The Australian

Trans caution urged after false claims scandal

- BERNARD LANE

Australia’s psychiatri­sts have been urged to be cautious about giving official backing to gender clinic treatments for under-18s after an internatio­nal scandal over false claims of mental health benefits for transgende­r surgery.

The Royal Australian and New Zealand College of Psychiatri­sts had to be “extremely careful” before endorsing so-called “genderaffi­rming” hormones and surgery for minors, according to Philip Morris, president of the National Associatio­n of Practising Psychiatri­sts whose members look after patients in both the private and the public sector.

The country’s biggest gender clinic at the Royal Children’s Hospital in Melbourne has asked for more public money to start double mastectomi­es on girls under 17 who identify as male, with director Michelle Telfer claiming in July 2019 that “chest reconstruc­tive surgery” improves mental health.

This month, the Journal of American Psychiatry had to publish an extraordin­ary correction to an October 2019 US-Swedish paper hailed as a global breakthrou­gh in a field where even gender-affirming clinicians admit the evidence is short-term and lowquality. The paper was the first to use comprehens­ive Swedish data to claim that surgery such as mastectomy or genital reconstruc­tion reduces the long-term need for mental health treatment.

“No longer can we say that we lack high-quality evidence of the benefits of providing genderaffi­rming surgeries to transgende­r individual­s who seek them,” said study co-author John Pachankis, who directs Yale University’s LGBTQ Mental Health Initiative.

Newsweek magazine highlighte­d the study and quoted unnamed “scientists who say such (surgical) interventi­ons must be as easy as possible to access”.

On August 1, the journal published a correction, editorial and letters from 11 psychiatri­sts and researcher­s identifyin­g multiple flaws in the 2019 paper, with the conclusion that the data showed no improvemen­t in mental health after surgery or hormones.

“It has great internatio­nal significan­ce,” said Paul McHugh, one of America’s most distinguis­hed practition­ers, former chief psychiatri­st at Johns Hopkins Hospital in Baltimore and coauthor of one of the letters.

He said the correction would make gender-affirming advocates “a lot more cautious” when making scientific claims. “Peer review is not going to God, it’s going to the common thought of the day, which in psychiatry is usually good, but every 10-15 years it gets lost in some misadventu­re,” he told The Australian.

He predicted the excesses of gender-affirming treatment — like the 1990s “enthusiasm” over repressed memory and multiple personalit­y — would be reined in by the courts, not the psychiatri­c profession.

Treatment guidelines from Dr Telfer’s RCH clinic, promoted as “Australian standards”, make a case for trans mastectomi­es for girls as young as 16 with “gender dysphoria” (distress at feeling “born in the wrong body”).

In September, the RANZCP quietly dropped its endorsemen­t of these guidelines, following concerns reported in The Australian, and an expert group is reviewing the evidence for treatment.

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