A warning about the “major risks associated with gender affirming care” published in a top psychiatry journal is set to intensify the debate regarding this experimental and highly controversial field of medicine.

George Halasz, Monash Medical Centre child and adolescent psychiatrist, and Andrew Amos, a psychiatrist who previously held a training role with Queensland’s health department have published an article in the journal Australasian Psychiatry, publicly calling on doctors to resist the ideological activism that has triggered widespread ‘subordination of clinical governance to social and political goals’ in the rush to affirm distressed children’s chosen gender.

The two experienced psychiatrists urge doctors to heed the lessons learnt from the healthcare scandal at London’s Tavistock clinic and related compensation cases in the UK.

They highlight the importance of doctors having the freedom to question the evidence base of affirmative medicine:

“The natural history of gender dysphoria suggests two critical ethical questions: first, is the ‘transition pathway’ – social, medical or surgical – in the best interest of the child?” the two psychiatrists wrote. “Second, is that pathway consistent with the principle ‘first, do no harm’?”

Expanding on their article in an interview with The Australian newspaper, Dr Halasz said:

“I think it’s wise that any hospital that has been following what’s happened to the Tavistock to start to distance itself as much as possible, as urgently as possible, lest they suffer the same fate,” … “What I would ask is, where is the transparency? Where (are) the outcomes of the procedures, whether they are social transitioning procedures, or medical procedures of prescribing puberty blockers or cross-sex hormones?

“And where is the data on the number of surgical interventions that follow after the Royal Children’s Hospital care is finished and these patients transition over to adult services? Where is the data? Or the follow-up to document detransitioners? Where is the evidence?”

They have also expressed concern at the lobbying by activist groups which they describe as “aggressive and intimidatory”, and which has led to a culture of intimidation and fear. They refer in particular to the treatment of HRLA client Dr Jillian Spencer:

[Dr Amos] said it has been very difficult to get psychiatrists to make public statements about gender dysphoria even though the majority appeared to share a more moderate, exploratory approach. Doctors were afraid for their professional reputations.

“The major reason for this fear is that trans advocates appear to be both aggressive in their rhetoric, and unwilling to engage in any discussion that does not adopt their basic viewpoint… the protracted suspension of child psychiatrist Jillian Spencer for expressing an alternative view of the approach to gender dysphoria appears to have confirmed the real threat behind such fears.”

Dr Halasz is also concerned about the breach of trust between parents and psychiatrists that has occurred, with psychiatrists overriding parent’s “gut instinct for caution over affirmation”:

“Our profession is entrusted by parents to do what’s in the best interest of their child,” he said. “The trust that we have built up with families over years, I believe, actually has been absolutely shredded by this process”.

Dr Spencer, with the assistance of HRLA, will be challenging the requirement by her employer to use preferred pronouns and names and keep all clinical records according to a patient’s preferred gender identity. 

Her case will be important in the defence against compelled speech and the harmful imposition of unscientific political ideology onto medical practice – an ideology that is evidently failing to protect children.

This latest publication from Dr Halasz and Dr Amos represents an important and long overdue contribution to the ongoing debate about a field of medicine that is highly contested, lacks robust evidence, and is evolving rapidly.