SEGM 1 – 0 AusPATH

AusPATH (the Australian Professional Association for Trans Health) claims to “promote the health and well-being of trans people, including those who are gender diverse and non-binary.” So we should presumably expect its recently released “Public Statement on Gender Affirming Healthcare, including for Trans Youth” to be scientifically rigorous, balanced, cautious, and free of ideological bias. 

Not according to the Society for Evidence-Based Gender Medicine (SEGM), who have taken the time to break down AusPATH’s latest guidance item by item.

An example: AusPATH claims that immediate “affirmation” (social transition, followed by hormonal and surgical interventions) is the only appropriate treatment for gender dysphoric people, including youth. Expressly cautioning against all other approaches (claiming that these may “cause harm”), AusPATH states that “affirmation” is the international standard approach, and is supported by robust evidence.

Yet SEGM – whose members have decades of clinical experience between them – point out that

AusPATH relies on poor quality research, fails to highlight the methodological limitations of most studies and at times misrepresents or exaggerates the research findings and conclusions. AusPATH also mischaracterises psychotherapy for gender dysphoria as potentially harmful.

SEGM goes on to say: 

AusPATH […] claim that “medical and surgical affirmation can frequently alleviate gender-related distress and yield a variety of benefits to the individual [our emphasis]”. It is important to note that there are no studies that have assessed long-term adult outcomes of individuals who underwent youth transition.

AusPATH makes no mention of well-documented risks, which might understandably lead readers to assume there are no safety concerns. There is evidence of significant physical harm from medical interventions for gender affirmation…

Whilst AusPATH have no doubts that gender-affirming interventions are beneficial to youth with gender dysphoria, other independent expert bodies around the world are reporting concerns about the serious limitations of the available data and safety.

AusPATH opines that psychotherapeutic approaches are experimental and risky, although they do not call for research to test their opinion […] The recent European reviews […], in addition to the review by Heneghan and Jefferson (2019), suggest that it is medical gender-affirming treatment that is risky, unproven and “experimental”, rather than psychotherapy, being a safer option.”

There is no evidence for AusPATH’s claim that psychotherapy for gender dysphoria can cause harm. AusPATH goes much further, however, mischaracterising ethical psychotherapy by conflating it with ‘Conversion Therapy’.

We believe that high-quality healthcare guidelines cannot be produced by single special-interest groups acting in isolation but require rigour and independent quality assurance processes.

Finally:

SEGM concurs with the findings of major systematic reviews that the current evidence for gender affirmation is uncertain. The viable treatment alternative is psychological intervention, the orthodox foundation of contemporary child and adolescent mental health care. Established psychological treatment models for helping distressed youth should be the first-choice treatment for youth with gender dysphoria.

Have a look at this recent important study conducted in Australia, which raised significant concerns about the affirmation model, pointed to the complexity of the psychosocial issues being seen in the current cohort of gender questioning youth, and called for a broader, “biopsychosocial” approach to assessment and management of dysphoria.

The AusPATH statement explicitly cautioned that this study should not be relied upon, lest it “undermine current widely accepted practice.” But this recommendation was made without evidence and without further explanation.

Once again, SEGM lets the evidence lead. It seems that not all organizations can say the same.

This article was written by an anonymous Australian parent of a gender-questioning child. Genspect would like to thank this parent for drawing our attention to this important matter.