On 27 November 2022, The Sunday Mail, the Sunday edition of The Courier-Mail, published an article, “Aussie doc: ‘I see 300 trans patients a year’,” by Julie Cross (2022).
The article has several problems. Here are a few.
Table of contents
- “… make them look more like the opposite sex …“
- “open to prescribing … quickly“
- “prescribed ‘gender affirming’ drugs“
- “… being shared on government platforms“
- “News Corp is not suggesting …“
- “The government’s own website … states that it is wrong …“
- “… other countries around the world …“
- “TransHub … promotes the informed consent model as best practice“
- “… just two or three appointments“
- “… no mental health professional needs to be involved“
- “For trans children …“
- “… psychologist Dr Roberto D’Angelo said …“
- “His own assessment of the evidence …“
- “… almost all … have autism or … ADHD“
- “‘wise’ rather than ‘irreversible decisions‘”
- “transition as an adult female to a male“
- “‘If you don’t feel comfortable … then don’t’“
- “months or years of therapy“
- “transitioning can sometimes seem like the explanation“
- “‘regret can take up to 10 years’“
- “… one identified as male …“
- “… adults and children wishing to change their gender …“
- “… the vast majority … have little understanding in this space“
- “… happy to prescribe … in just two sessions“
- “… new national guidelines … carefully exploring …“
- “… almost all of his patients … are neurodivergent“
- “a group of health professionals working with trans people“
- “it’s a grey area … should be able to consent“
- “the rates of people regretting … is ‘almost zero’“
- “He warned … it could result in people taking their own lives“
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Trans patients are swapping tips online on where to find ‘friendly’ doctors who are willing to prescribe hormones to make them look more like the opposite sex.Cross (op. cit.)
First of all, may I say how delightful it is to see Cross taking part in News Corp’s long corporate tradition of suggesting that hormones are simply a skin-deep intervention which allow perverted, predatory, subhuman transgenderists to deceive their well-meaning, normal, fully human cisgender peers.
Now, the word “friendly” implies bias, like having a “friendly” judge. It might be possible to superficially get away with the use of the word “friendly” here if it were a direct quote with this meaning in context. However, the only online source which we know Cross actually consulted is a single reddit thread in which the word ‘friendly’ is not used in the OP1 (u/camxeli, 2022), and is only used in one comment, which describes a Brisbane-based trans health provider as having a “very comforting and friendly manner” (u/CafeCodeBunny, 2022).
The construction of the paragraph suggests that it’s decisive proof of bias to prescribe gender-affirming hormones at all. In fact, where they’re clinically justified, to not prescribe them would be medical negligence — because it would fall short of the relevant standard of care (Armstrong Legal, n.d.).
Reddit is one go to site where the trans community shares information on which doctors are open to prescribing cross sex hormones quickly.Cross (op. cit.)
In the one reddit thread we know Cross actually consulted (u/camxeli, op. cit.), the OP was asking where to find informed consent model (ICM) care, because the first appointment he could secure at the Brisbane Gender Clinic was 11 months away.
Note that this would have been a particularly time-sensitive and urgent matter because the first appointment would have been the OP’s first opportunity to receive any gender-affirming medical care at all. He doesn’t say this; what he does say is that he’s 15. Forcing him through 11 more months of the wrong puberty could do significant damage which would be permanently impossible to reverse.
Cross is trying to make timely care look shady by asserting trans people are trying to get “friendly” doctors who will prescribe hormones “quickly”. “Less than 11 months for medical intervention on a matter of life-altering urgency whose time sensitivity is immediate,” however, is an objectively reasonable expectation by any metric.
One person [u/JamieRoseCleverly, 2022 — Ed.] wrote on Reddit how they were prescribed ‘gender affirming’ drugs at a walk-in clinic in Queensland, after waiting about “’30 minutes for the informed consent and prescription, and another 15-20 minutes for the pharmacy next door to fill it”.Cross (op. cit.)
“Gender affirming” appears in quote marks, as if there were some debate about the wording. In the literature, gender-affirming therapies are referred to as such even by their most ardent opponents (e.g., D’Angelo, 2018; Malone & Roman, 2020; Clayton, 2022; etc.). “Gender-affirming” is standard terminology; News Corp is putting it in quote marks to convey a suggestion that it doesn’t have either the authority or the guts to make out loud.
While we’re on the topic of conveying suggestions, while the word “drugs” is perfectly clinically accurate here and often used in the technical literature, that’s not why News Corp uses it; it’s used because compared to “hormones” or “medication” it is much scarier, and therefore, for News Corp’s purposes, ideal.
It also ties into a common anti-trans narrative theme: namely, projecting artificiality onto trans people, portraying them as somehow unnatural and fake. Calling hormones “hormones” runs the risk of someone pointing out that hey the human body produces those too.2 Even “hormone blockers” sounds too close to something natural and real. “Drugs”? Now those could be anything. That’s the ticket.
Honestly the weirdest part of this paragraph is how Cross leaves in “and another 15-20 minutes for the pharmacy next door to fill it,” as if it were suggestive of something nasty. My pharmacy takes about 2 minutes to fill my prescription for estrogen; 5 on a slow day. Should they artificially take longer because I’m trans? What’s the objective here?
There are lists of “gender affirming” doctors, who all approach patient care differently, being shared on government platforms.Cross (op. cit.)
The use of the word “platforms” here is slightly confusing, because it feels like it’s suggesting Australian governments are running public Mastodon instances or something (are they? I haven’t heard), but actually I think this is referring to, at least, the “gender incongruence” page on the Australian Government’s Healthdirect service (mentioned by Cross shortly afterward), which says:
You can find a list of gender affirming clinicians at TransHub [“Gender affirming doctor list,” n.d. —Ed] and AusPATH [“Providers,” n.d. —Ed].Healthdirect Australia (2022); links in source
This seems like another version of the narrative also favoured by the ABC’s Media Watch (Moreton, 2022),3 to the effect that “it’s wrong for government to cite or consult external experts in any way”. I personally have only ever seen journalists try that one when attacking trans people, and I expect other marginalised groups, because in any context other than discrediting authorities who defend marginalised people, it would be correctly recognised as blatantly absurd.
News Corp is not suggesting doctors on these lists are doing anything wrong.Cross (op. cit.)
News Corp is in fact doing precisely that. Simply saying that they’re not doesn’t actually change it.
The government’s own website HealthDirect promotes ‘gender affirming care’ and states that it is wrong for any health professional to try to change someone’s gender or identity.Cross (op. cit.)
Healthdirect does indeed “promote[…] ‘gender affirming care’,” for example by saying:
People with gender dysphoria need to get gender affirming care.Healthdirect Australia (op. cit.)
It seems pretty obvious and straightforward to say
PEOPLE_WITH_CONDITION need to get
TREATMENT_FOR_CONDITION. Not seeing a lot of objections to “People with muscle aches need to get Nurofen.”
Healthdirect does indeed also state that
It is wrong for any health professional to try to change your gender or identity in any way.(ibid.)
This is also very obviously unassailably true. Part of the impetus for banning conversion therapy was the strength of the argument that trying to change someone’s identity is wrong even without considering direct observable material harm, because people have other human rights like autonomy and freedom of conscience, of which they would be deprived by an attempt to forcibly psychologically modify them, even if they weren’t otherwise harmed.
However, conversion therapy does do harm; it consistently leaves its subjects with lifelong psychological trauma (Blosnich et al., 2020; Forsythe et al., 2022). Then again, many other therapies which are widely accepted in clinical practice also inflict harms, which are accepted because the benefits outweigh them; anyone who’s been through chemo, or knows someone who’s been through it, has witnessed this principle in action.
If we accept for some dickhead reason that changing someone else’s gender is actually a clinically beneficial thing to do, then are the harms of conversion therapy worth it to achieve that end? No, because conversion therapy doesn’t actually do that. It has no demonstrated effectiveness (Higbee et al., 2020). Even in the terms in which its advocates claim to believe, conversion therapy can’t be justified because it doesn’t work.
News Corp’s careful framing implies that Healthdirect calling conversion therapy “wrong” is emotive and debatable. In reality, not only does conversion therapy have shitty ends, it can’t achieve them; Healthdirect calling it “wrong” is as close to objectively correct as any statement about science can get.
However, it comes as a growing body of mental health professionals believe the government’s current advice is out of step with other countries around the world that have started taking a more cautious approach to medical and surgical intervention.Cross (op. cit.)
Oooh, which countries? I assume one of the usual suspects, so is it Britain (Moore et al., 2022)? Is it Sweden (Jaeger, 2022)? Please, go on, tell me more, I’m enthralled.
TransHub, which provides resources for trans people and health professionals, promotes the informed consent model as best practice for GPs — which is when the doctor takes the patient’s lead and accepts their new gender identity.Cross (op. cit.)
I was unable to verify this claim. The summary of the informed consent model (ICM) is close enough that I’m not gonna argue with it here. However, the strongest assertions I could find by TransHub about the ICM, which are in its guidance for clinicians on the ICM (TransHub, “Clinicians: Informed consent,” n.d.), are subjectively very positive but don’t actually appear to amount to an endorsement as a single best practice (i.e., superior to other alternatives), simply a discussion of one option among many.
The strongest assertion I could find by TransHub that was relevant to the ICM was in the guidance for clinicians regarding diagnoses (TransHub, “Clinicians: Diagnoses,” n.d.), which asserted that “the requirement of diagnosis [of gender dysphoria] is no longer considered best practice”. This doesn’t actually enthrone the ICM instead, however. It simply — and correctly — places the traditionalist “gatekept” model which it discusses as one option among many.
In some cases a prescription for cross sex hormones can be handed over in just two or three appointments.Cross (op. cit.)
This is pretty clearly trying to tap into the unspoken and inarticulable feeling that many cis people have that there’s some minimum number of appointments it should take. In reality, like anyone else, trans people are entitled to have medical care no later than they need it.
In many cases, no mental health professional needs to be involved.Cross (op. cit.)
The suggestion here is that it’s somehow weird or even dangerous that the ICM doesn’t ordinarily require medical transition to receive signoff from a mental health professional (MHP).
Of course, what News Corp is relying on here is cis people’s, again, unspoken and perhaps inarticulable assumption (cis assumption) (cissumption?) that being trans inherently means you’re fucked in the head — or more specifically that you’re fucked in the head such that you can’t give informed consent (shuster, 2019). In reality, no aspect of transness impairs competence to consent in any way.
For trans children, the parents need to agree to any medical intervention before drugs are prescribed and they need to be assessed by mental health specialists in what can be a significantly longer process.Cross (op. cit.)
The movement from the previous paragraph to this one gives this the effect of suggesting that trans kids can also be sloppily and quickly ‘rushed’ into ICM care.
In reality, the fact that parents and MHPs have to be involved means the kids are by definition not receiving ICM care, so even if ICM care were reckless and negligent the way News Corp needs it to be, the implication would still be a lie.
However, psychologist Dr Roberto D’Angelo said some kids are still only having up to half a dozen sessions before being prescribed drugs.Cross (op. cit.)
News Corp somehow forgot to mention that Roberto D’Angelo is a clinical advisor to the Society for Evidence-based Gender Medicine (SEGM), a pseudoscientific anti-trans pressure group (Stahl, 2021; Kuper et al., 2022; Ring, 2022) which pretends to be supported by crowdfunding while actually being supported by large donations of opaque origin (Moore, 2021).
News Corp knew this, of course, but even if they hadn’t, D’Angelo isn’t exactly subtle about his views. His interaction with the public discourse is primarily through contributions to academic journals; on his profile on the academic social network ResearchGate (D’Angelo, n.d.), on the list of publications which he authored or co-authored, every publication since May 2018 (Clayton et al., 2021; Clayton et al., 2022; d’Abrera et al., 2020; D’Angelo, 2018, 2020a, 2020b, & 2020c; D’Angelo et al., 2020; D’Angelo et al., 2022; Malone et al., 2021) has been open advocacy for trans-hostile views. That’s 10 of his 13 listed publications, incidentally; talk about Riley’s law!4
[D’Angelo’s] own assessment of the evidence for the benefits and harms of puberty blockers is that it is too weak and inconclusive for him to support prescribing them to children, even though ‘in some cases they can have positive effects’.Cross (op. cit.)
It’s unclear in what way D’Angelo’s opinion of “the evidence for the benefits and harms of puberty blockers” would be at all relevant even if he weren’t being paid to hold it. The nature of the alleged harms is such that the specialists qualified to professionally evaluate them are endocrinologists, neurologists, and rheumatologists. D’Angelo doesn’t appear to be qualified in any of those areas, nor does it appear he’s talked to anyone who is. His judgement is no more relevant than mine.
[Charlotte Hespe] said that a lot of the kids are “troubled” and almost all of the ones she has seen have autism or Attention Deficit Hyperactivity Disorder (ADHD) and so “it’s tricky to navigate safely”.Cross (op. cit.)
In the first place, the current global standard for trans healthcare — the World Professional Association for Transgender Health’s Standards of care, version 8 (SoC 8) have something to say on this topic and they’re pretty clear about it:
There is no evidence to suggest a benefit of withholding GAMSTs from TGD people who have gender incongruence simply on the basis that they have a mental health or neurodevelopmental condition.Coleman et al. (2022), Statement 5.3.c, pp. S36–S37
In the second place, how the hell were “almost all” of Hespe’s patients either autistic or ADHD? It’s certainly been observed that trans people seem to have higher rates of autism and ADHD — respectively 3–6× (Warrier et al., 2020; Warrier & Baron-Cohen, 2020) and 3–7× (Becerra-Culqui et al., 2018) more common. However, the population prevalences of autism and ADHD are 1–1.5% (Warrier & Baron-Cohen, op. cit.) and ~4.1% respectively (Deloitte Access Economics, 2019), so in trans people they should be, at most, 9% and 28.7%.
Even if those populations were completely separate — which they’re not, lmao (Rusting, 2018) — they should make up fewer than 4 patients in 10. Does Glebe Family Medical Practice only accept referrals from the local fidget spinner and model train emporium?7 What’s the story?
[Hespe] said she tries to make sure her patients make “wise” rather than “irreversible decisions”.Cross (op. cit.)
The location of the quotation marks here strongly suggests this statement has been creatively chopped and screwed a bit. Whoever’s responsible for it, though, the intention is clearly to suggest that in this area, irreversible decisions and wise ones are mutually exclusive.
The reasons why this is a bad take and the reasons why someone would advance it anyway are both clear enough at this point that I don’t feel like I need to waste my breath further.
Out of more than 100 patients [Hespe] has seen in 22 years, she said only one person, who wanted to transition as an adult female to a male, regretted the effects of being on testosterone and surgery. They now identify as gender neutral.
“She had three lots of surgery,” Dr Hespe said. “Had breasts off, had breasts put back on, had breasts taken off again.”Cross (op. cit.)
In the first place, are this person’s pronouns “they,” or “she,” or both?
In the second place, I’m wondering whether this is a permissible disclosure by Dr Hespe. This seems like it would make it exceptionally easy to identify the individual described, which seems — note that I am not a lawyer — as if it might be questionable under the medical privacy provisions of the Privacy Act 1988 (Cth).
In the third place, I think it’s significant that News Corp has chosen to report this part. Previously they’ve largely focused on the suggestion that trans kids are too young to decide to transition (or to stop puberty) and that they’ll regret it later. This seems to mark a further advancement along the narrative line established by e.g. Robinson (2022) — beginning to suggest that “they’ll regret it later, so they have to be stopped,” applies not only to kids, but adults, too.
This is a logical advancement to push for. After all, if you can bring yourself to levy immense suffering, permanent damage and possible death on kids simply because they were unlucky enough to exist around you while being trans, doing it to adults should be a piece of cake.
Dr Hespe said the doctors need to make sure they “cross every single ‘t’ and dot every single ‘i’.” “If you don’t feel comfortable prescribing then don’t.”Cross (op. cit.)
This seems self-contradictory. You should “cross every single ‘t’ and dot every single ‘i’” — a saying which typically means being meticulous in your fulfilment of an established requirement, such as a standard of care — but also you can make a vibes-based choice not to?
I feel like there has to be an implied conditional statement here — if you want to prescribe, you need to make sure you cross every single t and dot every single i, but if you don’t, simply not “feel[ing] comfortable” is more than enough.
Meanwhile, Dr D’Angelo believes it can take months or years of therapy for some people to work through all their problems. He said many kids questioning their gender are also struggling with social anxiety, making friends or there’s family dysfunction, and think changing their identity will help.Cross (op. cit.)
I mean even if this wasn’t Roberto D’Angelo, wow, no way, a therapist thinks people might need “months to years of therapy”? Colour me absolutely shocked. Seriously though, this is such a blatant attempt to deprive trans people of capacity. “Months to years”? That’s “indefinitely”. That’s “never”.
Moreover, “changing their identity” is, as I’m sure D’Angelo knows very well, a blatantly malicious misrepresentation of what it’s describing. There’s a reason it’s called “gender-affirming” and not “gender-changing” — it simply supports and upholds what’s already there.
“Everyone now looks online when they are not feeling good about themselves,” Dr D’Angelo said. “Many of these young people feel desperate and are looking for a way to feel better. There’s a huge amount of material online which encourages transition which vulnerable, struggling and troubled teenagers may feel offers them a way out of their difficulties. Gender dysphoria and transitioning can sometimes seem like the explanation for their problems.”Cross (op. cit.)
Have we considered that “these young people feel desperate and are looking for a way to feel better” because they’re experiencing dysphoria, the condition literally defined as a clinically significant degree of feeling bad?
Have we considered that “vulnerable, struggling and troubled teenagers may feel” that “material online which encourages transition” “offers them a way out of their difficulties” because it actually does?
Have we considered that “gender dysphoria and transitioning can sometimes seem like the explanation for their problems” because they actually are?
He said he’s worked with several people who have transitioned when they were young but regretted it, saying “regret can take up to 10 years”.Cross (op. cit.)
Convenient. I don’t know if I’ve ever met a single person who was confident enough to say they knew exactly where their life would lead them in ten years’ time. If any possible regret is waiting so far into the tall grasses of the future that you can’t possibly see it when you’re standing out on the fringe, the only rational decision is not to venture in at all. In fact, the decision to go anyway might very well be considered insane …
Anyway, isn’t probability fun? Two other doctors quoted in this article report having patient populations in which the rate of autism and ADHD is near 100%, when all the other data we have suggests that the most impossibly high upper bound conceivable should be less than 4 in 10. D’Angelo, a single therapist in private practice — in fact a psychoanalyst, not a specialty known for treating gender-diverse people with acceptance and kindness (Evzonas, 2020; Saketopoulou, 2022; etc.) — seems well on his way to including among his clients not only every detransitioner but every detransitioner-to-be on the east coast. I wonder how he fares with Scratch-its.
He said one identified as male and had a mastectomy, a hysterectomy and ovaries removed. “When she came to see me she was identifying as male and very depressed,” Dr D’Angelo said. “She could not understand why as she had done everything she thought that could help (surgery), but she felt worse. It took two years to try and understand her history.
“She came to the conclusion she was not a man and that other things had led her to take these steps. It was eye opening. It was alarming. She only had a handful of appointments with a psychiatrist before transitioning. There were other more complicated issues that had not been adequately diagnosed and had never been addressed. She is now identifying as a woman. She is happy with her gender now but is dealing with enormous grief and is struggling to rebuild her life.”Cross (op. cit.)
While she’s not named, this has to be about Jay Langadinos — it’s a very specific backstory and the probability that D’Angelo has two patients who share it is realistically zero.
In that case, it seems apropos to introduce the facts that D’Angelo is leaving out; as Langadinos filed suit against her psychiatrist, Dr Patrick Toohey, and The Age and The Sydney Morning Herald reported on it (Szego, 2022), we’re lucky enough to have those facts on hand.
In short, the only “complicated issue” which Langadinos has alleged was unaddressed was social phobia, better known as social anxiety disorder (American Psychiatric Association, 1994). SAD
- is not a contraindication to transition
- does not impair capacity to give informed consent (Cundill, 2020),
- is — like everything else — not known to generate an illusory or transient sense of gender incongruence, and
- is known to be relieved by transition (Butler et al., 2019).
Moreover, Toohey urged Langadinos to seek treatment for it and she refused. By Langadinos’ own account filed with the New South Wales Supreme Court, which Szego (op. cit.) cites, not only was her phobia clearly and concretely diagnosed, but the reason it wasn’t addressed was because she didn’t want it to be.
D’Angelo is clearly trying to suggest that Langadinos was failed by the system, but Langadinos made her own choices. No one had even the hint of a justification to intervene to stop her.
A GP who prescribes cross sex hormones and puberty blockers to adults and children wishing to change their gender said they have to search for doctors like him that accept “patients are the experts in their own body”.Cross (op. cit.)
Once again, News Corp presents this as a matter of people “changing their gender,” rather than matching their bodies to the gender they have. At this point, it’s pretty safe to say it’s not accidental.
[Matt Barber] said the vast majority of GPs in Australia have little understanding in this space, which is why people seek out “gender affirming” doctors.Cross (op. cit.)
This seems like it’s supposed to at least allow the interpretation that Barber is an arrogant egotist, but it’s actually just uncontroversially true. While actual useful data regarding practitioner competence in trans care is thinner on the ground than I would like, the little that exists isn’t promising.
By way of example,
- Davidge-Pitts et al. (2017) found that in a sample of 411 United States practitioners who were members of the Endocrine Society, the proportion who said they’d never received training in trans healthcare was c. 81%.
- Christopherson et al. (2022) found that of a sample of 188 GPs and nurse practitioners working with trans patients in Saskatchewan, Canada, in 2019, the proportion who felt comfortable providing transition-related medical care was 30%.
- Irwig (2016) found that among endocrinologists attending an American Association of Clinical Endocrinologists conference, the fraction able to answer a fairly basic knowledge question about trans endocrine care was an eye-watering 5% (!!). You’ve got to hope things have improved.
He said in straightforward cases he is happy to prescribe hormones in just two sessions.Cross (op. cit.)
… I mean I already know the answer but is this supposed to be in some way wrong or bad?
In Australia “doctors are free to operate under their own opinions and beliefs”, Dr Barber said.
In the UK doctors have to follow new national guidelines for children with gender dysphoria, including carefully exploring any mental ill health issues.Cross (op. cit.)
In the first place, this framing makes it sound like it’s complete open slather in Australia, which is not the case at all. As the article later admits, in an extremely minimising fashion and with clear reluctance, there are set standards of care and doctors risk legal action by violating them. Given that doctors’ chain of command usually ends with their clinic, however, practitioners across Australia have broadly varying levels of independence in interpreting and implementing those standards as they see fit, depending on what their employer permits.
This is not the case in the United Kingdom. The status quo — which is currently in the process of changing, but toward an unclear end — is that there is only one paediatric gender clinic in the whole of the United Kingdom, the NHS Gender Identity Development Service (GIDS). “National guidelines” sound rather less impressive when you realise that they currently apply to a total of one clinic, which also contributes most of the data that underpin them, and which, in large part, directly writes them.
In the second place, UK doctors don’t yet “have to follow” any “new national guidelines” at all. The guidelines in question, which are the NHS Interim service specification for specialist gender dysphoria services for children and young people, are still in consultation and will be until 4 December (NHS England Specialised Commissioning, 2022). They have also been the subject of absolutely blistering criticism from every peak body that has at least one keyboard and internet connection (e.g., World Professional Association for Transgender Health et al., 2022).
The intention here is clearly that UK paediatric trans health practices should be understood as disciplined and careful, when they’re nothing of the sort — they’re an act of gleeful sadism motivated by the barely concealed inadequacy and resentment of an increasingly ailing UK government and increasingly openly reactionary British state.
[Barber] said almost all of his patients, both adults and children, are neurodivergent — meaning they have autism or ADHD.Cross (op. cit.)
In the first place, “neurodivergent” doesn’t just mean “has autism or ADHD,” as much as I and other autistics and people with ADHD sometimes act as if it did.
In the second place, this claim is no less improbable coming from Barber than it was from Hespe. Then again — Barber’s home clinic Stonewall is only 500 metres from Windsor traino.
[Barber] said he follows Australian guidelines promoted by AusPath — a group of health professionals working with trans people — that says gender affirming care is evidence-based and saves lives.Cross (op. cit.)
What an absolutely delightful paragraph. For relatively few words, there is so much going on.
AusPATH are the Australian Professional Association for Transgender Health, the Australian affiliate of WPATH, and the peak body for trans health in Australia. AusPATH are “a group of health professionals working with trans people” in much the same way that the Australian Army are “a group of people in green clothes who like guns”.
Being the peak body, AusPATH don’t “promote” guidelines; they set them. Nor is their setting of guidelines simply a matter of ineffectually wringing their hands and saying “well, doctors should do this, pretty please”. As noted above, civil action for medical malpractice rests largely on whether the defendant provided the standard of care which would be reasonably expected from a medical practitioner of that kind acting under those circumstances (Armstrong Legal, op. cit.). Those standards of care are precisely what AusPATH (and WPATH) define.
AusPATH can literally “promote” guidelines in the alternative common meaning to the one used here, i.e., raising them up: endorsing a protocol used by an individual clinic or in a small area, and distributing it under AusPATH’s aegis. That just effectively makes it another standard they set, though, not some other thing they’re shilling for.
Finally, the fact that gender-affirming care is evidence-based and saves lives isn’t a matter of what either Barber or AusPATH “says”. It’s simply true (Huckins, 2022; Matouk & Wald, 2022; Oliver, 2022; etc.).
[Barber] said for kids aged 14 to 16 years it’s a grey area, as they need parental consent while those aged 16 to 18 should be able to consent.Cross (op. cit.)
This also isn’t a matter of Barber’s opinion. “He said … those aged 16 to 18 should be able to consent” makes it sound like he’s winging it: “Oh well, they should be able to consent, it’s fine, she’ll be right”. That framing suggests his practice is endangering children left and right.
In reality, he’s simply accurately, and perhaps even slightly conservatively, summarising Australian and Queensland law. People under 16 have to either get parental consent, or actively prove they’re Gillick competent.8 People over 16 are assumed competent by default (Legal Aid Queensland, 2022).
But he said the rates of people regretting going on gender affirming drugs is ‘almost zero’ and those taking it see an upswing in their mental health.Cross (op. cit.)
Again, this is not simply something Barber “said”. Not only is it true that regret rates are close to zero, they have remained stable or dropped over time.
- Smith et al. (2004) found that in a sample of 162 trans adults at 2 gender clinics in the Netherlands, the number who “expressed regrets” was 2 (1.4%).
- Davies et al. (2019) found that of 3,398 British trans adults, the number who experienced transition-related regret was 16 (0.47%) or fewer.9
- Turban et al. (2021) found that, among respondents to the 2015 U.S. Transgender Survey, of the 2,242 who reported a history of detransition, 54 (2.4%) endorsed “uncertainty or doubt around gender” as a factor.
The usual argument at this point is “oh but even one is too much!” which is obviously bullshit both on principle and in practice. For instance, Wilson et al. (2017), reviewing patient decisional regret around surgery — all surgery, of any kind — found that in the studies reviewed, the “average prevalence” of “self-reported patient regret,” which they described as “relatively uncommon,” was 14.4%.
Moreover, the fact that “gender affirming drugs” cause “an upswing in [trans people’s] mental health” is not realistically in any doubt.
- St Amand et al. (2011) found “clear evidence that HRT is associated with improved mental health outcomes”.
- Colizzi et al. (2014) found that “psychiatric distress and functional impairment were present” in a significantly lower percentage of subjects after 12 months of HRT.
- Bouman et al. (2016) found that “the use of cross-sex hormones … appears to be associated with psychological benefits”.
I have about 40 more studies here on this topic and I could go on but 3 is enough because we all already know this. Only News Corp is pretending it’s news — I can’t imagine this is the first time someone’s said that sentence.
[Barber] warned that if Australia followed the UK route and more barriers were put in the way of people seeking to transition it could result in people taking their own lives.Cross (op. cit.)
Yet again, this is clearly supposed to be at least open to being interpreted as an activist doctor intentionally overselling the politically correct narrative, and again, it’s simply objectively true.
As noted in the withering WPATH-led joint statement in response which was published 25 November (World Professional Association for Transgender Health et al., op. cit.), virtually every change made by the NHS draft service specification (NHS England Specialised Commissioning, op. cit.) is in a direction comprehensively demonstrated to increase the risk of suicide.10 Among the more significant such changes are:
- “discourag[ing] social transition in pre-pubertal children” (WPATH et al., op. cit., s 6), even though denial of social transition is known to increase suicidal ideation (Pariseau et al., 2019);
- “severely limit[ing] access to puberty suppression” (WPATH et al., op. cit., s 7), even though denial of access to puberty suppression is known to increase suicidal ideation (Rew et al., 2020; Turban et al., 2020);
- refusing to “describe any process for provision of estrogen or testosterone therapies for older adolescents” (WPATH et al., op. cit., s 7), even though denial of access to HRT in adolescence is known to increase suicidal ideation over the remainder of the patient’s life (Turban et al., 2022);
- a “‘psychotherapeutic’ approach, which was used for decades before being superseded by evidence-based gender-affirming care, [and] has not been shown to be effective” (WPATH et al., op. cit., s 9), even though the approach “is tantamount to ‘conversion’ or ‘reparative’ therapy” (ibid.), a form of torture (International Rehabilitation Council for Torture Victims, 2020) which is known to be linked to increased incidence of suicidal ideation and suicide attempt (Turban et al., 2019; Green et al., 2020).
Once again, Barber’s statement is not a matter of opinion — scientific investigation has repeatedly and exhaustively shown it to be thoroughly factual in every way. News Corp’s decision to present it as simply a personal warning from one source spun heavily as dubious does not reflect a commitment to informing readers of the truth — but then again, that won’t be news to anyone.
I usually don’t bother wasting the effort required for a Several Problems on any News Corp outlet; “Never wrestle with a pig,” etc. (Quote Investigator, 2017). There’s basically no overlap between people who read my work and people who think News Corp is credible. This particular masthead is so well known for being toilet paper that there’s a local proverb (e.g., Page, 2016) and multiple songs about it: “Is it true, or did you read it in The Courier-Mail?” (e.g., Future Primitive, 2020; The Mangroves, 2022).
However, I think it’s occasionally useful to check in on them and see how everything is going over there on the other side – see what shape the hate campaign is taking today. News Corp is suggesting trans people are fake, artificial, predatory, a danger to kids, backed by a doctors’ plot and a captured state. It’s not good news, nor is it surprising., but keeping track of the tropes can be useful in determining where fires are being set, why, how — and, ideally, for whom.
If you thought this article was good or in any way useful — I’m honoured! I hope you will consider supporting my work via Ko-fi, Patreon, or PayPal so I can continue to sustain the absolutely obscene and unremitting expenses of remaining alive.
If you thought this article was bad, please feel free to contact me at either of my two email addresses or any of my four million social media and messaging accounts. Annihilate me so that it will finally be over and I can finally rest.
(You can also contact me if you thought it was good, or if you’d like to say hi.)
1 — “Original poster,” or “original post,” depending on context (e.g., the OP said in the OP …).
2 — It really does! All exogenous hormones (i.e., hormones from outside the body — “hormone drugs,” if you will) currently standardised and widely used in gender-affirming care are bioidentical (i.e., exactly chemically identical to those produced by the body).
3 — Self cite lmao, cringe
4 — The maxim that “once you post transphobia you will never post normally again,” popularised by Alice Caldwell-Kelly (2020) of Trashfuture, who may have been quoting or summarising a remark by Trashfuture colleague Riley Quinn.
5 — Gender-affirming medical or surgical treatments.
6 — Transgender and gender-diverse.
7 — I have both of these conditions and am therefore allowed to make this joke.
8 — Competent according to the test stipulated in the UK House of Lords case Gillick v West Norfolk and Wisbech Area Health Authority  AC 112, which was adopted into Australian law by Secretary, Department of Health and Community Services v JWB and SMB (1992) 175 CLR 2018 (“Marion’s case”).
9 — 16 subjects “expressed transition-related regret or detransitioned,” which are, while intuitively clearly associated, not mutually inclusive.
10 — Trans-eliminationists often claim that the data means nothing because it’s based on proxy parameters, typically suicide attempt and/or suicidal ideation. In doing so they’re seemingly relying on their audience not to realise that they’re saying “data about suicide doesn’t count unless you get it by interviewing people who are dead”.
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