Episode 3

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

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Jillian Spencer

I think it’s a really big deal to change a child’s, or to impair a child’s fertility and to reduce their sexual functioning and there’s no way that a child can understand the long term implications of that when they are at the cusp of puberty about to take them so in my opinion we shouldn’t allow the prescription of puberty blockers.

Australian gender clinics promote puberty blockers as safe and reversible, and necessary for mental health. They’re both the first stage of medical transition and a diagnostic tool, that gives child time to think about whether to proceed to the next phase of cross sex hormones. Often, they’re described as lifesaving. Let’s explore these claims and have a look at what lies ahead for children put on the path of medical transition.

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Welcome back to Desexing Society. I’m your host, Stassja Frei. Episode 3: Lifesaving Healthcare

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Dr Jillian Spencer is a child and adolescent psychiatrist with 20 years’ experience working for Queensland Health. Eight of those years were with the Queensland Children’s Hospital, including three years as campus director. In 2017 the hospital opened a gender clinic modelled on Melbourne’s Royal Children’s Hospital Gender Service. 

Jillian Spencer

And I remember attending the hospital information session given by my boss in which he told us that the treatment was lifesaving. Then in 2018 I expressed some concerns to the team leader of the clinic and she assured me that the gender clinic knew how to spot a true trans child and as proof of that she said only one child who’d started on puberty blockers had decided not to continue and that was due to a needle phobia and I’d worked with these people for a long time and so I trusted what they were telling me. And then so in 2021 I was reading Abigail Shrier’s book and I felt completely shocked and betrayed when I realised that what they, what my colleagues had said to me was completely untrue 

The book Jillian mentions, by Abigail Shrier, is called Irreversible Damage: The Transgender Craze Seducing Our Daughters. It was a groundbreaking book, offering the first in depth account of rapid onset gender dysphoria in teenage girls. 

In 2018, a year after the Queensland gender clinic opened, Jillian noticed an increase in children presenting with gender dysphoria. She saw them in the psychiatric inpatient unit, the emergency department and in late 2019 when she changed roles, she saw them in the general paediatric wards.

Jillian Spencer

So I was working in the consultation liaison psychiatry team as a psychiatrist and what that team does is gets referrals from the paediatric wards, so kids having medical procedures or surgical procedures or they’ve been admitted because they’ve had an overdose or some serious self-harm and the consultation liaison psychiatry team goes and sees those kids and does an assessment and arranges their mental health care or provides mental health care depending on how long they’re going to be in hospital for.

Jillian became deeply troubled by what she was being asked to participate in. She no longer trusted gender clinics to act in the best interests of children and she wasn’t willing to silently participate in something she thought was harmful.

Jillian Spencer

Well I started raising concerns about the gender clinic which led me to have a series of unpleasant meetings with my bosses, and that intensified when I said I wasn’t comfortable using the preferred pronouns of children and then my bosses decided to broaden the issue further to the question of whether I would ever refer a child to the gender clinic and this is because they were comparing my concern about the affirmation model to doctors who have concerns about abortion. And they said that I had to either agree to refer the child to the gender clinic or refer the child to a doctor who would refer to the gender clinic. And so I ended up being given a lawful direction by the hospital executive that I must always use a child’s preferred pronouns, always take an affirming approach to children, and always refer gender questioning children to the gender clinic and then in mid April of this year I received a complaint from an adolescent who was having treatment through the gender clinic who alleged that I said things that I didn’t actually say and then so the hospital took this as an opportunity to say that I’d breached my lawful direction and removed me from clinical duties on the grounds of being a danger to trans and gender diverse children. 

When a doctor is removed from clinical duties, they have 7 days to notify AHPRA, the Australian Health Practitioner Regulation Agency. This body oversees all health practitioner registrations, ensuring they’re adequately trained and qualified. They also investigate complaints against health practitioners. Jillian is now facing the possibility of losing her licence to practice psychiatry and, her livelihood.

Jillian Spencer

It is the case that there’s been some signs from AHPRA that they’re now regarding the controversy around childhood gender treatments to be something that is up for discussion where people that have previously had problems with AHPRA that was because they’d raised concerns about childhood gender transition and it was considered that they weren’t voicing opinions in line with medical consensus. But it looks like AHPRA might be understanding that there’s a debate about this issue so I am feeling a little bit safer but you just never know.

The Royal Children’s Hospital and their Australian Standards of Care and treatment guidelines for trans and gender diverse children and adolescents, have very much created the illusion of medical consensus on childhood transition. Brave clinicians like Jillian are acting as whistleblowers for the many others that are too afraid to speak up.

Jillian Spencer

And one surprising thing that I’ve learnt out of this experience is that a lot of people will protect their career rather than speak up about harm happening to other people’s children. One of the most disturbing things I saw at the hospital was colleagues who I knew, knew the harms, and they would continue to deliver care according to the affirmation model and they wouldn’t even take little steps like taking off their pronoun badges which is not something that would jeopardize their career.

If you’re not aware, pronoun badges reading she/her or he/him are promoted by LGBT+ organisations as a way for trans allies to signal their support for the trans community. With nothing left to lose, Jillian has taken her message to the media. She’s appeared on channel 7’s Spotlight, ABC’s Four Corners, sky news and radio, warning of the harms of gender affirmation. 

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Michelle Telfer

Isobelle was very clear about what she wanted to do and what she needed was puberty blockers. So we went through the risks and we went through the benefits. Puberty blockers are reversible. The only risk is that it can affect your bone density.

That’s Michelle Telfer on ABC’s Australian Story. Isobelle is an 11-year-old boy who had gender dysphoria from a very young age. Telfer’s claim that puberty blockers are reversible is highly contested. The effects on bone density can be debilitating and the impact on the developing brain is largely unknown. 

Historically the drug has been used to treat prostate cancer, endometriosis and precocious puberty, which is a condition where puberty starts at an abnormally young age. It’s also used to chemically castrate sex offenders as it blocks testosterone production and in doing so, blocks libido.

Jillian Spencer

Puberty blockers are technically called gonadotropin releasing hormone agonists, and what they do is overstimulate the pituitary gland so that it stops producing the hormones that travel to, mainly the ovaries and the testes to tell them to produce oestrogen or testosterone.

Without oestrogen or testosterone, secondary sex characteristics, such as body hair, facial hair, breasts and voice deepening, never develop. 

Jillian Spencer

Puberty blockers have side effects similar to menopause so fatigue, hot flushes, weight gain and mood problems and they also reduce bone mineralisation at a time a time of life when bones should be reaching their peak density. 

The Australian Standards of Care do recognise the impact on bone density. They recommend yearly monitoring during and after puberty suppression. There’s a well-publicised case from Sweden of a gender dysphoric girl called Leo, who was put on puberty blockers at 11 years old. At 15 she had chronic back pain and was diagnosed with osteopenia, a precursor to osteoporosis. And it’s a similar story for girls with precocious puberty who were treated with Lupron, the most prescribed brand. As young adults, in their 20s and early 30s, some of these women have a range of serious health complaints – osteoporosis, deteriorated jaw and hip joints requiring artificial replacements, degenerative disc disease, cracked vertebrae, thinning bones, brittle bones prone to fracture, and teeth shedding their enamel and cracking. These are diseases that usually only develop in old age.

Jillian Spencer

There’s suspected effects on cognitive development because adolescence is such an important time for brain development.

Two studies of girls treated for precocious puberty found that their IQ was lower than girls not treated with puberty blockers. One study found a 7-point IQ gap and in the other, an 8-point gap. The number of participants in these studies was too small to draw definitive conclusions. In a different study involving men treated for prostate cancer, Lupron was found to affect short term memory. The only studies really looking at the impact on the developing brain involve sheep, mice and monkeys.

Jillian Spencer

Yeah it’s hard to know what to make of those studies. I understand that the sheep had permanent impairment in their ability to, in their visual spatial memory, in their ability to get through a maze. I think in looking at those studies what leapt out to me was that the gonadotropin releasing hormone receptor is not just in the pituitary it’s in other parts of the brain and so this hormone has a function in other parts of the brain that we don’t know about but nonetheless we’re using it, and the other parts of the brain which have it are the frontal lobe and olfactory bulb, so the olfactory bulb affects sense of smell so maybe that’s not so significant but the frontal lobe is very significant so I think it’s the case that in medicine we aren’t as far advanced as maybe people who aren’t in medicine think we are and they do assume that doctors know what they’re doing.

Melbourne’s Royal Children’s Hospital must be aware of the uncertainty around what impact puberty blockers have on the brain, because in their June 2022 newsletter, they announced a PhD research project taking place at the Melbourne gender clinic. The study aims to investigate changes in cognitive skills for children on puberty blockers. It’s unclear whether this will involve brain imaging scans or just cognitive tests. Brain imaging scans would be useful because the sheep studies found that puberty blockers lead to a permanently enlarged amygdala – a part of the brain central to processing emotions.

This brings us to Jillian’s final point on potential side effects:

Jillian Spencer

And last year the FDA put a warning label on puberty blockers for a condition that is rare but serious, because it causes raised intracranial pressure.

The medical term for this is pseudotumor cerebri because its symptoms mimic a brain tumour. Patients present with severe headaches, nausea, blurred vision, and it can lead to permanent vision loss. The US Food and Drug Administration identified six cases in young girls, five of them being treated for precocious puberty and one for gender dysphoria. It’s unknown whether Australian gender clinics warning parents and children of this potential side effect.

The claim most heavily promoted by gender clinics is that puberty blockers improve mental health. But this has never been proven conclusively in any studies. On the contrary, even the safety information sheet for Lupron warns of new or worsened psychiatric problems in children. Problems like including crying, irritability, restlessness, anger, and aggressiveness. This matches with data from the London Tavistock clinic that showed an increase in suicidal thoughts amongst girls prescribed puberty blockers. A more recent re-analysis of the Tavistock data found that for 34% of patients, their mental health deteriorated on puberty blockers, while 29% improved.

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Like Michelle Telfer, Dr Dylan Wilson is also a paediatrician. For 20 years he’s worked with diverse children and teens presenting with all sorts of health problems. It was events that occurred during the 2022 federal election campaign that prompted him to finally speak up. Liberal Party candidate Katherine Deves was front page news for about two weeks straight. She’d made supposed transphobic comments on Twitter. And in one of those tweets she said that children were being “surgically mutilated and sterilised.” The media went absolutely nuts over it. 

Dylan Wilson

A lot of it was about how well she’s, “who’s Kath Deves? She’s not a doctor, she doesn’t know what goes on,” 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.

He wrote an open letter to Australian doctors outlining the harms and imploring them not to refer children to gender clinics.

Dylan Wilson

Children are being sterilised by the treatment pathway. When children are put on puberty blockers, particularly at the very beginning of puberty, so tanner stage 2, it is inevitable that they progress from puberty blockers on to cross sex hormones, nearly every child we know does that and as a result they are sterile. 

The Royal Children’s Standards of Care devote five paragraphs to fertility counselling and preservation procedures. Interestingly they talk about semen collection but not about egg retrieval. And confusingly, it talks about how testosterone treatment for trans males, by which they mean females, doesn’t necessarily cause infertility. But it doesn’t say that if you block puberty at what’s known as tanner stage 2, a girls’ eggs won’t mature. Can children really understand at 10, 11, 12 years old, what they’re giving up? In a leaked recording of a WPATH meeting, that’s the World Professional Association for Transgender Health, endocrinologist Dr Daniel Metzger confirms that even at 14 years old, kids aren’t able to comprehend the impact of infertility.

Daniel Metzger

Last week at the paediatric endocrine society, some of the Dutch researchers started, gave some data about young adults who have transitioned and, reproductive regret, like, regret. And it’s there and I don’t think any of that surprises us. It’s always a good theory that you talk about fertility preservation with a 14-year-old but I know I’m talking to a blank wall and the same would happen for a cisgender kid, right? They’ll be like, “Eww. Kids, babies, gross.” Or the usual stock answer is “I’m going to adopt – just going to adopt. I think now that I follow a lot of kids into their mid-twenties. I’m always like, “oh” I’m like, “the dog isn’t doing it for you, right?” yeah, they’re like, “no, I just found this wonderful partner and now we want to have kids and da-da-da.” So I think ya know, it doesn’t surprise me but I don’t know still what to do for the 14-year-olds. The parents have it on their minds, but the 14-year-olds, you just, it’s like talking about diabetic complications with a 14-year-old. They don’t care. They’re not going to die. They’re going to live forever, right? So I think, I think when we’re doing informed consent, I know that’s still a big lacuna of -that we’re just, we do it, we try to talk about it, but most of the kids are nowhere in any kind of a brain space to really, really, really talk about it in a serious way. That’s always bothered me, but you know, we still want the kids to be happy. Happier in the moment, right?

It’s easy to give a kid an injection to make them happier in the moment. It’s a lot harder to sit down once or twice a week and talk that kid through their pain and trauma and help them face their fears. Rather than treating gender dysphoria, are clinicians naively reinforcing the symptoms of gender dysphoria?

Dylan Wilson

The gender clinic practitioners, they lose perspective of what kids are like generally. All the other mental health issues that go on, all the other ways that the kids get distressed and get upset and the things that cause trauma in their lives. They’ve lost perspective on the fact that these kids who are presenting to the gender clinic, that’s just how they are manifesting that, but there’s children manifesting their distress in other ways but underlying it there’s no real difference, it’s just which pathway they take. Some stop eating, some self-harm, there’s a whole range of different ways and there’s a certain group who for a variety of different reasons manifest that distress with the gender confusion. They’ve lost all perspective of the whole range of different, the spectrum of child development and distress. They just see it through the gender lens. 

The Australian Standards of Care are unique in that they did away with minimum age requirements for medical interventions. The Dutch picked 12 as the minimum age for puberty blockers. But the Royal Children’s argued that this should instead be based on the child’s “capacity and competence to make informed decisions.” 

We have all sorts of laws based on age of consent and for good reason. Personally, I got a stupid and rather large tattoo when I was 19. And I regretted for many years before I finally got it covered with something else. I was legally an adult when I did that. As many have pointed out, we don’t let children get tattoos, but we’re allowing them to choose infertility? 

Dylan Wilson

That’s a very tangible thing that a child of the age of12 can understand – if you give me this injection, I won’t grow any breasts, that’s a simple and straight forward thing to understand. But you can’t tell me that a 12 year old can understand the fact that your eggs won’t mature and that means you won’t be able to have a baby when you’re older if you want one, you won’t be able to have a pregnancy, your uterus won’t ever develop, your external genitalia and your vagina won’t develop properly, you won’t be able to have sex properly – a 12 year old can’t understand that and no one will ever convince me that a 12 year old can.

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Journalist: Prime minister, prime minister, Katherine Deves has said that it is the correct terminology to refer to that procedure as surgically mutilated and sterilised, if you stand by her you must stand by her definition of that procedure, where you engage with the fact as well that there are no, but there are no adolescents that can have the surgery. You are saying, you have implied, prime minister you have implied that young people 18 and over enter into a fundamentally life changing surgery lightly, you said it’s not something to be taken into lightly that implies, yeah but you’re implying that people are going into it…

Scott Morrison: You’re implying that, I’m not implying that…

Journalist: Do you stand by her language…

Scott Morrison: I wouldn’t use that language…

Journalist: Prime minister, Children under the age of 18 can’t undergo gender reassignment surgery in Australia, picking up on Claire’s comment in this country, so how are your comments relevant?…

Scott Morrison: But you will also understand that this process can begin in adolescence, you would know that, you would know that the process of discussions about gender and gender reassignment – the surgical procedure can’t but the process, the process by which these discussions commence[fade] 

It’s a painful listen. Clearly Scott Morrison, then Prime Minister of Australia had not been properly briefed on what’s really going on with youth gender transition. Under enormous pressure from the media, and presumably from within the Liberal Party, Katherine Deves had apologised for having describing children as being sterilised and surgically mutilated by the treatment pathway. But she soon wound back her apology, saying “mutilated” was actually the correct medico legal terminology used in medical malpractice cases. 

Aside from Morrison’s fumbling answer, the other thing that stands out to me is the impassioned tone of righteous indignation from the journalists, as though the issue is very personal to them. Journalist Bernard Lane who we met in Episode 2, offers some insight into what’s going on here:

Bernard Lane

Part of the confusion more recently is that once you use the term ‘gender affirming surgery’ – some of the activists, I think they do this deliberately, they say “there’s no gender affirming surgery in Australia under 18, it’s against the law” or something like that. What they really mean is there’s no sex reassignment surgery in that narrow sense of bottom surgery but trans mastectomy is gender affirming surgery, it’s described that way in the RCH treatment guidelines, so gender affirming surgery, does happen in Australia under 18. We don’t know the full extent of it because there’s no good record keeping.

The Standards of Care does have a section on surgical interventions for under 18s. It focuses largely on what they euphemistically term “chest reconstructive” surgery. Nowhere do they use the correct term, mastectomy. It reads “Chest reconstructive surgery, also known as top surgery may be appropriate in the care of trans males during adolescence.” It goes on to say that genital surgeries are more complex and those procedures should be delayed until adulthood.

Contrast this with what Michelle Telfer said on Australian Story:

Michelle Telfer

But we don’t provide any surgery. To access surgery one has to enter the adult system and that only occurs once someone’s over the age of 18

This contradicts her own gold star Standards of Care. And it seems the ABC didn’t bother to fact check it. It’s highly likely that the Royal Children’s Hospital has made referrals for girls under 18 to undergo double mastectomy. Their treatment guidelines summarise the roles various doctors should perform when treating gender dysphoric children. It includes, quote “counselling of the adolescent and their parents or caregivers on the available options for gender affirming surgical procedures such as chest reconstruction with referral where appropriate.”

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. 

If you’re still not convinced, my fellow gender critical campaigner, Leah Whiston made the following phone call to Valley Plastic Surgery in Brisbane.

Receptionist: Thank you for calling Valley Plastic Surgery, you’re speaking with [beep]

Leah Whiston: Oh hi [beep] I think I spoke with [beep] just a minute ago but, I asked some questions and silly me didn’t write down the answers, could I ask you?

Receptionist: Yeah

Leah Whiston: Ok

Receptionist: Fire away

Leah Whiston: So I was asking about the protocol of top surgeries for trans boys and I couldn’t remember if you said if she said the letter from the psychiatrist has to be 5 months or 3 months in advance

Receptionist: Um 3, a minimum of 3 months before surgery

Leah Whiston: Ok cool. And was it 15 and upwards the age limit, or, have I got that right?

Receptionist: Yeah that’s correct

Leah Whiston: 15 and upwards. I couldn’t remember is she said 15 or 13

Receptionist: Yeah, um, technically you can go from 13

Leah Whiston: Right

Receptionist: Um but generally speaking 15 is…

Leah Whiston: Ok cool. That’s great. I’ve written that down so shouldn’t need to call you again. I’ll pass that on to my client. Thank you.

Receptionist: That’s no problem at all

Leah Whiston: Bye

The trend of girls and young women having double mastectomies is all over social media, TikTok in particular. It’s trendy, not just amongst trans identified girls, but also amongst girls who believe themselves to be non-binary. They document their recovery, their complications, their trans joy at becoming breastless and their celebratory first trip to the beach where they finally get to go topless. Some opt to have their nipples completely removed. For others the nipples are removed, trimmed to reduce the size of the areola so they appear more male and then reattached or grafted back onto the chest. A Florida based surgeon, Dr Sidhbh Gallagher markets directly to teenagers on TikTok. She playfully calls herself “Dr Teetus Deeletus” and has over 250,000 followers. 

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A high-profile case of someone who had surgery young and is a role model for many of the kids identifying as trans today, is the star of US reality tv show, I Am Jazz. The show follows a young boy, Jazz Jennings, whose parents raised him as a girl since age four. The series starts around the time Jazz begins puberty blockers and has now been running for eight seasons. Now, in 2024, Jazz has gone through the full Dutch Protocol – puberty blockers, cross sex hormones and sex reassignment surgery. His surgery was complicated by the known problem caused when puberty is suppressed in boys. His penis hadn’t developed, meaning there wasn’t enough tissue to work with. He also suffered an added complication in that his stiches split open soon after surgery. This required emergency intervention. Still not happy with the cosmetic appearance, he underwent a third revision surgery.

Dylan Wilson

Who knows what Jazz’s anatomy is like, because there’s an episode where Marci Bowers and the other surgeon – Dr Ting I think it is – where they’re arguing in surgery about where things are placed. They can’t agree whether that’s anatomy or a problem or a scar. They’re actually arguing in theatre and it’s like – cos they’ve artificially created something that’s not healthy.

Vaginoplasties require ongoing maintenance. Different surgeons recommend different regimens, but what’s required is dilation, that’s the insertion of a dildo like object to keep the neovagina from healing shut. As time goes on, the dilation regimen is supposed to decrease. So where earlier you might be doing three 30-minute dilation sessions a day, you may be able to reduce to once every three days. But that’s not always what happens, as this young transsexual explains on YouTube. 

Adea

The reason I’m dilating twice a day is because if I miss once, it is so painful and I feel like I’m stuck and like I have to do it or else like I’m gonna have the worst time like the next morning or if I go out and I come back at like 4 am I’m gonna go to sleep and I’m not gonna dilate, but then the next morning when I wake up, I like dread it so much because it’s so painful cos it’s like so tight.

At a time when this young man is supposed to be going out, partying, coming home at 4am and sleeping til midday, his whole life revolves around dilating a surgical wound that’s trying to heal. Even more disturbing is his experience of sex.

Adea

Like I’m too tight, like guys love that, like guys love to hear that, but I’m actually like too tight, like every time I’ve had sexual relations, I’ve bled and they think it’s my first time, and I’m like no, I’m in pain, and like, while they’re doing it, I want to faint and it’s horrible but I mean what can I do except go and have another revision.

His neovagina has been created for other men to penetrate. He receives no pleasure himself. It doesn’t engorge or lubricate like a normal vagina. It doesn’t have the internal part of the clitoris which extends into the anterior vaginal wall. Its only function is to be penetrated and supposedly, cure gender dysphoria. 

A possible complication from vaginoplasty is a fistula, or hole, developing between the neovagina and colon. Some patients even end up living with a colostomy bag. Strictures in the urinary tract are common, which means a narrowing or even blockage of the urethra.

This makes urinating nearly impossible and requires a catheter. That can then lead to urinary tract infections that sometimes travel to the bladder and kidneys. And one study found that 30% of post operative males are unable to orgasm. 

Dylan Wilson

In an episode, a few episodes, Jazz talks about having never experienced orgasm. And then all of a sudden the penny goes, drops and you go, well of course, you need puberty – puberty is by definition the stage of human development where we reach sexual and reproductive maturation, so if you don’t go through puberty you don’t reach that stage.

In an early interview Barbara Walters asks 11-year-old Jazz if he’s attracted to boys or girls. He says boys. Then at 17, he tweeted that actually, he’s pansexual, that’s the all-inclusive sexual orientation that means you’re also attracted to trans people. In the eighth season which aired in 2023, Jazz is in his early 20s and finally starts dating. It becomes apparent that he isn’t comfortable dating men and feels safer with women. Given that puberty blockers are also used to chemically castrate male sex offenders, it follows that the same happens to a teenager. They don’t experience sexual urges. This means at a time when a child like Jazz, most likely a gay boy, should be exploring and coming to terms with his homosexuality, his entire psychosexual development is blocked.

In a leaked recording, Jazz’s surgeon, Dr Marci Bowers who’s also a trans identified male and the president of WPATH, explains the effect of puberty blockers on male sexual function.

Marci Bowers

Every single child who was –  or adolescent – who is truly blocked at tanner stage 2 has never experienced orgasm. I mean, it’s really about zero. Of course these are just assigned male at birth, so trans feminine, and it’s because they never in their lives are exposed to testosterone.

How does a 12-year-old decide to forego the experience of orgasm if they’ve never experienced it to begin with?

Dylan Wilson

Jazz was a little gay boy who’s been transed. That’s his life now, he goes on dates with boys but he’s never going to have any sexual function, no sexual enjoyment. And god forbid that Jazz ever actually does have any form of sexual relationship with a man ‘cause there’s nothing in it for Jazz. Like, what’s in it for Jazz? There’s no pleasure to be had, nothing enjoyable for Jazz at all.

I feel really sad for Jazz Jennings and what could’ve been. I’ve wondered if in future years he might regret what’s been done to him and how catastrophic that would be for his mental health. I wonder the same about all of the so-called trans children. But at least their transition, their social difficulties and their family dynamic wasn’t broadcast for the whole world to watch.

Dylan Wilson

In our clinic we started seeing patients who were starting on puberty blockers as early as Jazz. Previously we hadn’t seen any and there was a few that started coming here for other issues and as young as 11 and well that’s just like Jazz Jennings, they’re going to end up just like Jazz, there’s just no other way around it, if they continue or don’t ever stop these puberty blockers they’ll be in exactly the same situation – they’ll never experience sex, they don’t have any fertility. And then you learn all about the other complications and the problems that the medications bring.

It’s almost inevitable that children put on puberty blockers will proceed to cross sex hormones. In a 2021 research paper from the London Tavistock clinic, 98% of patients proceeded to hormone treatment. Far from being a diagnostic tool allowing children time to think and possibly resolve their gender dysphoria, puberty blockers seem to further solidify the desire to transition. If it is a diagnostic tool, then why does it almost always produce the same outcome? I asked Dr Jillian Spencer why puberty blockers seem to lock in a trans identity:

Jillian Spencer

I don’ think it’s fully known but, is it because they don’t get to experience the full effects of puberty? It’s possibly so because the qualitative studies looking at people who have recovered from gender dysphoria in adolescence indicate that the experience of, the experiences of puberty like the broadening of friendships and activities, the individuation from parents and the sexual awakening and experiences of intimacy, all those experiences can help someone to feel comfortable in their own body. Or is it that the brain doesn’t mature because of the puberty blockers and so the current thoughts and ideas are more likely to be retained and kept rather than as would be normal through the course of puberty and adolescence for people’s ideas to change with various experiences and with changes in their brain, particularly development of their frontal lobes 

Another possibility is the sunk cost fallacy where these children have invested a lot in their cross-sex identity. They’ve asked their friends, family and school to support them. Now on puberty blockers, they’ve started the medical process. To reverse course could be embarrassing and it might cost them their reputation and their social group. 

For children like Jazz Jennings who were socially transitioned before puberty, the possibility of resolving their gender dysphoria becomes even more unlikely. In a way, they’ve been conditioned to fear their natural puberty.

Jillian Spencer

Social transitioning children is a relatively new thing, it’s only been in the last decade that gender clinics have been recommending social transition to kids. In 2012 the Dutch gender clinicians who pioneered this field of medical transition of minors issued a warning against prepubertal social transition because they’d realised that social transition can lead a child to lose touch with the reality of their actual sex. When kids are little they can have magical thinking about such things. And at such a young age a child can’t possibly comprehend the enormity of the path ahead of them if they wish to try to continue to present as the opposite sex as they get older. And the Dutch noted that it was harder for children who’d been socially transitioned to change back when they recovered from their gender dysphoria because everyone around them apart from the family knew them as the opposite sex. 

Despite this, the Australian Standards of Care encourage social transition, claiming improved mental health.

Whatever the reason, social transition, followed by puberty blockers leads to cross sex hormones. And these are not without risk. As Dr Dylan Wilson explains:

Dylan Wilson

Every single hormone that exists in the human body – if you have too much of it or too little of it you get a disease. That’s the way medicine works. If you have too much thyroid hormone you get hyperthyroidism, if you have too little, you get hypothyroidism – both of those cause disease and every single hormone doesn’t matter which one it is, there’s a disease that goes with that. We are deliberately elevating or supressing children’s hormone levels and adolescents’ and young people’s hormone levels to a point outside the normal range – we’re either making them way too high or way too low on purpose so we are causing hormone disease, on purpose.

Female bodies just aren’t designed to process high levels of testosterone. Some of the more serious health complications include high blood pressure, high cholesterol, increased risk of cancer, blood clots, stroke and heart attack. There’s also vaginal atrophy where the lining of the vagina dries and thins, as well as ovarian and uterine atrophy, leading to severe cramping. 

And likewise, male bodies aren’t meant to have high levels of estrogen. It can lead to blood clots, stroke, heart problems, high blood pressure, breast cancer, high levels of triglycerides and potassium in the blood.

Both males and females taking cross sex hormones are at increased risk of developing type 2 diabetes.

Dylan Wilson

Unless you’ve got an underlying medical condition, the vast majority of 20 year olds have no reason to go to the doctor on a regular basis. But if you’ve been through a gender clinic and you’ve been on puberty blockers or testosterone, or estrogen, you have to see a doctor all the time. You’ve automatically been medicalised, instead of living life and just doing normal things you’ve got to be constantly going to appointments, you know, and testosterone injections.

Do the mental health benefits of medical transition really outweigh the risks? Would you rather your child learn to live with gender dysphoria? Or with type 2 diabetes? Or a colostomy bag?

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So far we’ve talked about top surgery for girls and bottom surgery for boys, but what about the much rarer, phalloplasty, the surgical creation of a penis?

Dylan Wilson

There’s no doubt that phalloplasty is by far and away the worst of all the surgeries, like it is just absolutely grim, and brutal and horrible and should be banned. There’s absolutely no way anyone should be allowed to completely and utterly dissect a person’s arm, down to the bone and construct something that looks nothing like a penis, surgically attach that to a human’s body, and they have almost 100% complication rate, the complication rate is huge with these surgeries. They have urinary tension, the urethra doesn’t work. They have to use, in some cases they use the skin from the cheeks, inside and scrape the – what goes through a person’s mind, as a surgeon, to say, they’ve got someone on the table and say “I think this is a good idea what I’m doing”? How do they possibly comprehend and go to sleep at night saying it is a good idea for me to completely and utterly ruin this person’s arm and give them something that will never work. It’s a form of mutilation. I know people who have suffered from mutilation, they don’t like that word, but it is, you’re mutilating a person’s arm and attaching something to their body that is never functional and causes a huge among of problems and they never once, again, they don’t stop and say, “what are we doing?” The phalloplasty is the worst.

I was three years into my gender critical journey before I saw a photo of an arm being harvested for skin to create a fake penis. It’s as brutal as Dylan described. They don’t just harvest skin, they also take nerves from the arm and attach them to clitoral nerves. 

Dylan is however, slightly exaggerating when he says phalloplasty has a near 100% complication rate. A systematic review of available research did find a shockingly high complication rate of 76.5%. Here’s a first-hand account from a TikTok video, of what can go wrong:

TikToker

We are at day two of recovering from urethroplasty. I was supposed to be released from the hospital today unfortunately that didn’t happen cos as soon as I got to the hospital I contracted two infections. And what is urethroplasty? It is the reconstruction of your urethra. About 30% of trans men have this problem when they get phalloplasty done, meaning they cannot urinate on their own, they lose the ability to, and usually it’s because of a stricture or a fistula, for me it was neither of those. My entire urethra was actually not viable and it didn’t work at all so he had to reconstruct one completely for me which is why I’ve been in the hospital a little bit longer this time around. This is something that you really don’t see much information on, so what do they do? It’s actually quite gruesome what they do. They take you, they take your ding-dong and they open it like a hot dog bun. And from there, they take skin grafts from your cheek and they build a urethra, and that has to be open for six months for that urethra to grow. Then once that urethra grows, six months later they take your hotdog bun and roll it back and stitch it back together and I will be able to stand to urinate in about six months’ time.

Did you follow that? The surgeon cut open her neophallus long ways, like you would a hot dog bun, and she has to live with that for the next six months – an open wound. This is what trans activists are talking about when they say “transgender healthcare”. This is what gender clinicians mean when they say “gender affirming surgery”.

There are several different phalloplasty techniques. Some use donor skin from the lower back rather than the arm. Some use skin from the thigh. Because thighs are more fleshy than forearms, some patients end up with a neophallus with the girth of a soft drink can. And the fix for this is liposuction. 

No neophallus functions like a real penis. To get erect, one has to have implants which is yet another surgery. One type of implant is a stainless steel, bendy rod that you simply bend upwards to mimic an erection. The other types are inflatable. So you’ll have a pump installed in your neo-scrotum and when you squeeze it, a saline solution moves from the scrotum into a cylinder inside the shaft. The pumps are known to deteriorate, and so you’ll need yet another surgery down the track.

Since 2021, the Australian Greens have been pushing for these surgeries to be covered by Medicare. Presumably that would mean taxpayers covering not only the initial surgery, but all the corrective surgeries that follow from the high complication rate. Here’s the leader of the Greens, Adam Bandt trying to sell the idea to the Australian senate”

Adam Bandt

Trans and gender diverse people deserve to feel affirmed for their gender expression. For some, it can be lifesaving. In our current system, trans people have to spend up to $30,000 to access surgery and transitional health care because it isn’t covered under Medicare. This is unacceptable.

There’s that term again, lifesaving. Thankfully, the Greens have no real power at the federal level and this demand was largely ignored. But it would be interesting to know exactly which surgeries they want covered. The penile implants? Tracheal shave to reduce the size of a man’s Adam’s apple? Or facial feminisation surgery where the male jaw and brow bones are shaved down. Does Adam Bandt consider nose jobs to be lifesaving? 

In September 2023, the Greens got a boost from the Australian Society of Plastic Surgeons when they applied for trans surgeries to be covered by Medicare. The only surgeries not on their wish list were penile implants and nose jobs. Gender affirming medicine is big business, so it’s no wonder plastic surgeons see this is a lucrative new frontier.

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In light of the many serious health risks that come with puberty blockers, hormones and surgeries, you might be wondering why these treatments are so frequently described as lifesaving. The claim here is that medical transition prevents suicide. And the claim that trans youth in Australia are at significantly increased risk of suicide comes from a 2017 survey called Trans Pathways. Dr Jillian Spencer has spent some time looking at this survey.

Jillian Spencer

In looking at the survey there were some really unusual responses like 21% of the subjects were not sure if they were intersex and intersex is obviously very rare so these people were a little bit confused about their own medical condition and also it was unusual because 42% of the subjects identified as trans but had not socially transitioned and only a third had had any medical intervention.

Online surveys are notorious for producing unreliable data. There’s no way to verify that the results are an accurate snapshot of any given demographic. Despite two thirds of the Trans Pathways respondents having no medical intervention, the researchers still counted them as transgender. This, in addition to the bizarre intersex responses, immediately casts doubt on the alarmingly high rates of self-harm and suicide attempts. 

Jillian Spencer

Three quarters of the subjects had depression and anxiety and 80% had self-harmed and almost half had attempted suicide. So these are very disturbed young people. 

48.1% reported having attempted suicide. 

Jillian Spencer

And in terms of diagnoses there was an enormous amount of suffering, so 25% had PTSD and 20% had a personality disorder and remarkably 16.2% had psychosis which is huge. In the general population that would be round about maybe 1%. 25% had had an eating disorder and 25% of respondents said they had an autism spectrum disorder. So it’s a really unusual sample they’ve collected of people with incredibly high levels of mental health problems.

Again, as this was an online survey, there’s no way to verify that the respondents actually had these diagnoses or whether they had self-diagnosed. Despite this, these figures are repeated by Australian gender clinicians as though they’re fact, including in the introduction to the Royal Children’s Hospital’s Standards of Care.

Jillian Spencer

So it’s hard to know what to make of the survey in that it’s probably a survey of the most disadvantaged and mentally ill people in our community and it doesn’t seem to be a survey that looks at the experience of people who have transitioned or had medical interventions in that two thirds had not had any medical interventions. And because it’s not a medical survey, it’s self-report, it’s hard to trust the reliability of the data. And we do know that in these communities there is a promotion of a suicide narrative and there is a promotion of using suicide as a means to communicate distress and need for assistance so it might be that some of this is over reporting because they perceive that that will promote their cause or get access to services that are required.

The truth is, we simply don’t know the true rate of attempted or completed suicides amongst gender dysphoric youth. Sociologist Dr Michael Biggs, who we met in the last episode, used data from London’s Tavistock clinic to try and bring some clarity. He found 4 completed suicides in a span of 10 years. Two had already begun treatment and the other two were on the waiting list. This amounted to 4 in 16,000, which is roughly 4 or 5 times higher than the general adolescent population. But that’s still lower than other patient groups. For anorexics the risk is between 18 and 31 times greater. And for depression, it’s 20 times greater. Still, the idea persists that kids will commit suicide unless they’re given puberty blockers.

In July 2023, the ABC’s Four Corners aired an episode called Blocked, hosted by Patricia Karvelas. It pushed the idea that a young girl, Noah, who identified as a boy, committed suicide because she was denied puberty blockers by Sydney’s Westmead hospital. Westmead is the only gender clinic in Australia that takes a more cautious approach to medical interventions for children. The reason they denied Noah puberty blockers, was because she had an eating disorder. As a result of the ABC’s investigation, the NSW health minister, Ryan Park, announced a review of the service. That review will likely bring the clinic into line with the Royal Children’s affirmation model. Jillian Spencer appeared on the ABC program.

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. In our community it is children and adolescents who are most impressionable to acting out on those sort of subconscious messages, but it’s also not, possibly not subconscious, it could be considered more overt and insidious in that it’s coaching children to express suicidality in this situation to ensure that their parents go along with what they’re demanding.

The weaponisation of suicide by gender clinicians – that awful question: would you prefer a live son or a dead daughter? – has left parents fearful and more likely to agree to risky medical interventions. But puberty blockers could be the worst thing for an adolescent who’s already contemplating suicide.

Jillian Spencer

I know that in Finland what they do do is, if there’s any risk or reported thoughts of suicidality then they take puberty blockers off the table. Because it is understood that a group of kids and probably it’s at least a third, will deteriorate on puberty blockers with their mental health and so there would be an argument that, if the child is that distressed and overwhelmed then it’s actually risky to start the puberty blockers.

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Have Australian gender clinicians got it right, where London’s Tavistock got it wrong? Have they worked out the magical formula for predicting which children will be gay or lesbian adults as opposed to transsexuals? With thousands of Australian children started on puberty blockers each year, we’re set to find out in the coming years. 

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Coming up in the next episode of Desexing Society, we’ll look at how gender identity ideology became embedded in Australian schools.

Moira Deeming

The other reason why when I was a teacher I didn’t pay attention to this program, it was called the Safe Schools program, that sounds good to me, I’m all on board, it’s to stop bullying against gay kids, good, I already don’t agree with that.

It was only when I looked at the curriculum that I thought, where is the anti-bullying material in here? This is a sex ed curriculum and it is full of transgender ideology.

And we’ll learn about the philosophy that underpins Safe Schools 

Elisabeth Taylor

So the political claim of queer theory, and this is the thing that people generally don’t understand, is that they want to eradicate the moral distinctions between good/bad, healthy/unhealthy, acceptable/unacceptable sexual behaviours and interests so that everything is normal and good.

People who understand queer theory would not go along with this, most people. But nobody wants to have the queer theory conversation.

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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