible to imagine otherwise.
There is no evidence that proponents of hormonal affirmation raise these issues with confused children and carers, but they should, perhaps especially in the context of the high rate of suicide in transgendered adults. Proponents argue that the high rate is due to ostracism, even though it is derived from epidemiological studies in the most accepting of European societies. It is not implausible to wonder if the rate reflects the absence of gold at the foot of the transgendered rainbow, but also to wonder if the structural and functional effects of hormonal interruption of the cerebrum results in such disorder of mental processes that death is considered more preferable than life.
It is not known how much detail of side-effects of surgery is revealed to clients, but known euphemisms suggest unrealistic assurance. For example, mastectomies are described as “reversible” as if the function of the female breast can be reduced to a cosmetic appendage replaceable with a silicon implant. Castration is described as “reduced reproductive capacity” which may be avoided by preserving frozen biopsies of gonads or sperm: a process in which only expense is guaranteed, and in which there is an apparently undiscussed higher rate of foetal abnormality.
Faced with a confused child and parents, wherein lies the duty of care of a therapist or teacher? If the child is referred to a gender clinic which practises hormonal and surgical intervention, there is vicarious participation in an experiment involving massive intervention in the minds and bodies of children: one that is biologically implausible, unnecessary and associated with numerous side-effects, according to the international literature.
The excuse that emerged from Nazi Germany, that the “government made me to do it”, is not generally accepted as valid. Yet, that obligation is what the Andrews government appears determined to inflict upon its citizenry. On pain of civil and, probably, criminal sanctions, carers and teachers of confused children will be obliged to entrain them to “affirmation”.
Given that most confused children revert towards their natal sex without medical “affirmation”, surely there is a greater “duty of care” to avoid the experiment. Such a campaign is needed in Victoria.
Dr John Whitehall is Professor of Paediatrics at Western Sydney University. He has written several articles for Quadrant on childhood gender dysphoria.
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