I should start this article by stating my credentials. I am not a psychologist, psychiatrist, or paediatrician; however, over the course of 50 years of medical practice I have looked after my fair share of children, adolescents, and adults, in many countries and many cultures. I am also a concerned parent and grandparent.
Over this time, I have witnessed a disturbing rise in youth behavioural problems in Western society and seen the description of new psychological conditions as an explanation of what used to be called anti-social behaviour.
Autism was once a clearly defined medical condition; the rapid rise of an alphabet of behavioural disorders such as ADD, ADHD, OCD, ODD, and autism ‘spectrum’ (ASD) leave parents at a loss. Does this outbreak of mental illness relate to excess screen time (from phones, computers, and tablets), reduced parental input, poor class discipline, dietary factors – or does the availability of financial reward from the National Disability Insurance Scheme (NDIS) feature?
Some believe that a few of these new disorders have become a fashionable excuse to explain bad behaviour.
‘Mission creep’ has also occurred in other psychiatric areas. Having been recognised relatively recently in 1980 as a medical condition, the explosion in the diagnosis of gender dysphoria leads to concerns it might also be a fashionable, attention-seeking diagnosis for many – one with potentially hazardous consequences for children.
The current trend of gender education at an earlier age is likely to produce more candidates for gender confusion, leading to hormone therapy or worse. That this could possibly happen without parental input in those who are below the age of consent, should set alarm bells ringing. The recent Northern Territory plan to treat those identifying as transgender without parents’ consent, at as young as 14, has taken the debate to another level.
Statistics confirm the trend, with numbers referred to the Tavistock Centre and the UK gender development identity service (GDIS) increasing from 200 in 2011-12 to 2000 in 2016-17. Similar statistics, with several thousand percentage increases, have been reported in other countries. The reason for this increase is yet to be elucidated.
Is it due to trending on social media and attention-seeking? Is it due to educational input? Is it perhaps a consequence of chemicals in the diet – so-called endocrine-disrupting chemicals (EDC’s) have been suggested as a cause of falling sperm counts and infertility? The fact that a big part of this increase occurs in adolescents without previous concerns, suggests social media involvement is important.
A prominent whistle-blower, Psychiatrist Dr David Bell, worked at the Tavistock Centre in the UK for 15 years. He revealed non-evidence-based records, with little documentation of indication for, or outcome of, treatment.
The High Court subsequently ruled in 2020 that children under 16 were not able to give consent. Prior to this, children as young as 8 had been given hormone blockers, with the potential for permanent sterility, moving on invariably to take cross-sex hormones at puberty.
With the knowledge that three-quarters, left untreated, change their minds at puberty, and as many as half presenting with mental disorders, it is staggering that this situation has been allowed to occur. The growth in gender reassignment surgery, which usually follows, is even more disturbing, with operations increasing in Europe and America with 10,000 to 15,000 having had surgery in France alone.
We are starting to witness the blowback, with those permanently disfigured looking for legal redress.
Australia has also seen an explosion in numbers referred to gender clinics. In 2003, the Melbourne Royal Children’s hospital had only a single case, they now have 200.
Studies from the US have suggested that as many as 10 per cent of students now believe themselves to be transgender, this for a condition that as recently as 20 years ago, was thought to occur in 2 or 3 per 100,000. The ongoing concern is that medical and surgical interventions may turn ‘a healthy child into a patient for life’.
Underlying these treatments is a remarkable lack of evidence of long-term benefit, with transition failing to improve mental health and subsequent regret featuring strongly. There is also a physical downside from cross-sex hormones, with a five-fold increase in heart attack and strokes. The incidence of suicide, one indication for commencing treatment, is comparable with the degree of psychiatric illness and is not altered. It appears that gender dysphoria is perhaps a better marker of homosexuality in very young people than a desire for transition.
The movement to treat younger age groups came from the perception that earlier commencement could lead to a more acceptable, less masculine appearance. A Dutch gender clinic initiated the studies on those who had had identity issues from childhood and had no mental health problems. Their conclusions have been expanded to include adolescents and those with psychiatric disorders, who were never part of the original study.
Three-quarters of these gender issues in children are female to male, whereas in the adult group the sex ratio is for some reason reversed, with an incidence of 0.005-0.014 per cent in males and 0.002-0.003 per cent in females; the reason for this difference is unclear. Surveys of adults from America suggest a higher range, between 38 and 500 per 100,000 (0.38 to 0.5 per cent), with as many as 1 in 4 seeking surgery. In Europe, 1 per 30,000 adult males seek gender reassignment surgery and 1 per 100,000 females.
Despite these tiny numbers, the LGBTQ+ lobby has already invaded the debate by suggesting the whole population should adjust personal pronouns to accommodate gender fluidity. They go further by demanding that the ability to identify as a different sex should be determined by the individual, without medical or legal input, a situation courting disaster.
The current debate plays out in many areas of society.
Particular concerns have been raised about transgender individual’s participation in women’s sport. These issues also apply to children’s sport. A few sporting organisations, such as women’s rugby, have grasped the nettle and prohibited what is plainly an unfair physical advantage. Too many, including the International Olympic Committee, have squibbed decision-making for fear of an activist pile-on and passed the dilemma on to local sports committees. In Australia, Sport Australia released guidelines to encourage transgender inclusion. Whilst fulfilling human rights aspirations, they have not addressed the resulting disadvantage to women.
The feminist movement has remained unfathomably silent, despite the obvious implications. Those who have questioned the concept, such as children’s author JK Rowling or current LNP candidate Katherine Deves, have been subjected to vitriolic online trolling. Fortunately, female sportswomen, such as Martina Navratilova and, in Australia, swimmers Emma McKeon and Emily Seebohm have spoken out.
Recent sporting examples include weight-lifters and swimmers achieving success by claiming transgender status, the vast majority being those who have transitioned from male to female.
Attempts to bypass the issue by claiming athletes’ low testosterone levels will achieve equality, have failed to address the differing strength and endurance between the two sexes. The fundamental issue is unfairness in competition, achieved by the time of puberty, resulting in a 10 per cent advantage. Having switched from male to female competition, the American swimmer Lia Thomas moved from 65th to first in university rankings.
There are many other aspects to this trend. Biological males, with male genitalia, can claim female status and demand admission to change facilities, toilets, and social and sporting events. Legal issues become another minefield, particularly involving parenting. An example of how this can go wrong was the discovery of two pregnant women in a female jail in America – there were also 27 men claiming transgender status! The potential threat to adolescent females from males claiming gender dysphoria is obvious, but any discussion is currently considered discriminatory by the LGBTQ+ lobby.
As a retired doctor with significant experience, I am concerned about these developments. The advent of what may be considered surgical mutilation has been practiced for male to female transition since the 1960s, I saw my first male to female procedure in 1967 in London. It is an expensive procedure with a cost up to $30,000 in Australia.
The surgical procedures, in either direction, have significant risk attached and there is little evidence of ensuing improved life satisfaction; indeed, allowing for pre-existing psychiatric illness, their suicide rate was still 2.8 times that of a control group. There may also be the need for additional surgery for face and chest, Medicare may cover the ‘bottom’ surgery but other procedures are usually considered cosmetic.
Adult sex-change is a decision for the individual, but there should be clear legislation as to what the implications of this change are, the current management of children and adolescents is unacceptable. Some countries, such as Finland, have banned all treatment apart from psychotherapy, until the age of 18.
I do not wish my grandchildren to be put at risk on or off the sporting field. The rights of the majority should remain paramount. It is depressing that public figures and politicians run for cover for fear of upsetting activist minority groups, even more so that feminist groups fail to involve themselves.
It’s time to stand up and be counted.
Dr Graham Pinn, FRCP, FRACP, FACTM, MRNZCGP, Retired Consultant Physician.
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