RUTHFULLY YOURS

Four studies recently published in Pediatrics, the prestigious journal of the American Academy of Pediatrics, confirm the experimental basis of the “Dutch Protocol” of medical intervention for childhood gender dysphoria now practised throughout the Western world, including special clinics in Australian children’s hospitals. They reveal the tunnel vision of appraisal of the nature of associated mental and social disorder, when viewed through the lens of the ideology of gender fluidity. That ideology maintains there is no such binary entity as a girl and a boy: our gender exists on a variable locus on the “rainbow”. It perceives associated mental disorder to result from parental and societal frustration of fulfilment of a chosen gender distinct from chromosomal reality. This frustration is the root of the problem, and gender dysphoria is but one symptom of an underlying, innate mental disorder. The ideology of gender fluidity would lead to the conclusion that confused children should have their desired gender affirmed by the medical profession, practised by society and enforced by the law.

Known as the Dutch Protocol because it was developed in the Netherlands, the medical pathway may result in massive intervention into the mind and body of a child despite the lack of scientific basis. The newly released “Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents” publicly declare they are not based on the usual standards that justify Western medical therapy, including biological plausibility, proof of effect and absence of complications in bench studies, animal experiments and human trials. Rather, they are based on “clinical consensus … and a limited number of non-randomised clinical guidelines and observational studies”: in other words, on the “expert” opinion of the doctors running the clinics.

In effect, there are five phases in the Dutch protocol, which begins with social transitioning in which the child adopts the name, pronouns, dress and persona of the opposite sex. Phase 2 follows with the administration of drugs which block the release of those hormones from the pituitary gland which should travel to the gonads to stimulate production of sperm and ova, as well as the secretion of the sex hormones (testosterone and oestrogen) that induce puberty and then maintain the characteristic male or female attributes. These drugs are known as “puberty blockers”. They may be given at the onset of puberty: the youngest child in Australia to receive them so far was only ten and a half years old.

Phase 3 involves the administration of hormones of the opposite sex with the intention of evoking characteristics of that sex. In time, exposure to the opposite hormones will lead to chemical castration. Although international guidelines suggest irreversible surgery be delayed until eighteen years of age, at least five girls in Australia have undergone bilateral mastectomy before that age.

Phase 4 would involve surgical remodelling of the genitalia and other features of the natal sex such as the masculine “Adam’s apple” and distribution of hair, but not all choose to go that far.

Phase 5 does not feature in promotional literature. Is the lifetime commitment to supervision of hormonal therapy and, probably, psychological state. For those emerging from Phase 4, there will be the need to maintain uro-genital plumbing and the problems of leaks and blockages.

The articles in Pediatrics confirm the lack of scientific basis for this massive intervention. The authors of the first study acknowledge a “scarcity” of information on the topic: they could find only thirteen research papers of any relevance since 1946! While some of these articles consider general effects of the hormone therapy, for example on bone growth, they reveal no significant research on the effect of the Dutch Protocol on the growing brain of adolescent humans, despite the fact that the hormones involved are known to play a major, widespread role in that organ.

The other three studies acknowledge the need for more research on the reasons for associated mental and family disorder but, in doing so, they reveal the tunnel vision of their appraisal, confined by the ideology of gender fluidity.

Study 1: Australian authors declare scarcity

The first study is titled “Hormonal Treatment in Young People with Gender Dysphoria: a systemic review” and is a summation of international literature on the “psychosocial, cognitive and/or physical effects”. It is a significant article in the Australian context because its authors are associated with such prominent institutions as the Royal Children’s Hospital, Melbourne, which is at the forefront of the Dutch Protocol in this country.

To declare in their introduction that such studies are “scarce” is an understatement: between January 1946 and June 2017 they could find only thirteen publications of any relevance. They find this scarcity to be “problematic” because “adolescence is a period of rapid development across multiple domains” to which hormonal therapy in transgendering adults may not “translate”. The problem lies in the virtual absence of scientific literature that pertains to the intervention that may be about to be inflicted on the brains of children undergoing the cerebral growth spurt of puberty and adolescence.

The authors introduce the actions of puberty blockers and cross-sex hormones and detail some physical effects, concluding that “overall, hormonal treatments for transgender youth were observed to be relatively safe”. They then undermined that assurance by acknowledging “the relatively short follow-up duration of the studies”. They considered the effect on bone growth to be of particular concern but also warned of “various metabolic and cardiovascular effects” known to be associated with cross-sex hormones in adults.

Regarding “psycho-social effects”, the authors report claims that transgendering therapies were “associated with significant improvements in multiple psychological measures, including global functioning, depression … and behavioural and/or emotional problems”. However, they report the studies revealed “unclear effects on anger and anxiety” and “no significant effect on symptoms of GD [gender dysphoria]”. Indeed, one study suggested “an increase in GD and body image difficulties”.

The authors, however, do not discuss weaknesses in the studies claiming psychological benefit, and admit there is a knowledge “gap”. These weaknesses include the limited number of children studied, the limited time of study, the lack of controls, and the possibility of observer bias. When the same people are diagnosing, treating and measuring outcome (without comparison) on a relatively small cohort of suffering children, the possibility of observer bias is obvious. Compassion, alone, would lead to optimistic thinking.

Another major confounder of psychological benefit is the large number of children suffering from associated mental disorder (as emphasised in the second paper). The effect of concentrated, compassionate, professional support, by a team of adults committed to increasing a child’s happiness is likely, by itself, to be positive, not to mention the effect of any other medications the children may be receiving.

Regarding “cognitive effects” of therapy (on the brain power and behaviour of the recipient), the authors could find only two references, both pertaining to very weak studies. One study examined “executive function” in eight children on blockers, and though it found “significantly reduced accuracy” in transfemale adolescents, the importance of this negative finding was downplayed by arguing the number of children was too small for validation. The other study examined visio-spatial ability, which is generally believed to be greater in males, and was reported to have been enhanced in natal females who had received testosterone for ten months. No other effects on the brain were assessed.

The “quality” and “risk of bias” of the thirteen studies were independently assessed by two of the Australian authors, who concluded: “In all studies there was a medium to high risk of bias” because of the small numbers of subjects, absence of controls, loss to follow-up, retrospectivity, absence of randomisation and “no blinding” of researchers.

Appropriately, the Australian team proclaimed the need “to reassess and expand on the findings of the existing studies”. They explained the inability of blockers to reduce symptoms of gender dysphoria to be “probably not surprising”, arguing it would be unreasonable to expect blockers to “lessen the dislike” of existing sexual features and to “satisfy … desire” for the physical features of the opposite sex. They did not discuss the inability of blockers to alleviate innate mental disorder of which the dysphoria might have been but a symptom.

With regard to the effect of cross-sex hormones on cognition, apart from the minimal reference to testosterone, reviewers could find no relevant literature.

Overall, the Australian authors conclude the existing studies have “neglected several key outcomes”. These include “psychological symptoms … which is a critical knowledge gap”; the impact of treatment on fertility; the possibility of other physical side-effects including growth and cardiovascular function; and the manner of withdrawal from treatment, especially with regret.

The article reporting scarcity of study is far from unique. Other publications in mainstream paediatric literature complain of “lack of consensus regarding appropriate intervention or even appropriate goals of intervention”, “limited long term data”, “small numbers from only one clinic”, “lack of randomized, controlled studies that provide definitive recommendations for treatment options”. Thus, the best evidence available is characterised as “expert opinion”, which is influenced by prevailing cultural belief systems and “theoretical orientations”.

Study 2: Mental disorder associated with gender dysphoria

The second study is named “Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers” and considers American children aged from three to seventeen years who had been diagnosed as “Transgender and Gender Nonconfirming” (TGNC) by therapists in their health care provider, Kaiser Permanente. The records of 1333 children were examined, of whom 251 were aged from three to nine, and 1082 from ten to seventeen.

Mental illness was confirmed to be very common. Of the children from three to nine, 31.7 per cent had received official diagnoses in accordance with the International Classification of Diseases, Ninth Edition (ICD-9). Most often they suffered from attention deficit disorders (approximately 15 per cent), anxiety (14 per cent), and conduct or disruptive disorders. Of transfemale children 5 per cent were autistic, and 11 per cent of transmales suffered from depression.

Of the older group of 1082 children, a huge 73 per cent had been diagnosed with mental disorders ranging from anxiety (approximately 38 per cent), attention deficit (19.6 per cent), depressive disorders (56 per cent), and autism (5 per cent). Frank psychoses had been diagnosed in 4.7 per cent and schizophrenia spectrum in 1.6 per cent. In all, 14.5 per cent of the children had been so badly affected by mental disorder they had needed to be hospitalised.

The researchers avoided the basic question: Which came first: mental disorder or gender dysphoria? Surely a temporal relationship could have been drawn from their records? As if avoiding the question of cause and effect, the authors equivocate, declaring that “children who receive meaningful gender identity support do not necessarily experience elevated rates of depression and anxiety”. They do not define such “affirmative intervention” but seek to assure that its “follow-up” will permit its impact to be examined. Meanwhile, they remain in a state of “considerable uncertainty”.

In that meantime, while they are “following up” as to whether the gender dysphoria experiment is going to be a success or not, a child with an innate mental disorder, such as autism, could be ushered onto a pathway towards castration and the physical features of the opposite sex.

There are substantial reports of gender dysphoria following rather than preceding the onset of mental disorder. For example, a review of cases presenting to Finnish hospitals from 2011 to 2013 declared 75 per cent “had been or were currently undergoing child and adolescent psychiatric treatment for reasons other than gender dysphoria when they sought referral”. 64 per cent had treatment for depression, 55 per cent for anxiety disorders, 53 per cent for suicidal and self-harming behaviours, 13 per cent for psychotic symptoms, 9 per cent for conduct disorders, 4 per cent for substance abuse, 26 per cent for autism spectrum disorder and 11 per cent for ADHD. Of these children, 68 per cent had had their first contact with psychiatric services due to reasons other than gender identity issues.

Study 3: Victimisation

The third article, “A Closer Look at the Psychosocial Realities of LGBTQ Youth”, confirmed the high rate of associated depression, particularly in natal females, which continued into the “young adulthood of sexual minorities”. It found “family satisfaction” was lower than normal in the affected children, “cyberbullying” was higher, but “peer support” was comparable. More research was declared to be needed, particularly on the effect of parental rejection of non-heterosexual identity.

The authors admit a limitation of their study was its failure to examine the temporal relationship between the onset of depression and dysphoria. However, the emphasis they place on the need to further examine parental rejection and cyberbullying promotes the line of thought that the mental disorder was caused by the victimhood of gender fluidity. Another weakness of the study was its failure to report the use and effect of any standard therapy for depression.

Regrettably, the authors probed no further than the accusation of victimhood by cyberbullying, avoiding the propensity of social media for grooming and recruitment into non-conforming behaviour. Personal accounts on the website 4thwave.com report the grooming power of pro-transgender websites such as Tumblr: the courage of “coming out” and standing up to parental opposition, and the wisdom of assuming one’s “true self”. All the while there is the warmth of acceptance into the “new on-line family”, and the provision of advice about blockers and cross-sex hormones, chest binders, mastectomies and gender surgery, and the manipulative power of threats of self-harm and the spectre of suicide.

One adolescent explained to me how she would spend hours on the website, which had become like a family: welcoming, encouraging, uncritically supporting all explorations of alternate gender identity, and answering all intimate questions. Cyberbullying only emerged when she began to express doubts. When she questioned abortion, the bullying moved from the generic airways to her e-mail address, which she had considered private. After extricating herself, she declared (perhaps still a bit surprised), “Mum was right after all.”

Study 4: Childhood adversity

The fourth study, “Disparities for LGBTQ and Gender Nonconforming Adolescents”, examined patterns of childhood adversity in Lesbian Gay Bisexual Transgender and Questioning adolescents (LGBTQ) which included having a parent or guardian in prison, living with a problem drinker or drug abuser, psychological, physical and sexual abuse, and witnessing family abuse. The idea was to find out which adversity or combinations thereof were more associated with being LGBTQ. Not surprisingly, the study reported higher levels of adversity in some LGBTQ youths and, the greater that adversity, the greater the degree of non-heterosexual conformity. Most LGBTQ youth, however, reported low levels of adversity.

Despite the range of tumultuous experiences that were considered, any one of which might be expected to wound the development of a child, the main recommendation of the article was for “additional research on parental rejection” of sexual minorities. Highlighting adherence to the hypothesis that the root cause of mental disturbance is parental failure to accept gender fluidity, the authors appear flummoxed at the origin of gender confusion when parents are physically or mentally absent. They confess, “it is currently unclear why LGBTQ adolescents … would be more likely to have … a parent who has been incarcerated or abuses drugs”.

Such tunnel vision distracts from other possible causes of gender dysphoria: promotion of dysphoria for the emotional gain of parents, known as Munchausen’s Disease by Proxy; recruitment to a psychological fad fanned by sensationalist media; fellowship of unhappy adolescents in promotional websites; escape to a more desirable gender after exposure to hardcore pornography or sexual abuse; preference for a gender presumed to be more favoured by an authority figure; psychosis, in the manner of anorexia nervosa or even schizophrenia; and, finally, natural childhood questioning exacerbated by a promoting media and so-called “Safe” programs in schools.

The editorial: saving lives by affirmation

The editorial accompanying two of the papers declares that physicians should recognise “risk factors”, and be able to provide “lifesaving” support, including “gender affirming treatment”. Thus, it strengthens the manipulative concept that gender dysphoria, per se, is likely to lead to suicide. The second article reports an incidence of self-harm that is above that of the reference adolescent population but does not discuss the intent of the action. Was it to secure attention or was it an act of self-destruction? Did it emerge from gender dysphoria or pre-existing mental disorder?

Certainly, there is a higher risk of self-harm and suicide in adolescents affected by mental disorders, such as depression, with which gender dysphoria is so often associated. All children with distortions of reality require the utmost care and compassion, including those who are uncertain they are boys or girls, but there is no scientific evidence to support the threat that gender dysphoria, per se, is so likely to result in suicide that the sufferer should undergo the massive intervention of the Dutch Protocol. Indeed, as European studies confirm the high rate of suicide in adult transgender identities, more lives may be saved by avoiding youthful transition, given the statistical expectation of re-orientation to natal sex through puberty.

The corollary: failure to affirm is child abuse

In corollary to the argument that affirmation will save lives is the accusation that failure to affirm will endanger them and, therefore, constitutes child abuse. In Australia, this concept is being fortified by the growing legal vulnerability of parents who are not convinced of the proclaimed advantages in the transitioning of their child to the opposite sex. Similarly unconvinced therapists are similarly vulnerable.

The 2017 Victorian Health Complaints Act gives power to a commissioner to investigate and prosecute therapists who do not affirm non-natal gender identities. In an astonishing inversion of human rights, those accused will be assumed guilty until proven innocent.

Teachers and principals in the New South Wales Department of Education have been reminded of their mandatory duty to report child abuse to authorities, and instructed how this might include parental opposition to a child identifying with the non-natal sex.

The draft platform prepared by the Australian Labor Party for its National Conference later this year includes, for the first time, in Chapter 10 (“Strong democracy and effective government”) a specific provision regarding gay conversion therapy. Paragraph 83 says, “Labor opposes the practice of so-called conversion and reparative therapies on LGBTIQ people and seek [sic] to criminalise these practices.”

The ALP’s federal health spokesperson, Catherine King, has been reported to have declared that “stamping out gay conversion therapy would be a ‘personal priority’ if Labor wins the next election”. There is no age limit for conversion therapy and, therefore, these new laws would “ensure child protection authorities acknowledge attempts to ‘cure’ Gender Questioning children and young people as serious psychological abuse, and would acknowledge these harms, when suffered within the family, as domestic violence against the child”.

“Conversion therapy” is double-speak for any attempt to reduce gender dysphoria by helping the child become comfortable with its natal identity, and not ushering the child onto the pathway of affirmation. Merely waiting expectantly for the orientating effects of puberty may be considered a sin of omission, deserving punishment by federal law. In the future, it may become very dangerous for a child to express confusion of gender: no one will be able legally to protect it from the protocols of the state.

Ironically, in all this, some homosexuals are beginning to perceive their future genocide. “I am glad I grew up in an earlier era,” said one male, “otherwise my preference for softer clothing, colours and play, and the company of female children, could have led to my transition!” Had he grown up in the pending era, his parents could have been charged with child abuse for not submitting him to the protocols, and a resistant doctor could have been deregistered, at least.

Scarcity of evidence? Look to the animals

What is most apparent in these recent articles is the lack of scientific basis for the Dutch Protocol. That protocol must surely, therefore, be recognised as experimental. Worse, as the authors of the first study reveal, the current experiment has no basis in prior experimentation.

The first principle of medicine used to be “Do no harm” and, given the complex interplay of hormones and neurons in the central and peripheral nervous systems, it might be expected that the effects of medical interruption would have received paramount attention. But that is not so in human children and adolescents under the Dutch Protocol. The first paper found only one study that even barely considered the effect of testosterone, and none that examined the cognitive effects of progestin, antiandrogens and oestrogen. This is astonishing scientific neglect, given that thousands of children are reported to be lining up at gender dysphoria clinics throughout the Western world and are, therefore, at risk of hormonal therapy.

If the authors, however, had extended their search to the effect of blockers on the brains of adult humans as well as laboratory and animal work (which, incidentally, used to be mandatory for drug regulation) they would have been rewarded with many references that would have warned them that the effects of blockers are not “safe” and “reversible” as asserted by proponents of the Dutch Protocol.

Gonadotropin releasing hormone (GnRH) is secreted in pulses from brain cells near the pituitary gland to cause that gland to release other hormones (gonadotropins) that will travel in the blood to the gonads to induce their release of the sex hormones, oestrogen and testosterone. “Blockers” are very similar chemicals to GnRH but they cause sustained stimulation of the pituitary (rather than pulsatile) and exhaust the capacity of that gland to continue to produce and release the gonadotropins. Lacking the stimulation of gonadotropins, the gonads will not produce the sex hormones and, thus, puberty is blocked.

Because certain medical problems may be worsened by oestrogen (for example, endometriosis in women) and testosterone (prostate cancer in men), blockers have been employed to reduce their secretion. Side effects have been reported but differentiation from associated factors such as ageing has been difficult. Nevertheless, their use has been reported to have been complicated by emotional disturbance and reduced “executive function” of the brain. More recently observed, their use in women has been associated with an unexpected increase in intestinal problems apparently caused by degeneration of the nerve cells that cause peristalsis. These studies have suggested a role for GnRH beyond the specific stimulation of the pituitary to a general responsibility for the maintenance of nerve cells.

Soon after the discovery of GnRH, over forty years ago, studies on animals revealed that branches of the brain cells that secrete GnRH extend well beyond the pituitary to areas of the brain concerned with sexuality, cognition, memory, emotion and executive function. Activity of GnRH in those regions was substantiated by finding the presence of its appropriate receptors. That GnRH could be found in the cerebro-spinal fluid that bathes the brain suggested that fluid could be another medium for widespread distribution, beyond the actual presence of GnRH secretary cells.

Subsequently, injection of GnRH into specific sites of the brain resulted in specific effects. In particular, its injection into regions concerned with sexuality was found to facilitate sexualised behaviour in both male and female animals. Conversely, sexualisation was reduced by blocking the effect of GnRH with special antibodies, and the special inhibiting hormone that is believed responsible for influencing seasonal sex behaviour in animals. It appears GnRH turns sexualisation on, and its blocking turns it off.

A more general influence of GnRH on sexual identity and behaviour was generated by the finding that various odours (pheromones) of the opposite sex could stimulate the release of GnRH to act on local sex centres in the brain, as well on the pituitary to bring about the secondary release of gonadal sex hormones with their added sexualising effect. Soon, however, it was found that other “sociosexual stimuli” for gender identity and behaviour existed in the “rich and complex social environment that is full of the sights, sounds, and smells of their neighbours, mates and offspring” of mammals. Thus, in sheep, the presence of an odourless member of the opposite sex could cause an immediate release of GnRH. Even a photograph of a ram could induce sexualisation in a ewe, as could the mask of a ram on the face of her sister.

These investigations on sheep pointed to poorly understood “sociosexual” stimulation of sexualisation involving the mind, memory and senses, impacting on hormones, being exacerbated by their response, all under the direction of the original complement of chromosomes. Though not understood, the force of these stimuli is obvious. The description of love as “A beautiful dream with glandular activity” is physiologically apt but even the Bible does not understand the “way of a man with a maiden”, though its force is obvious to everyone.

Ultimately, GnRH receptors were found throughout the body from brain to spinal cord, to cardiovascular and intestinal systems and to the gonads, confirming the likelihood of a widespread role. And, if not in medical institutions, certainly in some veterinary schools, questions were being raised about the consequences of blocking that widespread activity.

These questions began to be answered over ten years ago by a series of investigations on the brains of sheep administered blockers but not deprived of sex hormones. Effects beyond the pituitary were confirmed. In universities in Glasgow and Oslo, administration of blockers to sheep was proven to result in lasting damage to the amygdala component of the limbic system to which branches of the cells that produce GnRH had been proven to reach. The limbic system integrates cognition, memory and emotions and leads to appropriate “executive function”. On blockers, the amygdala hypertrophied, and the function of many of its component genes was shown to be altered. The affected sheep demonstrated sustained reduction in memory and an increase in emotional lability.

Recently, bench studies in other laboratories have confirmed a deleterious effect of blockers on the integrity of nerve cells from the hippocampus, another part of the limbic system. Perhaps by influencing delicate cascades of enzymes within those cells, exposure to blockers has resulted in deformation of the tiny extensions through which nerve cells communicate with each other and, ultimately, contribute to the function of the brain.

Much, indeed most, remains unknown about the widespread function of GnRH but there is sufficient evidence for a maintenance role in widespread neuronal function to challenge its experimental administration to the growing brains of children.

How can a blocked young brain comprehend a sexual future?

The gender clinics administer puberty blockers with the argument that they provide the young person with more time for better consideration of future gender identity and procreation, while reducing the provocation of unwanted sexual characteristics. The question is how can a child maintained in a neutered state, from as early as ten and a half years of age, be expected to understand such things when denied the sexually orientating effects of natural hormones? And how can the child be expected to “think straight” when denied the sustaining effect of, in particular, GnRH on various parts of the brain that integrate memory, cognition and emotion into rational action?

According to bench and veterinary literature, administration of blockers may be expected to block not only the outward signs of puberty but also:

• the sexually orientating and energising effect of general “sociosexual stimuli” on the brain as mediated by GnRH secretion;

• facilitation of sexualised behaviour by the specific action of GnRH upon local “sex centres” within the brain;

• the secondary effects of testosterone and oestrogen in their selective energising of a pubescent brain that has been quietly awaiting them, as organised and directed by the body’s chromosomes since the early weeks of foetal life.

• the timely exposure of the brain to those gonadal hormones, according to the natural orchestration of the pubertal symphony—late arrival has been shown to reduce their effect in sexualisation;

• the capacity of the limbic system to fully integrate cognition, memory and emotion and exert “executive function” in favour of the propagation of the species.

While the natural process of the strengthening of gender identity is blocked, the neutered child remains exposed to the sustained pressure for transition exerted by its principal authorities: its (predominantly single) parent, its teachers, doctors, therapists, advisers and websites. Denied the orientation of natural hormones while exposed to such powerful influences, it is not surprising that studies reveal that, once started on blockers, medical escalation continues towards the other sex.

What about the effect of cross-sex hormones on the brain?

Surprisingly, it has been revealed that nerve cells of the brains of both males and females manufacture the female sex hormone, oestrogen, which was traditionally considered only to be produced by distant gonads in mature females. It has been shown that this locally produced oestrogen (known as a neurosteroid) is basic to the function of the neurons, in as yet unknown ways. More surprising is that testosterone, conveyed from the testes in large quantities to the brain cells in males, and in small quantities from the adrenal glands in females, is metabolised in those cells into oestrogen, contributing to its local concentration.

Thus oestrogen is believed to regulate differentiation of neurons and their supporting cells. It “generates sex differences in neuronal circuits controlling … reproduction” as well as local development of the extensions from the neurons and the way they communicate, in their many thousands, with each other. Interruption of the neuronal concentration of oestrogen results in deformation of the communicating branches of the neurons, similarly to the observed effect of puberty blockers on neurons in bench studies. Perhaps GnRH supports nerve cells by maintaining the balance of testosterone and oestrogen. No one knows.

The question arises: What will happen to the function of the individual neurons and their summation into a brain, if bathed in volumes of cross-sex hormones while deprived of the presence of those it was programmed to expect? Again, no one knows. It is known that a balance of sex hormones is responsible for the differentiation of an early foetus into a male or female, and for a sex-specific organisation of the brain that continues into early infancy to then await further development and specific sex hormone activation in puberty. Can the growing adolescent brain adapt to concentrations of hormones its chromosomal design was not expecting?

At first, cross-sex hormones were not advised to be given before the age of sixteen but now, in Australia, there is no age limit and it would appear early administration is likely. After all, the argument goes, if the child has decided to change sex, it will be disadvantaged by the appearance of enviable sexual characteristics in peers. Therefore, after a year or two of contemplation on blockers, it is only humane to encourage the outward characteristics of the chosen sex.

Until November 2017, the approval of the Family Court of Australia had to be secured for administration of cross-sex hormones to children under sixteen but the court, in accordance with all the assurances of staff in children’s gender clinics, abrogated that responsibility. Now the administration of these drugs and the practice of mastectomies is accountable only to those who prescribe them.

What effect can be expected from administration of cross-sex hormones on the growing brain? There are no relevant studies, but imaging of brains of adult transgenders has revealed shrinkage of male brains exposed to oestrogens at a rate ten times faster than ageing, and has revealed hypertrophy of female brains exposed to testosterone. Neuronal death has been noted on bench studies.

How many children are at risk?

Proponents of “affirmation” declare the prevalence of transgender to be 1.4 to 4 per cent of young people on the basis of self-reported questionnaires, though these are known to be unreliable, especially in adolescents. The second paper, reviewing prevalence in children and adolescents in the care of Kaiser Permanente, may present a rare insight into the results of actual diagnosis. It reports that 1333 children aged from three to seventeen were assigned a diagnosis of Transgender, Gender Nonconforming by Kaiser Permanente in the geographical regions of Northern and Southern California and Georgia where the organisation has 8.8 million people on its books. Presuming similar population distribution to California as a whole, 1333 children would represent 0.078 per cent of those aged from three to seventeen.

What happened to these children is not revealed, but publications assert that most gender-confused children will reorientate to natal sex and sexuality through puberty. Of the remainder, most are reported to orientate to natal sex but with homosexual orientation. Therefore, the number of “persisters” is likely to be much lower than 0.078 per cent.

Furthermore, the numbers diagnosed by Kaiser Permanente are likely to have been inflated by recruits to the current epidemic of “sudden, late onset, dysphoria in teenage girls”’. Given, therefore, the tendency of such psychological phenomena to dissipate, the percentage of persisters is likely to be lower still: approaching the adult prevalence of 0.005 to 0.014 per cent in natal males, and 0.002 to 0.003 per cent in natal females, as published by the Diagnostic and Scientific Manual of Mental Disorder.

The rarity of the real problem is just one reason for great constraint in consigning confused children to the intrusion of the Dutch Protocol. In a straw poll of twenty-eight paediatricians with a cumulative experience of 931 years conducted by this author, only twelve cases of gender confusion were recalled: ten were associated with mental disorder, two with sustained sexual abuse. The poll revealed that one case might be expected every seventy-six years. Now, hundreds are reported to be presenting each year in Australia. The Dutch Protocol is poised to change a lot of lives.

What else is at risk?

The ideology of “gender fluidity” is challenging basic human rights. Without any apparent protest the Victorian Health Complaints Act has abrogated the traditional presumption of innocence as extolled in Article 11 of the International Declaration of Human Rights.

If the Labor Party is victorious in the next federal election, the “right to freedom of opinion and expression … and to seek, receive and impart information and ideas through any media”, as expressed in Article 19 of that Declaration promises to be challenged by the ban on so-called conversion therapy. How long will questioning articles be permitted to be published by Quadrant?

Even the human right for protection in experimentation, so painfully expressed in the Nuremberg Code, appears to have been overlooked in the treatment of childhood gender dysphoria, which is confessedly not based on the usual standards. That code was established to protect human subjects from the egregious abuses of so-called research that were inflicted in Nazi Germany.

I am not accusing therapists in Australian gender clinics of such cynical abuses. I acknowledge both the suffering of children with gender dysphoria and the compassionate determination of staff to relieve that suffering. Nevertheless, medical history has confirmed dangers in unsubstantiated interventions, despite all the good will in the world. The advice of the Nuremberg Code remains salutary in its emphases:

• The necessity for the “understanding consent” of subjects. But, can blocked children understand their sexual future? Can mentally ill children understand such a future?

• The necessity for an effect that cannot be achieved in any other way. But most children will revert to natal sex and there is no reliable way of determining who will not. Who can predict that “compassionate, supportive watching and waiting” will not be effective?

• That experimentation will be based on previous knowledge, including animal studies. But, regarding childhood gender dysphoria there is virtually no previous knowledge, and animal studies that ought to be dissuasive are ignored.

• The risks of the experiment ought not to exceed expected benefits. But, animal studies proclaim the risk of sustained cerebral damage. Conversely, there is no long-term evidence that dysphoric children will be advantaged by affirmation. And, there is long-term evidence that transgendered adults have an inordinate rate of suicide.

• That staff must be fully qualified. But the very recent tsunami of childhood gender dysphoria means very few therapists possess long-term corporate expertise. People are learning as they go.

• Medical staff must stop the experiment when they observe the experiment is dangerous. But, given the absence of traditional study design, how will the staff know when things have gone wrong? In the absence of such standard trials, frontal lobotomies were pursued enthusiastically for a long time at the cost of tens of thousands of interventions.

• Subjects should be free to leave the study at any time. But what child will be able to walk away from a new identity, the persuasion of drugs and the commitment of authority figures?

The Nuremberg Code does not mention the freedom of medical staff not to be involved in the experiment. But, if the Labor Party has its way, the state will ensure no doctor will be free not to submit the child to the Dutch Protocol.