Dr Fiona Bisshop

It’s been a busy week in the trenches, and time to take stock of just what the flipping hell has happened in the last 7 days.

Those of us working in trans health, and the trans community and their families, are reeling from vile government decrees which occurred simultaneously in Queensland and in the US. Starting with our local situation, the state Health Minister declared at a press conference that no new medical treatments could commence in Qld hospitals for trans youth under 18, based on a whistleblower report about “inappropriate” prescribing of puberty blockers at a regional service, and pending a review of the service involved. He then went further and announced a formal state government-sponsored “review of the evidence” for puberty blockers in trans youth, as if this is some new-fangled idea that needs investigating. There is no time frame for when such a review would be completed, nor any promise that services would resume in the future. This knee-jerk reaction means that all of the 491 young people who are currently on the waiting list for the Gender Service at the Qld Childrens Hospital will not be able to receive any form of prescription through that clinic. Some of these young people have been on the waiting list for years, and some are in need of urgent care.

Just to remind you, there was an independent review of paediatric gender services in Qld undertaken just last year, which found the QCH clinic to be delivering high quality multidisciplinary care, with the major problem being underfunding, too few staff and lack of capacity to see new patients in a timely fashion. That review recommended an immediate increase in funding so that the service could operate more efficiently and expand to deliver more regional care. The previous Labor state government accepted these findings and acted upon them accordingly. You might wonder why another review is now needed? It would seem that the new health minister is perhaps receiving advice from conservative voices who didn’t like the outcome of the first review. And I have to wonder whether such an extreme measure as stopping all treatments would have occurred in any other area of medicine, say cancer treatments, if one service was under investigation? Of course it wouldn’t have….

Meanwhile in Trumpland, disgusting new executive orders have erased the term transgender from all government websites and school curricula, forced birth sex back onto passports, banned gender affirming treatment for minors, and forced trans people out of the military with dishonourable discharges. If you want to read a thorough explanation of these orders, and be warned they are very upsetting, see this excellent analysis

There is a wave of anti-trans propaganda and policy sweeping across the planet. I don’t blame people for feeling despondent about this. It really does seem that every achievement or advance we make in trans health rights is at risk of being taken away with a change in political power.

Coming back to Qld, I’d like to look at what exactly has really prompted this extreme decree by the conservative state government. One of the concerns they have expressed is that puberty blockers are potentially dangerous, and they have cited the Cass Review from the UK. Now I have written about puberty blockers before but let’s talk a bit about the Cass Review.

If you’re unaware, the UK government commissioned a review of NHS paediatric gender services which was undertaken by Hilary Cass, a paediatric endocrinologist who did not herself treat trans youth. The outcome of her review was a recommendation that the use of puberty blockers only be considered within a research protocol, and this led to the suspension of all gender affirming medical care for trans youth in the UK. Much has been written about the fundamental flaws in this review, and a good summary can be found here but in a nutshell, these are the problems with it:

• it ignored the large body of published evidence for gender affirming care for trans youth
• it fixated on the sort of evidence that comes from a randomised controlled trial (something you could not ethically conduct in vulnerable youth)
• it unfairly expected a much higher grade of evidence than would normally be accepted for other areas of paediatric medicine (ie why is trans health always held to more intense scrutiny than any other area of medicine???)
• it made incorrect conclusions about the mental health benefits of puberty blockers (largely because they do not relieve dysphoria, who would have guessed?)

The Cass Review has been picked up around the world and bandied about as “evidence” that puberty blockers are bad, and I understand why lay people without a science background (like most politicians) would be worried by it. However, it is inconsistent with international consensus and prior reviews, and has been widely critiqued since its publication.

Once again, the facts about puberty blockers are quite well known. They are

• reversible
• safe
• associated with good or stable mental health (sure they don’t relieve dysphoria because they don’t cause physical changes, they just stop progression of irreversible changes of puberty)
• most effective if started in early to mid puberty
• never prescribed without first extensively counselling the young person and their family about future fertility

Trans people make up such a small proportion of the population, yet it seems they are constantly singled out as a political football. Trans youth deserve to be allowed access to care and to be able to live their lives without constantly being discussed in the media. Decisions around gender care are a matter for the young person, their family and their clinical treating team, and there is NO role for government intervention in clinical decisions.

Take heart. There are many many allies here preparing for battle, and willing to fight to maintain the basic right to healthcare that all trans people should have. We will not give up, and we will ultimately win this war.