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Denying trans teens treatment ‘cruel and unethical’: GP
The UK’s Cass Review calls for puberty blockers to be limited in favour of mental health support, but local GPs say access to care is key in Australia.
Around 1.2% of Australian school children are thought to identify as transgender.
A new report into gender-affirming care in the United Kingdom has created sweeping and divisive changes to its healthcare system, but Australian GPs are concerned about applying its recommendations locally.
The Cass Review, named after its Chair, high-profile paediatrician Dr Hilary Cass, was commissioned by the NHS to recommend how best to improve gender identity services and ensure children are offered the safest and most effective care.
Handing down her findings last week, Dr Cass made 32 recommendations for change, the most prominent of which was to severely limit young peoples’ access to puberty blockers due to a lack of information and scientific evidence about their impacts.
‘The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health,’ the report said.
‘The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population.
‘The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.’
A ban of the medications was formally adopted by the NHS before the review’s official release, after it agreed there is ‘not enough evidence to support the safety or clinical effectiveness’ of the drugs.
But health experts in Australia have warned against comparing our healthcare system to the NHS, saying the review’s findings cannot be directly compared.
RACGP Specific Interests Transgender and Gender-Diverse Healthcare Chair, Dr Michelle Dutton, told newsGP Australia has been actively working towards improving accessibility of care for transgender people at all levels of the healthcare system.
She said while this is becoming increasingly available, there is more to be done, and the Cass Report does not consider the harms which occur when young people are denied access to treatment.
‘School refusal, impact on relationships with self and others, suicidal ideation, and self-harm are very real consequences of young people not being supported in the way that they need to be, and this does not seem to be acknowledged as much as it should be,’ Dr Dutton said.
‘Gender-affirming care in Australia, especially for young people, has always emphasised a holistic, patient and family-centred approach which recognises the complexity that exists around helping young people make important decisions about their bodies and their health.
‘Research and evaluation of outcomes is already embedded in many of our tertiary gender services in Australia.’
The Cass Review recommended that gender-affirming services operate to the same standards as other services seeing children and young people with complex presentations and additional risk factors.
It also called for services to establish a separate pathway for pre-pubertal children and their families, and extending services for regional children.
But in Australia, Dr Dutton said more data is needed to allow GPs to offer best-practice patient care.
‘We all want what is best for our patients and our patients deserve that,’ she said.
‘Data is currently limited because trans healthcare research was not given the funding it deserved until relatively recently, but to then use this as a reason to deny trans people access to certain treatments is cruel and unethical.
‘We can help guide people in decision making where uncertainty exists without denying treatment altogether, and we can do this while continuing to gather data to inform future shared decision making – it cannot and should not be one or the other.’
It is currently estimated around 1.2% of Australian school children, about 45,000 young people, are thought to identify as transgender; however, the true prevalence remains unknown.
Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, told newsGP giving young people access to multidisciplinary teams and specialist services is key, but currently lacking in Australia.
‘The children’s hospitals, we need clinics in this area, and we need more and better access to them because there is very limited access at the moment,’ he said.
‘It’s also really important that access is given from a GP point of view too, because we want to be able to refer our patients to that sort of service.
‘It’s all about the multidisciplinary team approach because that’s really the appropriate setting for these children.’
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