Journalists & youth gender clinics, THREAD #health

At a gender clinicians' meeting in 2018 @RCHMelbourne's Dr Ken Pang predicted new referrals of under-18s at Australia's busiest clinic would plateau by 2019, but keep rising until 2023 at the UK Tavistock GIDS clinic.

Dr Pang, who runs research at the RCH Melbourne gender clinic, documented spikes in new referrals following high-profile media coverage by Australia's public broadcaster @abcnews & @theage newspaper showcasing the clinic & positive stories of under-18s on hormonal treatment.

In line with the "gender affirming" narrative that media coverage promotes awareness of an inner trans identity immune from outside influence Dr Pang reportedly told the 2018 meeting: "What I'm not saying is that this media is turning cis (non-trans) people into trans people".

In 2019 RCH clinic director Dr Michelle Telfer said it was "really interesting" that a @4corners program, with "intelligent, articulate" transgirls from her clinic, went to air just before Victoria's Labor govt came to power & gave the clinic a "life-saving" $6m funds injection.

Dr Pang's 2018 projections missed the mark. At RCH, referrals were still rising in 2019: 336 more patients, 1,767% up since 2012. At the UK GIDS clinic, new referrals appear to have peaked in 2018-19 (treatment trends outside big public clinics are unclear).

In a September 2019 paper Drs Telfer & Pang declared that the exponential growth of teenagers in gender clinics might in fact be "just the tip of the iceberg".

In July 2020 Dr Pang co-authored a paper showing a correlation between 2,614 media items on trans & spikes in new referrals at the RCH & GIDS clinics 1-3 weeks afterwards. The authors, among them GIDS director Dr Polly Carmichael, suggest it's "growing awareness" at work.

They cite historic low rates of treatment regret (without noting reasons for scepticism, eg failure to track down many former patients). But, for a gender affirmation paper, there's an unusually neutral acknowledgment of the social contagion risk raised by their critics.

Also noteworthy is gender affirming clinicians citing papers by @LisaLittman1 & @LisaMarchiano which suggest that social contagion may help explain the post-2000s "flip" in patients from mostly pre-school biological males to mostly teenage biological females.

The paper involving Drs Carmichael & Telfer also recognises that the historic low rates of regret relied on by gender clinics today may not apply to the post-2000s group of teenage-onset patients diagnosed with gender dysphoria (or distress at feeling "born in the wrong body").

The authors imply that the 2009-2016 media coverage they tracked was mostly pro-trans -- it would be odd if negative coverage were associated with rising referrals --- but they hedge on this point.

It's true that investigative journalism in the UK (notably @BBCNewsnight & @thetimes) has recently begun detailed scrutiny of gender clinics & their medical treatments. UK media has also picked up the stories of regretful "detransitioners", who have impact on social media.

These first-person accounts from young people, many of them lesbians, who warn others that hormones & surgery did them harm, also turn up in the Trans Train reports by the program @granskning in Sweden, where 2019 referrals were reportedly down 65%.

With some exceptions, mainstream media frames self-identified trans status as an uplifting "identity rights" struggle -- like same-sex marriage -- & ignores the gender clinic medical debate & the concerns of women & LGB groups about risks & conflicts.

With the self-ID trans topic, vague outrage gets more prominent media coverage than what was actually said, making the backlash puzzling to most people. (When medically transitioned trans adults raise concerns about under-18 gender clinics, they are rarely reported.)

Melbourne-based philosopher Holly Lawford-Smith was struck by the missed opportunity of this coverage.

A search of the @abcnews website for the term "transgender" gives 8,930 results. Zero results for "detransitioner", "detransition" or "detransitioning". Google gives 11,500,000 hits for the term detransition.

The Australian public broadcaster's flagship program for investigative journalism @4corners, which in 2014 showcased the RCH clinic & transgirls, returned in March 2020 with a program on non-binary teens called "Not a boy, Not a girl".

One non-binary teen says: "I love my body the way it is". Other teens suggest testosterone & mastectomy saved them from suicide. The program shows little curiosity about how to explain these starkly different non-binary worldviews, as if they are personal choices beyond question.

The teens come across well & the program engages on an emotional level. It gives viewers no real idea of the serious global debate about medical ethics & evidence. Executive producer Sally Neighbour did tweet a "landmark study" for those "interested in the science".

This study, based on a low-quality anonymous online survey run by trans activists, claims puberty blocker drugs prevent suicides. Malcolm Clark of @ALLIANCELGB explains its weaknesses here https://twitter.com/TwisterFilm/status/1222662489911058432?s=20

The July 2020 paper on media coverage & clinic referrals says clinics are getting more referrals from non-binary patients & wonders whether media coverage has something to do with this.

In May 2020, Drs Pang & Telfer along with ethics experts put out a paper, "Forever young?", which deals with a hypothetical 18yo patient, Phoenix, a biological female who wants to stay on hormone suppression drugs for life, and never go through puberty.

The authors say that "distributive justice" may favour surgical removal of Phoenix's ovaries as the anti-puberty solution, because it's cheaper, but conclude it's "ethically defensible" to go ahead with puberty blocker drugs forever -- "ongoing puberty suppression" or OPS.

Australia's health minister @GregHuntMP has asked the country's top health bureaucrats to examine concerns about gender clinics -- including over-representation of autistic youth -- but @abcnews @theage & other "progressive" media have failed to report this.