Psychiatry body takes cautious first step on treatment of gender dysphoria

The Royal Australian and New Zealand College of Psychiatrists (RANZCP), the top psychiatry body for Australia and New Zealand, has taken a modest step in the right direction in the field of healthcare for people with gender confusion, with its recent position statement acknowledging the evolving international evidence regarding healthcare and the use of puberty blockers. This move is in contrast with the prevailing approaches of children’s hospitals and may indicate a slow turning of the tide in the medical discourse around treating children with gender confusion.

Although remaining supportive of “Trans and Gender Diverse” people, the RANZCP declined to unequivocally endorse gender-affirming care as the primary intervention for children questioning their gender identity. This cautious stance aligns with developments in several European countries, where there has been a re-evaluation of the medical pathway for transgender youth due to a lack of conclusive evidence supporting it.

The plight of detransitioners – individuals who have reversed or regret their gender transition – was acknowledged by the RANZCP. The college recognises the potential harms that medical transition can cause, a fact reported by an increasing number of detransitioners. This acknowledgment is crucial in understanding the complex nature of gender dysphoria and the impacts of medical interventions.

In addition, the RANZCP has made an unambiguous declaration regarding the definition of sex as a biological characteristic. The college states that sex is a binary biological reality for the vast majority, despite the existence of intersex individuals:

“Sex refers to the biological characteristics that define humans as female or male. While these sets of biological characteristics are not mutually exclusive, as there are individuals who possess both, they differentiate humans as males and females in the vast majority of people”.

The RANZCP’s position also acknowledges a diversity of professional opinions on the best approach to treating children with gender distress. The statement references the fallout from the Cass review in Britain, which highlighted concerns about the Tavistock clinic in London, where numerous children were rapidly put on hormone treatments without adequate oversight.

The statement emphasises the importance of a multidisciplinary approach, including psychological, social, and medical interventions, and calls for caution in the use of hormonal and surgical treatments, screening for coexisting conditions, and providing psychosocial support to explore gender identity.

The College’s position seems consistent with the approach advocated by HRLA client Dr Jillian Spencer.  Dr Spencer favours a cautious and holistic approach to treating children, and has expressed concerns that the “affirmation approach” does not allow for adequate investigation of a child’s declared gender identity  Despite her views finding apparent support in the RANZCP’s position statement, she is currently being investigated by her employer, a public hospital, for expressing these professional opinions.

Dr Spencer has lodged a complaint with Queensland’s Human Rights Commission, claiming a breach of human rights under the Queensland Human Rights Act 2019. HRLA is representing Dr Spencer in this complaint.

The RANZCP position paper represents a modest but important brake on the direction of the debate around gender dysphoria in Australia, and may indicate that the tide is turning in Australia as it has in other countries.

By advocating for a comprehensive approach that goes beyond just medical interventions, the statement emphasises the mental and emotional wellbeing of the child. This shift may lead to a more positive approach to the issue going forward, one in which health professionals are not penalised, as Dr Spencer has been, for adopting a cautious, holistic approach to treating people with gender confusion, and allows for the use of clinical and professional judgment in individual cases.