As Australia bravely publishes the world’s first treatment guidelines specifically written for transgender children (https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf), it is sure to get it’s fair share of criticism.
However, in highlighting the country’s progressive approach, the shortcomings in the provision of healthcare to gender variant children here in the UK, are plain to see. As a doctor with a passion for fair and equal gender care I am delighted to see such a bold, honest and open approach. In line with this, I have outlined the key learnings from which I feel practitioners here in the UK can benefit, in order to improve the situation for our younger patients. Because, let’s face it, with incidence of suicide attempts and self harm among this group at such alarming levels, the current rigid protocols just don’t seem to be working.
Australia believes in…
1. Individualised care
Every child is different. Ask any family that has more that one child – same parents, same parenting, different children. We are all delightfully different. As different as a group of office workers, as different as a staffroom of teachers. We are all unique and in the UK we have become used to being treated as such. Unless that is we are gender variant, and then a one size fits all ‘protocol’ seems to be applied.
2. Capacity to consent
The belief that a child has the capacity to determine their treatment pathway is a controversial one for many here at home. But in reality what this is promoting is: listening to the child, hearing their story, learning from them. Asking them what they understand and helping them to find out more where they are unsure. The protocol driven approach can ignore the perspective and voice of the individual on the basis of them being too young to understand. The result is that many younger patients are left feeling that promises are made that never seem to materialise. Something no one – let alone a child — should have to endure.
3. Prescribing medication for children that will affect their fertility
I have met so many trans women who would love to be able to carry a child. Imagine how heart breaking it is for any woman to not be able to conceive when they long to. We have all seen the pain and anguish that can cause. Trans women don’t have a womb, so they can’t get pregnant. Trans men can’t impregnate a woman for them to conceive. When considering the issue of children consenting to treatment that may impair fertility, consider a child with cancer who may have to store eggs or sperm in order to preserve the genetic material that will allow them to become a biological parent in the future. They aren’t told that they should wait until they are 16 to make that decision. Because they may never reach the age of 16.
4. Treatment according to capacity to consent and understand, rather than by age
When are we ever old enough, wise enough or clear enough to accept the full risks, benefits and side effects of any intervention? Parents and children with heart disease, diabetes, a broken leg or a brain injury have to make some pretty serious decisions about their future. Yes the trans children we are talking about are very young, but does that mean we should make them wait purely based on age? Force them to go through the wrong puberty and live with the lifelong physical changes that this brings? These children are asking politely for help with puberty suppression so they don’t feminise or masculinise inappropriately. And then they ask to go through puberty with their peers. Is that so wrong? Australian experts in the field don’t think so.
5. Medical intervention based on professional consensus, rather than evidence based research
So many professionals hide their lack of knowledge and understanding in relation to gender variance behind the ‘lack of evidence’. It is too late – not to mention highly unethical – to conduct a study in which we give one hundred children the treatment they yearn for, while withholding it from another one hundred children; and compare the results.
All of the parents, children, doctors and psychologists and nurses who have first hand experience in this field say that this treatment is very safe. Australia has realised that if we wait for the evidence, too many children and young people will suffer and tragically lose their lives. The days of a trans woman walking down the street as a picture of ridicule should be over. Our trans children today can and should have access to the help and treatment that will allow them to ‘blend in’. Australia will be the first country to lose the image of the ‘man in the dress’ or ‘butch lesbian’ because their transgender and non-binary children will have better access to the right treatment at the right time and will never have to develop breasts, beards, hips, Adam’s apples, big hands, small feet – or endure the invasive surgery of having them removed.
The UK is considered to be a forward thinking nation. The NHS a flagship to be admired. But in its approach to treating transgender patients – both young and old – I feel it is sorely lacking.
Those who try to rally against the old ways, those who challenge, who are not afraid to stand up and be counted are not encouraged but squashed. I am no longer able to practice as an NHS GP, I have been under lengthy and extensive investigation by the GMC, I have been rejected by Healthcare Inspectorate Wales. Why? Because I treat transgender adults and children with the respect, compassion and where appropriate medication to which they have every right. Because I did what Australia has been brave enough to publish as best practice.
Well done Australia.