Episode 2

Warning: this episode contains discussion of suicide. Listener discretion is advised.

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Michael Biggs

the Dutch Protocol is used to describe a new kind of drug and a new drug regime that was introduced in the Netherlands in the 1990s and the idea behind it was to transition children much younger. So before then the convention had been that you took, started taking cross sex hormones at the age of 18, maybe 16 at the earliest, but children, there was no medical intervention for children. The Dutch, the Dutch Protocol meant that you use this new type of drug, called puberty blockers, well became known as puberty blockers, the drug itself is gonadotropin releasing hormone agonist and then you could start children on the process, the medical process of physical transition at the age of 12. Puberty blockers at 12, cross sex hormones at 16 and at 18 you’d start the surgeries.

In Australia and around the world, this has become known as gender affirming healthcare. But there are significant differences in the way it’s being applied now, compared to the early Dutch research. And those differences could mean that thousands of kids might grow to regret their medical transition.

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Welcome back to Desexing Society. I’m your host, Stassja Frei. Episode 2: The Dutch Protocol

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Dr Michael Biggs is an Associate Professor of Sociology at the University of Oxford. He researched the evolution of the Dutch Protocol and reported his findings in a 2022 paper titled, The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence.

Michael Biggs

The driving force behind this was a Dutch psychologist called Peggy Cohen-Kettenis and she had worked [fade]

Peggy opened the first youth gender clinic in Europe in the late 1980s. She had the idea that if transsexuals transitioned young, they would pass better as the opposite sex which would be good for their mental health. So she decided to test her theory by referring 16 year olds for cross sex hormones.

Michael Biggs

And then she did some follow up interviews and she said that the children that were transitioned from 16 onwards, actually when you followed them up in their early 20s they’re doing much better than the older transsexuals, the much older transsexual who transitioned much later in life.

But there were a few things Peggy didn’t consider when comparing the young transsexuals with the older transsexuals who had grown up in the 50s and 60s. One was that times had changed. There was far more tolerance of gender non-conformity and transsexualism for the younger group, possibly contributing to better mental health outcomes. Also, the young transsexuals hadn’t reached a stage in life where they might regret not being able to have children. And, few of them had formed intimate relationships so it was unclear how transition would affect their sex lives or even their ability to find a partner.

Michael Biggs

Her comparison didn’t take account of these two major differences both in the sort of historical era but also in the place of the lifecycle that these people, these two groups of patients were, but she thought aha, the younger you do it, the happier they are, the more well adjusted they are, the better they pass and therefore if we if we take that logic to its logical conclusion we should start as soon as puberty hits. So it was definitely done with very good intentions but with very bad, not very good robust data to back it up. 

And so they tested it out on a young, gender non conforming lesbian. Known as FG, the girl was insistent since age 5 that she was a boy. At 13 she attended the gender clinic and was prescribed puberty blockers. Three years later she returned to the clinic and the doctors were very impressed with her boyish appearance. In their mind, the treatment was working great. 

Michael Biggs

And I think it’s very interesting in the case of FG that they would, they introduced FG to older male FtMs

FtM is short for Female to Male, also known as, trans men.

Michael Biggs

They could’ve introduced her to older butch lesbians and said that’s also a possible path – that’s a pathway that doesn’t require any medical intervention, and you could still have a baby and still, your reproductive and sexual aspects of your body aren’t affected in any way. 

If this is starting to sound like a medical experiment to correct homosexuality in children, well, that has certainly been pointed out by many older gays and lesbians. But more on that later. All up, FG was puberty blocked for 5 years. At 18 she started testosterone and then underwent mastectomy, hysterectomy, oophorectomy which is the removal of the ovaries, and metoidioplasty. When I googled metoidioplasty, the top result was a featured snippet from America’s Boston Children’s Hospital which states, “metaoidioplasty is the surgical creation of a penis using your existing genital tissue. It is a less-extensive procedure than phalloplasty and is performed after the clitoris has been enlarged through the use of testosterone therapy.” I’m going to rephrase that and call it the surgical creation of a micro penis using skin from the labia.

In 1998 Peggy released a paper detailing the results of the experiment on FG.

Michael Biggs

That was very important because it seemed that her dysphoria had been fixed. So they said at the age of 20 she’s doing very well, she looks very, she looks like a handsome young man, everything is great. And it seemed that it was great and of course the follow up, the later follow up showed that by the time she was in her 30s that things were not so good at all but it seemed that the initial results were very good of long, of puberty suppression followed by cross sex hormones and then surgeries.

At 35 years old, FG had depression and was not able to sustain a romantic relationship largely due to, “shame about his genital appearance and his feelings of inadequacy in sexual matters.” Coincidentally, a strong dislike of one’s sexual anatomy is one of the diagnostic criteria for gender dysphoria. 

To be fair, followed up again at age 48, FG had found a long-term girlfriend and she described puberty blockers as lifesaving. But would she have been better off just being a lesbian? Given there was no turning back for her, was it a case of sunk cost fallacy – of having to believe the treatment was lifesaving?

Based on the seemingly positive early outcome for FG, Peggy and the team persevered with the treatment protocol.

Michael Biggs

when Peggy Cohen-Kettinis moved from Utrecht to Amsterdam, the sort of main gender clinic, the main adult gender clinic, then this sort of, what had been a, just a very very rare intervention on kind of very few exceptions becomes sort of institutionalised and it sort of becomes part of the standard treatment protocol and of course you have a few more kids coming into the clinic and now that the standard treatment pathway is puberty blockers at 12, or you know 13 or 14 whenever you come into the clinic, and so you have a, an increasing number of kids being enrolled in this and eventually they get to the point where they have, ah well they started out they have 70 kids and then they have like just over 50 who go through the whole process and they write those up, the sort of the outcomes of those of those kids.

And what were the outcomes?

Michael Biggs

the puberty blockers are good, they reduce gender dysphoria, they reduce psychological distress and then when you follow them up after their first surgery, so they’re still very very young in their early 20s, that they are just, they’re well adjusted, they’re happy, and they just very similar to the general Dutch population, so it seems like, again, it seems like this kind of miracle cure ‘cause you have these very distressed gender dysphoric children coming into the clinic and then they go through this protocol and by their early 20s they’re just happy normal people that look like the opposite sex.

Sounds great, right? A miracle cure for gender dysphoria. But there’s a significant problem regarding how the researchers measured gender dysphoria. A problem so big that arguably, the results are meaningless. The Dutch used a scale called the Utrecht Gender Dysphoria Scale which was sex specific. So initially the girls were given the girls’ questionnaire and the boys were given the boys’ questionnaire. But in the next phase of the research, after cross sex hormones and surgeries, the girls were given the boys’ questionnaire and the boys were given the girls’ questionnaire. Michael explains further:

Michael Biggs

If you’re a male, you start off being asked, do you feel uncomfortable about having erections and you say yes ‘cause you’re gender dysphoric, but then by the time you’re in your early 20s and they’re doing this kind of follow up evaluation, they give you the woman scale, so they ask you are you uncomfortable about menstruation and of course, it doesn’t make sense because of course you’re not menstruating so, the scale itself, there are significant problems with the scale itself because some of the questions don’t make sense. So it’s not really clear that the gender dysphoria had been had been eradicated as they claimed. 

This point really needs to be emphasised. Because as others have pointed out, the same results could’ve been achieved with no medical intervention whatsoever. If you have a 12-year-old girl with gender dysphoria and you ask her to rate how she feels about the statement, “I prefer to behave like a boy”, she will tick highly agree, indicating gender dysphoria. And then 10 minutes later, you give her the boys’ scale and you ask her “My life would be meaningless if I had to live as a boy” she’ll answer, highly disagree. And voila, her gender dysphoria has magically been relieved simply by switching the scale. But that isn’t even the worst part of those early Dutch experiments. 

Michael Biggs

The most horrifying thing is that one of the children dies, and so you start out with a cohort of 70 and you end up with one child dying and what they do, they sort of say in the paper this kid who was a boy who was becoming a trans woman and he died of necrotising fasciitis after his vaginoplasty, or in the course of his vaginoplasty. What they don’t say is that was actually a direct consequence of puberty blockers because one of the paradoxes of puberty blockers, I mean the idea is that you’re going to look much better like the opposite sex and that’s generally true, but there’s one major disadvantage for physical transformation and that is for males, you need to, vaginoplasty requires you, ya know, using your penis as sort of the sort of donor skin for the new, this new orifice that you’re creating surgically, but if you don’t go through puberty, your penis is too small and therefore you actually have a much more, a much worse operation, much more dangerous operation with less satisfactory results, where you use part of the intestine, so you have to open up a new surgical site, you have to remove part of the patients bowel and use that as s the new kind of lining of this new orifice, and so because this boy had been puberty suppressed his penis wasn’t big enough to use and so they had to use part of his bowel, and that’s what caused the infection which caused him to die, immediately after the operation. But they avoid putting in that crucial piece of information which really is quite remarkable if you think about it we’ve got 70 incredibly health Dutch teenagers, this is one of the populations, the most healthiest populations in the world and then one of them dies, I mean that’s a, that’s a big, that’s a high death rate, you imagine if we had a covid vaccine that killed one in 70 people, I mean we’d be shocked, we’d say this is a terrible vaccine, but in this case they just sort of brushed that away, they present it as, it’s almost like a hospital infection, or just sort of a random accident as opposed to something that was a foreseeable consequences of the use of puberty blockers.

Necrotising fasciitis is a flesh eating bacteria. The irony here is that, like we saw with FG, trans activists and gender clinicians frequently describe puberty blockers as lifesaving. 

The fact is, there’s simply no good evidence to support the use of puberty blockers. The supposed good outcomes of the Dutch research have never been replicated, despite attempts. Perhaps the most notable attempt was London’s Tavistock clinic, which rolled out puberty blockers in 2011 under the guise of a study.

Michael Biggs

Before they’d even enrolled all the children, aged between 12 and 14, into the study, the new director of clinic, Polly Carmichael says, the study’s been a success and we’re going to continue to make this now general policy and then the results come out by 2016 or so the results come out and the results are actually worse than the Dutch results, so the kids don’t improve. So at least in the Netherlands there was some evidence that in the short term the kids became better off psychologically, in the case of Britain they didn’t see these improvements. And then there were some worrying signs about increased, slight increases in the rate of suicidal thoughts among girls. 

The results weren’t actually published. They came out in conference presentations made to the World Professional Association for Transgender Health, WPATH. Polly Carmichael described, an “increase in internalising problems and body dissatisfaction, especially amongst natal girls”. In other words, it increased girls’ obsessive, negative focus on their bodies. In another presentation, it was reported that gender dysphoria did not significantly improve and neither did instances of deliberate self-harm. 

Despite all this, in 2015 Polly Carmichael published a paper claiming that compared to adolescents only receiving talk therapy, those receiving both therapy and puberty blockers had “significantly better psychosocial functioning after 12 months.”

Michael Biggs

The Tavistock basically having this discordant information, despite the fact that they’d rolled out this new policy, they just basically didn’t publish these papers, they didn’t publish the results they gave a few conference papers and then it sort of disappears, this whole information disappears and basically they successfully disappeared it until I began to make inquiries in I guess 2018, 2019, yeah 2018 I think and then I used Freedom of Information requests and found some, trawling through stuff that was on the web that nobody else had looked at, I found the sort of preliminary results which were negative and I forced them eventually by making complaints to the health research authority, got them to actually publish the results which they published quite a few years later.

There was a lot of pressure on the Tavistock by this point. In the UK there was actual journalistic reporting, unlike here in Australia, there was Michael’s complaint to the ethics committee, and, importantly, a judicial review brought by a detransitioned woman, Keira Bell. She had been significantly harmed by the Tavistock treatment, given puberty blockers at 16, then testosterone and then had her breasts removed at 20. Eventually she realised she was a lesbian, not a trans man. Just days after the ruling, the Tavistock finally published the research, ensuring it was never seen by the court. 

It’s difficult to fathom why the Tavistock misrepresented the treatment outcomes. It’s even more difficult to understand why, in Australia, this scandal hasn’t led to intense scrutiny of gender clinics like the one at the Royal Children’s Hospital. Systematic reviews of the evidence for puberty blockers have now been undertaken in the UK, Sweden, Finland and Florida USA, and all of them returned similar results. The evidence base is graded as low or very low quality. There are no reliable long term follow up studies so we simply don’t know how these kids are going 10 years down the track. But none of this seems to be cause for concern here in Australia. Yet. 

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Early on in my descent down the rabbit hole of transgenderism, I came across a segment from 60 Minutes Australia on YouTube. It’s called “Transgender boy transitioning to life as a girl changes his mind.” It aired in 2017. It’s about a 14-year-old boy who fits the classic presentation of gender dysphoria. He’s been very feminine since a young age. His mother describes how at 3 years old he would dress up in girls’ clothes and at one point he asked her if the doctor could make him into a girl. At 12 years old he came out to his mother, very distressed saying he didn’t feel like a boy and wanted to be a girl. She took him to Adelaide gender specialists who, according to the mother, diagnosed him as transgender. 

Mother: He said that if he couldn’t get on the puberty blockers, that he would either run away and find a way to get them himself or kill himself.

So he goes on puberty blockers and the mother starts giving him hormones from her personal prescription in order to start feminising his body. But then, at 14, after he’s grown breasts, he says actually, I’m not sure that I am a girl.

Ross Coulthart: I’m not sure I understand, like one minute you’re really convinced you’re a girl and then you think, well, I’m happier being male. What happened?

Boy: I guess I just realised that I could be happy without completely changing who I am.

60 Minutes doesn’t say anything about the boy’s sexual orientation. But his speech and mannerisms are somewhat effeminate so it’s possible that he’s gay. 

His mother is now angry at the doctors for getting it wrong.

Mother: They were wrong to pigeonhole him so quickly. I think they should’ve said, here we have a child who does have gender dysphoria, and he’s going through a period of transition where he needs to work out exactly how he feels.

It sounds like she’s advocating for a careful psychotherapeutic approach. I bring all this up because, for me personally, this story demonstrated the unpredictability of childhood gender dysphoria. Some children will grow out of it. Others won’t. This boy would have been the perfect candidate for the Dutch study. He literally ticked all the boxes, was told by doctors that yes, he’s a trans girl and then, oops, the doctors were wrong. Now mum is looking into a double mastectomy for him – at 14 years old.

All the studies prior to the advent of the Dutch Protocol showed that most children with childhood onset gender dysphoria, would simply outgrow it. Puberty itself seemed to be the cure, forcing a reckoning with one’s own body. And this has been repeated in many studies. The lowest desistance rate reported was 61% and the highest 98%. Averaged out, that’s about 80%. Medical transition of minors is risky. Under the affirmative approach we’re much more likely to be wrongly affirming gay kids as trans than we are to be wrongly denying early transition for transsexuals. Take for example, Jude’s daughter:

Judith Hunter

Many years before she’d told me that she was a lesbian, and I didn’t care, I mean, so what, I told, all I said to her was, ‘cause she was quite young, and all I said was – ‘cause she was telling people at school and, and I said “just be cautious about what you say to people” because I was just wanting to protect her. But I never said anything negative about it. Your sexual orientation is what it is, but I sadly think that that seems to be the case for so many young girls who really are lesbians that they can’t be lesbians anymore, they have to say they’re trans boys. And then they’re still in a relationship with another girl who’s also a trans boy, and really, like, they’re lesbians, just let them be lesbians.

There’s a saying amongst gender criticals: once it was pray the gay away and now it’s trans the gay away. The old homophobia was religiously motivated. The new homophobia masquerades as progressive and supportive of trans people. But many are calling it conversion therapy 2.0. According to gender identity ideology, if a man is in a relationship with a trans woman, that is, a man who identifies as a woman, well that is a heterosexual relationship, even if the trans woman still has his penis. In this way, all you have to do to escape homophobia, is change sex. Can you see the allure for a 13 year old homosexual who’s getting bullied at school?

Whistle-blowers at London’s Tavistock clinic were alarmed by this. The Times newspaper reported in 2019 that two Tavistock clinicians had told them of a dark joke amongst staff that “there would be no gay people left”. This is backed up by more research from Dr Lisa Littman who surveyed 100 detransitioners. 23% reported difficulty accepting their sexual orientation as having contributed to their gender dysphoria.

Many adult gays and lesbians remember a time in their youth where they wished they were the opposite sex. Many were also gender non conforming as children and teens. And there’s good data to back this up – that cross gender behaviour in children is more likely to predict homosexuality in adulthood rather than transsexualism. Even the Dutch researchers acknowledged this in their early work. But then: 

Michael Biggs

And then after 2000 that whole recognition just sort of is eliminated and so in the literature they stop mentioning homosexuality as a possible resolution. Instead they’ve come to think anyone who’s gender dysphoric, at least by the age of 12, if you’re still gender dysphoric at the age of 12, that means that you’re transsexual and you must be put on this transsexual pathway. You could say, kids ya know, there’s two possible outcomes here and maybe we should explain both to the child and their parents, you’d say well, there are two ways of resolving this.

Of the 70 participants in the original Dutch puberty blockers experiment, only one was heterosexual. In Australia, the sexual orientation of children and teens seeking medical transition is currently unknown. Are Australian gender clinics unwittingly transing the gay away?

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So far we’ve looked at the origins of the Dutch Protocol. To understand how this model became embedded in Australia’s public health system, I met with journalist Bernard Lane. Bernard was a reporter for The Australian newspaper for 32 years, from 1990 to 2022. In 2019 he began investigating youth gender medicine.

Bernard Lane

The reason why I started to write in this area is that I could see that there was an unhealthy restriction of views and information able to be published.

Initially it was cancel culture that got him interested in the topic. As we saw in episode one, clinicians who criticise gender affirmation face vexatious complaints and attempts to strip them of their licence to practice. 

Bernard Lane

From roughly 2014 up until mid 2019 when I started reporting, the dominant kind of coverage – and there was a lot of it – was uncritically positive towards youth gender clinics, uncritically positive towards the hormonal interventions and the story was primarily told as an uplifting, emotionally engaging, personal story of these brave trans kids and their heroic doctors who were saving them from otherwise inevitable suicide attempts with these interventions.

In May 2021, ABC’s Australian Story aired an episode that perfectly fits what Bernard describes. It profiled paediatrician Dr Michelle Telfer, the then director of the Royal Children’s Hospital Gender Service. She’s the pioneer of the Dutch Protocol in Australia, mainstreaming the use of puberty blockers as the first line of treatment for children with gender dysphoria. Upon meeting her first so called trans child, a female named Oliver, she asks when she first started thinking of herself as a boy. Here’s a clip:

Michelle Telfer: And he was 10 at the time that he told me this story.

Oliver: All my life so for as long as I could remember, anytime I had a birthday or even like if someone said what would your three wishes be with a genie, anytime I had a like blow out the candles anything like that, I’d always wish that I would be a boy, that would be my birthday wish.

Michelle Telfer: It was such a, a beautiful story and I thought I can help, I can help this child have a boy’s body, um and, how many people can do that?

In 2018, Telfer and three other clinicians from Melbourne’s Royal Children’s Hospital released the Australian Standards of Care and treatment guidelines for trans and gender diverse children and adolescents. From here on I’ll refer to them simply as the guidelines or the Standards of Care. The title might lead you to believe that this treatment model has been sanctioned by some sort of government health body. But that’s not the case. 

Bernard has spent some time reading and reporting on the Standards of Care. I ask him what stands out.

Bernard Lane

One unusual thing about the Royal Children’s Hospital Standards of Care is that even though they are promoted as national, the only authors on the published document are from Royal Children’s Hospital Melbourne, which is apparently unusual – normally for a national guideline you’d have a group of clinicians from multiple clinics developing a guideline. They did not involve the various relevant medical colleges in formal consultation when they were developing it. So the College of Psychiatrists, for example, there’s two medical professional bodies for endocrinologists, they weren’t involved either. So from the point of view of a critic of that document it looks like it’s very much a gender clinician’s insider document. It is a bit surprising I think, that the College of Psychiatry wasn’t involved because gender dysphoria is a condition in the so-called bible of American psychiatric diagnosis, the DSM. 

They did however consult various transgender lobby groups, such as Transgender Victoria, Transcend Australia, and the Victorian government’s Trans and Gender Diverse Expert Advisory Group, of which Michelle Telfer was a member at the time the guidelines were released.

In the Standards of Care, the authors claim that the guidelines, “are based primarily on clinician consensus”. But this is misleading. While there may be consensus amongst those practicing the affirmation model, there’s an international debate raging about the best way to treat gender dysphoria in children. There’s even a not-for-profit organisation, the Society for Evidence Based Gender Medicine which formed in 2020 because of concerns about the affirmation model. 

Bernard Lane

One point that might be relevant is the National Health and Medical Research Council, they have an online database of clinical practice guidelines and they did a preliminary analysis of the Royal Children’s Hospital guideline and it didn’t qualify for further analysis, so it didn’t go into that online database and one of the issues was potential for bias, so, Dr Telfer might regard it as the gold standard but it’s come under a lot of scrutiny and criticism. 

The National Health and Medical Research Council is the Australian statutory authority responsible for medical research. It falls under the federal health minister’s portfolio. They allocate research funding, issue their own health guidelines and also review guidelines developed by other organisations. Their aim is to provide authoritative, evidence-based, health advice. Their rejection of the Royal Children’s guidelines is telling, because to get this stamp of approval, the Standards of Care would’ve had to have been high quality and based on the best available scientific evidence.

Despite this, Michelle Telfer has often described the guidelines as gold standard, sometimes without disclosing that she was the lead author. And while it failed to meet the standards of the National Health and Medical Research Council, it did get the stamp of approval from AusPATH, the Australian Professional Association for Transgender Health. This is the self described peak body for transgender medicine in Australia. Coincidentally, Michelle Telfer was on the board of directors of AusPATH at the time that AusPATH endorsed the guidelines. One might wonder if there’s not altogether too much Telfer involved here.

Accompanying the release of the Standards of Care, the authors also published a position statement summary in the internationally renowned medical journal, The Lancet. A position statement summary can be thought of as an opinion piece. In response, The Lancet ran an editorial praising the guidelines. 

Bernard Lane

No sooner had the Lancet editorial appeared, then there was a letter from I think three or four medical doctors expressing concerns about the RCH guidelines, for example arguing that it overplayed the very limited empirical evidence that there is.

In The Lancet, Telfer and her co-authors briefly acknowledge that: “The scarcity of high quality published evidence on the topic prohibited the assessment of level (and quality) of evidence for these recommendations.” Remember, that several systematic reviews in different countries have found the evidence base to be low or very low quality.

Bernard Lane

How it is that the gender affirming clinicians appear to ignore the demonstrated weakness of the evidence base, I don’t know how you explain that, I suppose you can say that the gender affirming worldview is so all consuming that evidence to the contrary gets ignored or explained away.

Michelle Telfer has been quite open about the fact that she considers herself to be a transgender advocate. She’s received awards from trans lobby groups, including the GLOBE Ally of the Year award in 2017. She was instrumental, in removing the requirement, that minors obtain approval from the Family Court before accessing hormonal and surgical treatments. And, don’t forget, she had a direct line to lobby the Victorian government via their Trans and Gender Diverse Expert Advisory Group. 

Bernard Lane

The appointment of Michelle Telfer, the paediatrician as director of the gender clinic at Royal Children’s Melbourne – 2012, that’s a sort of a useful marker I suppose because with her as director, that clinic rapidly expanded – it’s a gender affirming clinic – and because of her influence and the influence of that clinic, the influence of its treatment guidelines, the gender affirming model elsewhere in Australia was either introduced or promoted. 

There are now public youth gender clinics modelled on the Australian Standards of Care operating in children’s hospitals around the country, plus a stand-alone gender clinic in Newcastle, two hours north of Sydney, called Maple Leaf House. Adelaide, Perth, Brisbane, Hobart and Maple Leaf House all follow the Royal Children’s treatment model. To be clear, a set of healthcare standards, written by only four Melbourne clinicians, who admit there is a lack of evidence to support their treatment protocol, have now become the basis of treatment all around Australia. 

And all of those clinics have seen a surge in new referrals. In raw numbers, Melbourne’s Royal Children’s hospital receives more new patients than any other clinic, jumping from just 104 in 2014 to 1120 in 2021. We don’t know the sex ratio of these new patients, but we do know from London’s Tavistock that they saw a 4400% increase in girls over a ten-year period. A rough estimate is that now three quarters of new patients are teenage girls, whereas in previous decades, it was overwhelmingly very young boys. 

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One interesting quote from the Standards of Care is found in the general principles section, under the heading Individualise Care. At first glance, you might not think much of it at all. It reads, “The importance of tailoring interventions is especially true for those expressing a non-binary gender identity.” So what does this mean in practice?

Well first, I should probably explain what non binary is. Non binary is a bit like the old gender bending of the 80s, except that unlike David Bowie or Annie Lennox, today’s gender benders seem to entirely reject the reality of their biological sex. They believe their gender identity is neither male nor female, or in other cases, both male and female. There’s disagreement within the queer community over whether non binary can be classed as transgender. Some argue yes, because their gender identity doesn’t align with their sex. Others, especially those who’ve undergone sex reassignment surgery, argue that non binary makes a mockery of their distress and what they’ve been through to relieve that distress. Non binary can be as simple as changing your pronouns to they/them and nothing more. Or it can be as extreme as undergoing a double mastectomy. In between are non binaries who adopt the clothing and appearance of the opposite sex and others who aim for a more androgynous look. 

So what exactly does the Royal Children’s Hospital mean when they stress the importance of tailored medical interventions for non binaries? Well, I’ll let Michelle Telfer explain. Here she’s speaking with American YouTuber Coleman Hughes:

Michelle Telfer

Some people are opting to have hormone treatment for a certain period of time and then to deliberately and in a planned way stop taking it. So I can give you an example of this so um someone who for example is assigned female at birth and has a non binary gender identity they might come to us and say “I have a non binary gender identity and I want to masculinise to a certain extent but I don’t want to sort of look in a way that I am a man I want to look not exclusively male or female, I want my body to reflect my non binary gender identity. And some of these young people are opting to have testosterone for a certain amount of time often about 6 months where they want to have a deeper voice and they might um want also to have some masculinisation of their face but for them, um, they get to a point of masculinisation where they feel that’s right for them and then they stop taking testosterone so that they have some masculinisation but not too much for how they feel they are as a person.

This doesn’t seem to have much to do with treating clinically diagnosed gender dysphoria. Rather, this strikes me as being more akin to body modifications like piercings or tongue splitting. Is this really the role of a public children’s hospital, funded by tax payers?

Equally as troubling is the Royal Children’s willingness to affirm a non binary person’s desire to never go through puberty. Bernard Lane explains

Bernard Lane

There were a couple of cases in Australia – one a real case, I think at Royal Children’s Hospital where the young person did not want to stop puberty blocking, they wanted to remain sort of suspended in development like that and then there was a hypothetical case as well which involved some of the similar Melbourne bioethicists and the idea was that you might have a youth who wants to remain on puberty blocking indefinitely. In the actual case, the kid had extremely low bone density compared to same age peers, and so the ethical question was, should we allow this kid to continue on puberty blockers not withstanding that bone density issue and the clinicians and bioethicists came down in favour of this prolonged puberty blocking.

Michelle Telfer was co-author of both papers, along with fellow Royal Children’s gender clinician, Ken Pang. In the hypothetical paper, the authors explore three ethical questions: does ongoing puberty suppression align with the goals of medicine? Is it discrimination to not offer ongoing puberty suppression? And how should clinicians respond? The answers are predictable. Yes, this aligns with the goals of medicine. And yes, it would be discrimination because we wouldn’t deny puberty blockers to trans girls or trans boys. And yes, clinicians should facilitate this, because the risk of suicide if we don’t, outweighs the risk to bone density. We’ll look more closely at the issue of low bone density – a known side effect of puberty blockers – in the next episode. For now, I want to demonstrate just how far the Australian gender clinics have strayed from the original Dutch Protocol.

Let’s take Julie’s daughter Claire, from episode one as an example. She wouldn’t have met the criteria for the original Dutch experiments. Firstly, she had no history of childhood gender dysphoria. The Dutch only gave puberty blockers in cases where dysphoria had begun in early childhood. The other criteria that would’ve excluded Claire was that she was already suffering from depression, having been referred to CAMHS initially for self-harming. Originally, the Dutch only treated children without psychiatric comorbidities. So what do the Australian Standards of Care recommend in cases where a patient has co-occurring gender dysphoria and other mental illnesses? 

Bernard Lane

If a patient has serious mental health issues such as psychosis, depression, that that should not necessarily prevent medical transition, which, that position is regarded as lacking caution by critics of the treatment guideline.

As sinister as it sounds, it’s true. If you do a keyword search of the Standards of Care for the word “psychosis”, it’s exactly as Bernard describes. It’s hard to imagine a scenario where a teenager is experiencing a psychotic episode and clinicians decide it’s a good time to administer puberty blockers or cross sex hormones. It’s easy to see why Australia’s National Health and Medical Research Council were unwilling to endorse the Royal Children’s guidelines.

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Bernard Lane is one of the few Australian journalists committed to investigating and exposing this unfolding medical scandal.

Bernard Lane

I think it’s potentially an international medical scandal yeah. I think “medical scandal” is kind of a vague broad word but I think it means that something potentially damaging and harmful is being done on a serious scale and it’s something that should not have happened and it requires some kind of serious intervention or remedy to fix it.

His reporting for the conservative newspaper, The Australian, ultimately made him a target. While he’s not named in Michelle Telfer’s Australian Story episode, The Australian newspaper is. Telfer had had enough of the scrutiny, as she explained to the ABC. 

Michelle Telfer

And I decided that I needed to actively punch back. So I took a week off from my usual work and I sat down with every single article that had been written that referenced me. There are nearly 300 mentions of me and my work. I submitted the 42 page complaint to the Australian Press Council last year.

Bernard Lane

I had given this particular gender clinician every opportunity to comment, had suggested to the editors that they allow her a space to write an opinion article on our opinion page which is a prestigious place to write and she didn’t take it up so I thought her complaint was utterly unjustified. In 2019 I had predicted this would happen. Before this complaint from this gender clinician I had never had a complaint against me in more than 30 years of journalism.

In September 2021 the Press Council made its ruling.

Bernard Lane

The complaint was partly upheld and where it was partly upheld, on a question of accuracy, the Press Council inaccurately reported what I had written, which I found staggering then there were two questions which were essentially judgement calls and there the Press Council made judgement calls in line with trans activist values in my opinion. So, because this gender clinician is a central figure in Australia, her name appeared in quite a number of stories so it meant that those stories online had a banner at the top of them saying this story has been subject to a partially upheld complaint. When you look at the story, there’s no way of working out what material in that given story – there were 40 or 50 I think – what material in that given story is said to be unreliable. Who’s going to go off and read this lengthy complaint? So it seemed to me there was a generalised smear effected by the Press Council and so I decided I wasn’t going to put up with that and that’s when I stopped writing about this subject for The Australian and then eventually I moved full time to Substack.

Bernard’s Substack, Gender Clinic News is an invaluable resource for parents, clinicians and anyone interested in global developments regarding youth gender medicine. Ironically, cancel culture, which initially piqued his interest in this topic, eventually came for him. It makes me wonder what’s in store for me now that I’ve published this podcast series.

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Coming up in the next episode of Desexing Society we’ll look more closely at what’s involved in gender affirming healthcare.

Dylan Wilson

Well I’m a doctor and I can tell you that’s exactly what they do, those children are being sterilised all over the world and in Australia

Bernard Lane

When you explain to an ordinary member of the public that a child at 15 can have healthy breasts removed because that child regards herself as the opposite sex, I’ve had people just tell me I’m wrong and that that cannot happen under Australian law.

And we’ll examine the main justification for puberty blockers and cross sex hormones for minors

Jillian Spencer

I think the suicide narrative promoted by ABC in their four corners show and in other areas, is a very dangerous narrative which invites children to think that they should feel suicidal if they’re not affirmed or if they’re misgendered.

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Thanks for listening to Desexing Society. Written and produced by me, Stassja Frei. Thank you to my script editor, Ms Edie Wyatt, my sound technician Matthew Friend, and to everyone who made this podcast possible. For more information, or to donate towards this project – which I paid for myself – please visit desexingsociety.com