Latest / Uncomfortable Conversations with Josh Szeps / Is this Child Psychiatrist "Anti-Trans"?

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Is this Child Psychiatrist "Anti-Trans"? · Uncomfortable Conversations with Josh Szeps

• 0:03
  G'day humans! Welcome to the Safe Space for Dangerous Ideas. Well, an incredible story today. It is very rare for any institutional bureaucracy to admit defeat and concede where it was wrong, but that has happened in favour of today's guest, Dr Gillian Spencer. She was a senior child and adolescent psychiatrist
• 0:25
  working for Queensland Health at one of the biggest hospitals in the state of Queensland in Australia. And she was fired three years ago after she publicly criticised the way that puberty blockers and cross-sex hormones were being prescribed to young people and to adolescents in the new gender clinic that had been set up in the hospital.
• 0:46
  which she was working at. And now her employer, which is one of the biggest healthcare providers in the country, has issued quite a bombshell statement. They've announced that they're withdrawing their misconduct allegations against her. And more than that, they effectively admit that her concerns were legitimate all along. And,
• 1:07
  This could be a turning point in the whole transgender debate and in the permissibility of people to air concerns about the way that some young children, not all of them, are fast-tracked into a system that assumes their transgenderism is legitimate and treats it as such, whilst penalising any psychiatrists and physicians who might want to dig into other things that are going on in the young person's brain.
• 1:31
  In fact, Queensland, the state where Dr Spencer works, they last year joined a growing number of jurisdictions around the world to restrict or ban the use of puberty blockers or cross-sex hormones in young people until further research is conducted on their long-term effects.
• 1:49
  So she was in some ways vindicated by the policies of her own state, even before this gruelling and drawn out dispute with her employer was resolved. But resolved it has been. And Dr. Spencer was kind enough to fly down from Brisbane to Sydney to join us here in the Uncomfortable Conversations studios and speak for more than two hours. So this is definitely an episode that you want to subscribe to hear all of if you're only on the free feed and you're only hearing a preview section.
• 2:17
  The half hour that you'll get on the free feed is interesting, but the whole two hours is an amazing tale of defiance and courage and standing up to groupthink and institutional pressure and believing in medical integrity. It's an important story to hear. I hope you enjoy as much as I did the one, the only Dr. Gillian Spencer.
• 2:44
  Congratulations, firstly, on the statement you just mentioned off the air does not technically include an apology, but you wouldn't know it from reading it. I thought there was a lot of conceding. Can you just maybe take us back to the beginning? What happened?
• 3:00
  Okay. Well, I guess your audience would already know I'm a child and adolescent psychiatrist. And that means that I studied medicine at university, and then, you know, worked as an intern and a junior doctor and then trained in psychiatry, which takes about five years. So I became a psychiatrist in 2009. And I'm
• 3:19
  Yeah, I went to med school at Monash in Melbourne, but I came up to Brisbane for my internship. So I've worked for Queensland Health, or I should say I did work for Queensland Health from 2002 through to, well, 2026 now.
• 3:32
  And just to clarify, Queensland Health is the state government department that runs the hospitals, the health service essentially. All the public health services in Queensland. Because we have Medicare for all in Australia, but the actual health system is run by the states rather than by the federal government. So Queensland being a state, you're working for the government, but in your capacity as a psychiatrist.
• 3:56
  Yes, yes. So, yes, I qualified as a psychiatrist in 2009 and I did subspecialty certificates in forensic psychiatry and child and adolescent psychiatry. Oh, interesting. Yeah, it was great. And then, so, yes, I've worked in the public hospital system for, oh, since 2002. Just as an aside, what's forensic psychiatry? How do you do forensics and psychiatry? What does that involve? Oh, well, it's the intersection of psychiatry with the law and
• 4:24
  There's so many areas, you know, for example, pre-sentencing reports or things like where people have committed an offence and they're not guilty on the grounds of mental impairment. For example, in Queensland, we have our own mental health court for those sort of serious cases where there's murder or, you know, other very serious crimes committed while someone's got a mental impairment and then that court's...
• 4:46
  you know, there to decide whether the outcome for that person should be long-term mental health care, either in a long-term forensic hospital or in the community, or whether they go back to the criminal justice system because they're criminally responsible. So, yeah, forensics. And then also actually forensic psychiatry covers working in prisons and juvenile detention centres if you're in child and youth. So, no, it's a fascinating area. Yeah.
• 5:13
  Yeah, I did that first and then got interested in child and youth and then thought, right, well, I can combine the two and work with young offenders. And so I did those two. Each certificate takes about two years and then waited for ages to get the child and adolescent forensic job. There was one in Brisbane at that time and it finally became available.
• 5:36
  And this is a city of like a million and a half people or something. It's not like you're, for people who don't know Australian geography, you weren't out in the outback or something. This is the third largest city in Australia? Yeah. Yeah. Yeah. Well, the forensic servicing for children in Queensland has been massively expanded since then. So it's not the case now. But back then in 2014, you know, there was one psychiatrist job and then there was the director of the service, et cetera. Yeah.
• 6:03
  But unfortunately, I didn't like it. I just found it, oh, there's something about me that if kids don't have families, a lot of those kids in forensics, you know, they're really dislocated from their families. And I sadly just found it too frightening. Yeah, it's the first time I ever didn't like going to work. Frightening, why? Oh, kids that are so alone. Yeah, it was just too much. You're frightened for you or for them?
• 6:34
  Well, I guess that's the mystery of it in that what we do as human beings is pick up on other people's feelings and often people don't want to feel their own feelings. And so, I mean, it could be that they're frightened and I'm picking up on that and absorbing it. But also, I think just me feeling frightened for them because they're so vulnerable and on such a difficult trajectory that it's worrying sometimes.
• 6:58
  Yeah. And so they're people who are usually, are they mainly adolescents who are in the criminal justice system? Yes. Yeah. Yeah. Really disturbed and hurt, traumatized, horrible stories. Yeah. But to be honest, the other parts of child and adolescent psychiatry are
• 7:14
  mostly depressing too. It's all depressing. Pick your level of depressing. Yeah. Yeah. Sorry, I have gotten off track. I mean, you have to have, I guess you just have to have an enormously thick skin somehow, don't you, to be able to work with children who are in those kinds of situations. But yes, so you pivot away from... Well, I'll just stick on... Yeah. Because maybe I don't want to, you know, we don't need to jump straight into, but that's a notable exception about the gender clinic,
• 7:40
  Because in the gender clinic, it's wall-to-wall, rainbows, enthusiasm, positivity, and the clinicians are heroic, life-saving, you know, in their own perspective. And I think that's part of what attracts people to the idea of the gender clinic and working in the gender clinic because it's…
• 7:58
  It tucks away the pain. It controls the situation and the environment so people aren't comfortable in expressing doubts or their pain and they have to sort of go along with a pathway that's celebrated. Fascinating. Right. So if you're working as a psychiatrist with young people, nine times out of ten, it's going to be because they're fucked up in some way.
• 8:21
  They've been really good. One time out of 10, it's because they have gender dysphoria and you get to be the gatekeeper to the solution, essentially, right? And then you're the savior instead of the person who has to deal with all of their shit.
• 8:35
  Yes. So it's a fantasy solution in my point of view. It's held out as a fantasy solution for people who are very troubled. Yeah. So that's part of the reason why I have massive misgivings about that model. Yeah. Okay. So take us back. So you're doing forensics and pediatrics, I mean, psychology. Psychiatry, yes. Yeah. Psychiatry. Sorry. And how do you get out of forensics and end up finding yourself in
• 8:59
  Oh, yeah. So, well, I, yeah, luckily I got pregnant. Congratulations. Thank you. Retrospectively. Yeah, back in 2015, the last baby of three. And yeah, so that was an opportunity to, yes, discreetly move my way out of forensics without admitting as to not being able to handle it. Right, right, right. And then I started working in the Queensland Children's Hospital. Just blame the baby. Yeah.
• 9:23
  Yeah, yeah, yeah, yeah. And working in the Queensland Children's Hospital. And that's, yeah, from 2015, I worked in the Queensland Children's Hospital. And I had various roles, you know, child mental health unit, kids under 12, adolescent mental health unit, the consultation liaison team, which is going around and seeing the kids on the medical and surgical wards, emergency department.
• 9:47
  you know, telehealth to rural areas. So, and also I was campus director in the hospital for three years. So I knew a lot of people, knew the executive, felt, you know, actually loved and well-respected. Yeah, really loved the public health system. And yeah, I'm not someone that's gone out into private practice because I'm not like a lone wolf character. I like to be around people. I like to see...
• 10:13
  You know, because, you know, in the hospital system, you work with people and then all women, they get pregnant, they go on mat leave, they come back, you talk about your kids. You know, there's all that social element in the stairwell. That's all suitable for me. Some people don't like it. No, I love it as well. I miss that about working at the ABC as well. Yes, exactly. Having great colleagues, you know, people you do like, people you don't like, people gossiping about each other, you know, people, you know, it's great. It's a great community. It's something I miss about being a lone wolf as well now. Yeah, understood.
• 10:40
  So, yes, all right, so you're essentially running the hospital psychiatry division at that point? Oh, no, I stood down from that in 2019. Oh, okay. And at the time of all the trouble, I was working in this consultation liaison psychiatry team, which is that, once again, going around and seeing the kids in the medical and surgical wards that are going through mental health difficulties and giving an opinion to those. And do you go and see everyone, basically? I mean, when a kid is in a car accident or something like that, do you give them a quick psych eval or is that not a, you don't need to?
• 11:09
  No, the treating team, so the surgeons or the pediatricians, have to make a referral with the permission of the parents to the better health team. And then we, upon their request, go over and provide an opinion and care until they're discharged from hospital, which can be short or long. Right. So at what point do gender questions come into it?
• 11:29
  Yeah, so I was in the... So all through my training, I'd never seen a kid with gender distress and we weren't really taught about it. We knew it was rare. Obviously, in the DSM, they say one in 30,000 girls and one in 10,000 boys. And then...
• 11:45
  And what's gender distress? Is that in the DSM as a clinical condition? Gender dysphoria is. Gender dysphoria. So it's a persisting cross-sex identification with discomfort with, you know, stereotyped gender things. So, you know, preference for opposite-sex playmates and opposite-sex clothes, except, you know,
• 12:04
  all that sort of usual stereotype stuff. So this is the official sort of clinical thing of what I guess we used to call transsexuals, of people who from a very, very early age, from maybe the age of two or something, are like persistently, nope, I'm definitely a girl. Yeah, well, the criteria doesn't require that from the age of two sort of thing. It only requires six months. And importantly, the criteria is online, and kids, adolescents particularly these days, are online. And so the criteria is fully available and... And...
• 12:33
  Yeah, so make of that what you will, but kids seeking to present with that diagnosis would be easily able to report those experiences. Right, right. Sometimes obviously disputed by their parents, but then, yeah. So, oh gosh, Josh, where were we? Yeah, so no experience with gender distress in training because it was so rare, not seen. And then, yes, in the children's hospital from 2014 and then from 2017 is when the gender clinic was set up in the hospital.
• 13:01
  And so we got training from the gender clinic and we had, you know, lots of education about the affirmation model, the gender affirmation model. And we got told things that I now know are not true. But at the time, of course, I believed it, which is that, you know, puberty blockers are just a pause and that it's a lifesaving model that prevents kids from dying by suicide. Yeah.
• 13:25
  Yeah, so that happened from 2017. And then with the gender clinic getting up and running, that's when we started noticing more and more kids with gender distress coming through the system. So as you would have heard, you know, the waiting list for the gender clinic started blowing out fairly early but peaked in COVID and they had to start putting on Saturday clinics. And it's an interesting model because the gender clinic
• 13:53
  was set up to be, it was under the mental health service, but because the affirmation model considers that children with gender distress to be naturally trans or gender diverse, so that's a key element of the model, what that means is that the cause of the gender distress is not considered to be any other mental health condition or developmental problem or family problem or trauma. It's to do with being naturally trans. By definition.
• 14:23
  Yes, that's the work instruction for management of gender dysphoria in the hospital. It says children with gender distress are naturally trans or gender diverse. The significance of that is that it wasn't... that those people working in the gender clinic didn't use the mental health record because we couldn't consider it a mental health condition. So they were only documenting on the electronic medical record in reflecting that idea that it's a health condition, not a psychological or mental health condition.
• 14:52
  So if it's not a psychological condition, then what is it? Natural. Right. It comes from this gender affirmation model has the premise that the kids with gender distress are naturally trans, and any of the anxiety and depression they're going through will be cured by the process of affirmation and connection to the queer community.
• 15:16
  Right, okay. So it's more like being gay or left-handed or something like that. Yes, exactly. Than a condition per se. Exactly. And when you were being trained about that, did you have any question marks about whether or not it... Like, would your natural instinct be to go back through the mental health records of the individual in order to try to understand what is going on and put it in a context? And if you couldn't do that, was that a problem? Yeah.
• 15:45
  Yeah, well, that's what happened to me because when the clinic first got set up, it was just a matter of, oh, well, the gender clinic knows what they're doing. I would never have ever in my wildest dreams believed that my colleagues would be doing something that wasn't evidence-based. So there was no questioning in my mind. But the problem started because as these kids...
• 16:07
  started coming through the system and I started seeing them, I started seeing these kids with very complex histories
• 16:16
  And to me, it was very obvious that these kids had good reason to feel scared of growing up to be an adult of their sex or, you know, reasons to fear sex itself or, you know. So say, for example, what happened to me in 2018 is I was working in the child mental health unit. So that's a mental inpatient unit for kids under 12. And there was a girl who came in. When I say girl, it's a biological female child.
• 16:46
  And she was the youngest of quite a few girls and then had lost her father suddenly two years before and she'd been really close to him. How old was she? Sorry, she was 12. Oh, okay. Yeah, and then her mum had recently repartnered
• 17:02
  Um, and, you know, she was saying that she could hear her mum being intimate with the new partner in the next room. And it wasn't that, you know, it was a not, it was, you know, a small house. I'm not trying to cast aspersions there, but, um, so these older siblings were all sort of going their own way. She was the youngest mum was off with a new relationship. She'd lost her, you know, dad suddenly who she'd been really close to. And then, um, she told me that she was a gay man. So she
• 17:28
  I thought, well, you know, there's a lot of complexity there. There's grief. There's, you know, a sense of in her family, who is she connected to? The sense of belonging has been lost to her. How does she try and pull people back to her? How does she differentiate herself from her siblings? I mean, you could really unpack a lot there and try and understand what's going on.
• 17:50
  But because she'd presented with suicidality, she got fast-tracked into the gender clinic because they had that as their policy. And so she went to the gender clinic and I saw looking at the medical record that she'd had an interview and she hadn't said much, but the clinician had come to the conclusion that she was naturally trans and then she was commenced on puberty blockers.
• 18:18
  And I thought, oh, that's very quick and, you know, very complex. And it wasn't because in child psychiatry, it's a very, amidst psychiatry, it's a very snobby specialty in that, you know, because I went from forensics into child psychiatry and
• 18:36
  it was all about, oh, you know, in child psychiatry, we take a developmental approach and look at three generation genogram and look at the family relationships and understand the child in this context at this time and know that things, you know, adolescence is a time of growth and change. None of this was consistent with my training. None of this assuming that a child is naturally trans.
• 18:58
  is consistent with my understanding of how we do child psychiatry. So I just, from 2018, I wrote to the gender clinic about that child saying, please help me to understand. And they, you know, sent a letter back saying, you know, we're experts in this area and we can identify when a kid is truly trans and we thought this was so, and so we've gone ahead with puberty blockers.
• 19:22
  And so I let it drop because I didn't know any better. But from 2020, we had the Tavistock gender clinic in the UK closed down. And I knew that they had the same model as us, this gender affirmation model. Just explain a bit about the Tavistock and what it did and why it closed.
• 19:38
  Yeah, so the Tavistock was the UK's gender clinic. It was one of the first, you know, the biggest gender clinic in the world. You know, thousands of kids went through there and they had, the clinicians became increasingly concerned and eventually they had whistleblowers that led to a court action. Initially it was a whistleblower in the clinic, Susan Evans, who took court action to question whether kids could...
• 20:04
  adequately provide consent to hormonal interventions under the age of 16, I think. Eventually, Kirra Bell took over the case because my understanding is that Kirra Bell didn't have assets because the problem with taking that legal case is if you're someone with any, you know, just normal assets like, you know, mortgage, if you lost, you could lose them where they needed someone to take over from Sue Evans who could, you know, face that incredible risk.
• 20:33
  So having nothing is actually a benefit in that case because if you lose and you have to pay all the other side's legal costs or something, you can go, I haven't got nothing. I'll just be bankrupt then. That's fine. Pragmatics of legal action. Yeah. Hey humans, just jumping in here quickly to make sure you're aware that
• 20:49
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• 21:19
  Yeah, so the Tavistock eventually was closed in September 2020 is my recollection. And what came out of that was a lot of information about how children were getting fast-tracked. And they had a model of three to six assessment sessions. And our model at the hospital was...
• 21:38
  two to three in their written records, but it was getting down much lower because they were getting overrun and it was getting into telehealth and the assessment. I mean, the gender clinic at the Queensland Children's Hospital just clearly said we're not a mental health service and any therapy was outsourced to counsellors and psychologists in the community to do whilst the affirmation model was going ahead. So it wasn't prior to.
• 22:04
  Right. Interesting. Yeah. So, in other words, just to clarify that, the puberty blockers are not the end point of a judicious process that arrives at a conclusion. Rather, they're the starting point because the declaration of...
• 22:22
  transness is prima facie evidence of the child's condition. Yes. So the puberty blockers have begun and then you get the psychological or psychiatric counselling and help. Yes, the model was two to three sessions before the puberty blockers. Yeah, two to three sessions, but then the actual ongoing psychiatric care takes place after you're already on the blockers. Alongside this affirmation, hormonal affirmation. Yeah.
• 22:48
  I mean, I remember some of that from the Tavistock's closure, that there was, yes, when we talk about fast-tracking, essentially kind of a pipeline whereby, you know, kids who come in are their own declaration of their felt experience of gender –
• 23:04
  is treated as gospel. Yes. Yeah, and then any psychological assistance that they might get comes after that. Yes, and questioning that would be transphobic. Yeah, yeah. Right. That's right. It's a strange model.
• 23:21
  I mean, I understand just to sort of take the trans activist point of view here, which is that if you make the analogy to gayness, then there was a time when clinicians would say, well, it's very complicated. Maybe we need to understand why this 12, maybe this 12 year old boy has a crush on another boy because he wasn't loved by his mother well enough. So, let's spend a whole lot of time trying to figure out if we can
• 23:47
  un-gay him because there might be all kinds of other complicated things going on. And it was a watershed moment for gay rights when people said, no, fuck all that. Yeah. You know, it's fine. Acceptance. Yeah, accept the kid for who they are. They can sleep with whoever they want. They can love whoever they want. And they can sort it out throughout there.
• 24:06
  teenage years and chips will fall where they may, so stop interfering with your highly bureaucratic medicalisation of this natural way of being. Why can that not be transposed onto the trans condition?
• 24:25
  Yeah, well, the problem with the gender affirmation model is that it starts with social transition, which is where the family and the community pretend that the child is the opposite sex, opposite sex clothing, hairstyles, pronouns. And then it moves on to puberty blockers, and that's from age 9 to 11, at the ten of stage 2, the very start of puberty. Yeah.
• 24:52
  And then after that, it goes on to cross-sex hormones from the age of about 14. And this pathway has very long-term harms because the puberty blockers stop the genital tissues developing. So you're looking at risks of infertility and lack of sexual function, specifically lack of sexual pleasure, as well as physical health problems and obviously the risk of regret. So it's not...
• 25:21
  And just to clarify, those aren't temporary that get alleviated when you go off the puberty blockers. If you go on puberty blockers at nine and you change your mind, say, before you start taking cross-sex hormones, then is there a permanent impairment? It permanently impedes your ability to have an orgasm if you're a girl? Yeah.
• 25:39
  No, I think if you have puberty blockers for a period of six months or something like that, then I think it's highly likely that the body will just restart after the six months and you go through your biological puberty and you get away without any long-term implications. But the problem with this model is...
• 25:57
  We were sold puberty blockers as time to think, but what's been figured out from this model being implemented worldwide is that they don't allow children time to think because they lock in the gender distress. So what we know from the historical studies of kids with gender distress is that the vast majority, at least 80%, will recover during adolescence and become comfortable in their own body. And what they need in adolescence is...
• 26:24
  the physical development, the sexual awakening, the experience of relationships and friendships, broadening of interests, individuation from the family. So it's that whole course of identity development in adolescence, which means that most children with gender distress will come to feel comfortable in their body and a significant proportion of them will end up same-sex attracted and happily gay or lesbian. But what we've found or what we know from the
• 26:52
  the implementation of this model worldwide is that the puberty blockers, when they started in a child that's at the start of puberty, that period of recovery through adolescence doesn't occur. It sort of freezes in the gender distress because, as you can imagine, if a child is very scared of their body developing,
• 27:10
  If you freeze their body developing, it doesn't allow them to face that fear. They just continue with that fear and believe that this long-term pathway of blockers and then hormones and eventually gender surgeries is what will make them feel better, which they don't know. That pathway is a very long one over, you know, decades.
• 27:30
  a decade and obviously continues lifelong because people need hormones lifelong if they do this. Yeah, so... So are there two, it sounds like you're saying that there are sort of two parallel tracks of concern here, one being the medical cultural and one being the physiological in the sense that the...
• 27:51
  The sort of fast-track process of affirmation which puts kids onto puberty blockers makes it difficult to ever get off them because once you've been diagnosed, then you're diagnosed. And so the best standard of care is to go from the puberty blocker onto the cross-sex hormone and so on and so forth. You're sort of on the train and it's leaving the station in terms of the care that you get.
• 28:14
  Yes. But then there's also this physiological side of things, which is that the hormonal explosion that happens in puberty that might help resolve some of those identity questions, because all of a sudden you've got that crazy experience of being 12, 13, 14. Yeah, crazy and wonderful. Which is wild and wonderful and insane and horrible all at once. Yeah, yeah. Because that doesn't happen. Yes. Yes.
• 28:37
  you are essentially stunted as a nine-year-old, essentially. You don't get that messy hormonal experience of trying to figure out who you are and who you like. Yes, exactly. Right. Yeah. And just so you know, Josh, I understand that long-term there are going to be some people who...
• 28:56
  you know, have a persistent gender distress despite adolescence. They're a much, much smaller group. But yes, they exist and they may want to live their life, you know, presenting as the opposite sex. But psychiatrists, psychologists, anyone, no one has an ability to pick those people as children.
• 29:15
  Is that true, though? Because isn't, I mean, when I talk to people who are of an older generation in particular, who are self-identified as transsexuals, who, you know, went through this process in the 70s or 80s, they report...
• 29:32
  I mean, they tend to believe that it is a physiological condition of some kind. Yes. That they were born with, they have never felt any other way. And I was under the impression that, I mean, just as a layperson, if a child has persistently been insisting that they are the opposite sex for as long as anyone can remember and has been furious at being presented as their biological sex from the earliest possible age...
• 30:01
  then that would give me an indication that probably that's a different condition than the girl who you were talking about, who's 12, who's recently lost her father, who doesn't have a father figure, who's going through depression and anxiety anyway, whose sudden claim to be a gay man probably deserves more scrutiny than the person who's been the opposite sex since they were two. Is that not?
• 30:25
  No, I disagree with that because with that first group that you mentioned, the very highly insistent, consistent, persistent from a young age, usually boys, you know, the two-year-old boy wearing a tutu, etc. The historical research shows that the vast majority of them will become comfortable in their own body and a lot of them will be gay men.
• 30:46
  So yes, that's true. And yes, there are definitely individuals and they're adults now. And they say, I've known this from such a young age. They exist, but we don't have a way to pick from all the boys wearing tutus. We have no way of picking which ones are going to persist with gender distress, wanting to present as the opposite sex versus just ending up very happy gay men who are grateful to still be able to.
• 31:10
  have sex and, you know, enjoy themselves. I'm skeptical about that. I mean, I have to go back to the research. My understanding was that, I mean, there's a difference between being a camp, flamboyant gay boy who likes wearing a dress and being someone who throws a tantrum every single time they have to not wear a dress.
• 31:27
  Oh, the gender dysphoria, really severe gender distress in childhood, a lot of that can definitely resolve. I'm very, very confident of that. And I can assure you that there's no way of us to say, oh, that's a kid that will end up, you know, trans as an adult. We have no way of doing that. And, yeah, it's just not safe for us to pretend that we do know.
• 31:50
  Right. I mean, then the question would become in terms of safety, what is the trade-off between the lack of safety in, and to clarify, we're just talking at the moment about this cohort of people who might traditionally be called transsexuals who exhibit this very young behavior. We can talk in a second about the explosion of safety.
• 32:12
  gender dysphoria among adolescents as a separate question, because I think that's where things get much more genuinely muddy and where a lot of the heat in this debate comes from. But in that class of people who are, what did you say, insistent, persistent? And consistent. And consistent. It sounds like a bit of a tautology to me, but I'm sure there's like subtly different. I saw it written a lot in the notes of kids, sorry. Persistent and consistent. Oh yeah, okay. It was persistent different from consistent.
• 32:39
  then there's going to be some downside to the people who exhibit that kind of young transsexualism who then grow out of it by putting them on puberty blockers.
• 32:56
  But doesn't that have to be balanced against the downside for all of the genuinely transsexual people who cannot then avail themselves of puberty blockers and cross-sex hormones and have to go through the trauma of going through puberty in the quote-unquote wrong body of hiding themselves in much more traumatizing ways during adolescence and then going through much more aggressive medical procedures later on?
• 33:21
  Yeah, well, from my point of view, because we can't detect that very small number of, you know, before this explosion, it was a very small number of kids that had this persistence of gender distress into adulthood. And I'm open to the idea that, you know, with a lack of stigmatization, that has increased a bit.
• 33:40
  But, you know, as I said before, it was one in 10,000 boys, one in 30,000 girls historically. But just to clarify, there has been an explosion of gender dysphoria among adolescents. Yes. But has there been an explosion of parents coming in saying, listen, from the very, very earliest day that we can possibly remember, our child has always insisted that they're trapped in the wrong place?
• 34:04
  I think there's been a greater sensitivity to it amongst parents. So what they will do is see some gender nonconformity in their child and start thinking, well, this is what that means. And so, yes, there's a greater presentation. There's a context for them to put it into that they didn't have before. Yes, that's right. Otherwise, it might have been just ignored. Maybe that is just better diagnosis on the part of parents of a legitimate condition.
• 34:28
  Well, if we had any way of knowing who would persist into adulthood, it would be useful. But otherwise, if we just get a greater number of kids presenting with gender distress or long-term gender non-conforming behaviour, and we don't know, then we're potentially harming a lot of kids, removing their fertility and their sexual function and creating long-term physical health problems to treat that one sort of needle in a haystack scenario of the person who will persist out of this massive group of people presenting. And
• 34:57
  I think in healthcare we do need to look at the harms to kids. You know, like we can't just sort of take a broad brush approach to all these kids and give them the same treatment and not worry about the harms. I mean, I suppose there's also a kind of a Hippocratic principle here, isn't there, where like the doing of the thing is worse in a way than the not doing of the thing? Is that ingrained into your kind of thinking about...
• 35:27
  Medicine, you know, first do no harm. So you'd rather take the risk of inaction leading to a bad outcome than the risk of action leading to a bad outcome. Yeah.
• 35:37
  Well, I think that because the reason why this model took hold was because what they noticed amongst people who had transitioned in adulthood was that the outcomes are very difficult with high rates of drug and alcohol problems, mental health problems, being victims of crime, going into jail, drug use. It's a very difficult life that some of these people lead.
• 36:02
  And so they thought, well, if we bring it back to adolescence, we might be able to, they assumed that those bad outcomes were from not passing as the opposite sex. So the original intention was to bring this earlier so the rate of passing as the opposite sex would be higher. But yeah, that idea that this intervention improves mental health
• 36:25
  It's highly questionable. There's no evidence for it. We don't even, I guess, know that it improves mental health in the kids that, you know, in theory, you know, we have no idea whether those kids that are consistent, persistent, consistent actually improve their mental health. There was a study, you know, by the Finnish release this year, which showed that they looked at all the people in Finland who had transitioned under the age of 23 and
• 36:49
  between 1996 and 2019 and follow-up was at least five years and some as long as 25 years so it's about 2,000 people and what they found was that engagement with specialist mental health services increased after transition so people that were male that transitioned to um
• 37:10
  feminised, their rates of engagement with specialist mental health services went up from 10% before transitioning to 60% after. And then amongst the females, it changed from about 20% beforehand to 50% after. So there isn't, that suggests that transitioning, um,
• 37:29
  not only doesn't improve mental health, it actually, for at least a large proportion of these people, increases mental health problems because specialist mental health care is not something to be sneezed at. That's, you know, a weed. You've got a problem. You've got a problem. But I mean, isn't part of the problem? My head always starts spinning when we talk about these studies because
• 37:48
  It depends so much on what the cohort of people who you're talking about is. Like that study presumably was not limited to people who had been persistent, insistent, consistent since the age of two, right? It was all the people who came through that. It was, yeah, the total population of other people under 12. In which case you're capturing the 12-year-old girl who you were talking about, right? So, you know, if the question is, is there a condition that,
• 38:14
  you know, we might as well call transsexualism, which is distinct from the kind of kaleidoscope of gender playfulness that adolescents are currently including under the trans banner. Yes. And that deserves paediatric care.
• 38:30
  But is that still including the assumption that paediatric care for that group is beneficial? And I'm saying, well, we don't know. We have adults who say they wish it... We may not know, but I'm just saying that the Finnish study, for example, doesn't prove things one way or another. For that group. Yeah, for that group, because it also captures all the other people who might just...
• 38:48
  There might be a social contagion effect. There might be a bunch of 13-year-old girls on the autism spectrum who found each other online who think it's really liberating to be boys or whatever. And all of those things are also getting captured in a lot of the stats. All that adolescent exploration. Yeah, it is hard to tease out what the benefit or harms are to strict, quote-unquote, transsexuals. Just to clarify the physical harms, because you mentioned it a couple of times,
• 39:17
  So, as you said, six months on puberty blockers, probably not going to be a big deal. At what point does the medical treatment start causing long-term irreversible physical effects that you mean when you say long-term medical harms?
• 39:34
  Because once kids are on puberty blockers, about 95% or more will go on to cross-sex hormones. We don't have data about what happens if you are on puberty blockers for three to four years and come off. There's no studies about that. So that's unknown, which is a problem. It shouldn't be unknown. But there's some information from the Tavistock that people found it a bit hard for their body to restart puberty, like periods never became regular and all that sort of thing. But we
• 40:02
  Is that because we haven't looked or because, as you say, there are so few people who go onto puberty blockers and then come off them? Yeah, well, I don't know what the rates would be. I guess across the world, there's been thousands of kids put on this pathway. So we must have, you know, hundreds of kids or not hundreds, but you know what I mean? I don't know what the numbers would be. It would be a smaller group, but we should still try and follow them up. There's been a real problem with the lack of follow up of kids in this
• 40:28
  in this cohort. So we don't know the long-term outcomes, but certainly once the child starts on cross-sex hormones, then you lock in the impact of the puberty blockers in that their genital tissues, et cetera, don't develop, and then they start developing the cross-sex characteristics, many of which are permanent. Yeah, so that's right from the age of 14 there. And what are those, without getting too graphic? I mean, breasts in biological males...
• 40:58
  What happens to your genitals? Yeah, well, from the puberty blockers in males, it means that the genital tissues don't develop. So that has implications, obviously, for lack of fertility and lack of sexual pleasure. But also the problem is, I mean, they just end up with a little boy's penis. And then if they do want to have genital surgery, it becomes a problem because they have to use material from another site in the body, like the peritoneum or
• 41:25
  you know, the colon to create this neo-vagina. So it's a much more dangerous surgery. And then the risk of the estrogen, et cetera, in men is in the, like, more blood clots and cancers. That's sort of the health risks there. Obviously, the, you know, bone density, that seems to be problematic, although the cross-sex hormones may restore some of what the puberty blockers took away. Yeah, and then in women...
• 41:54
  the cross-sex hormones mainly cause metabolic problems, weight gain, high rates of heart disease, et cetera. And then they also have genital effects with atrophy of the skin of the vagina and pelvic floor problems with risk of incontinence, that sort of thing. And then with the puberty blockers, there's this
• 42:14
  I'm concerned that because adolescence is such a time of brain development that the brain doesn't get to go through that process of full development, but that's a really unexplored area. And I know that within medicine, we're used to things being unexplored, but really, when you're talking about children and putting them on a treatment, it really should have been tested out in high quality research studies first. It should never have been rolled out across the world with so many unknowns.
• 42:44
  It's amazing, isn't it? I hadn't thought about that brain component and with all of the necessary caveats and question marks around it, not taking that as gospel, but that period of puberty that we were talking about a moment ago, which is so chaotic and confusing and, you know, wonderful and terrible. Mm-hmm.
• 43:03
  even if there weren't a physiological effect on the brain tissue per se, the lack of, I mean, it may be the case that there's something fundamental about the human experience or the experience of being a mammal of any kind that go, that the going through that metamorphosis is useful or constructive in some way. It would seem a bit intuitive that that would be so. I mean, I'm,
• 43:33
  open to the research and I'd like to see what's shown. And as part of the, why is there, I mean, without being conspiratorial about it, you could, you know, one could be suspicious that one reason why there's a lack of research about the effect of puberty blockers on people who then go off them before they've gone on cross-sex hormones or the impact of puberty blockers on the brain might be because the
• 44:03
  transphobic or bigoted somehow to, you know, or a bit retrograde to look to pry too much about that when they're convinced that the overall mission that they're on is a good one.
• 44:17
  Yes, and I think that's exactly right. Obviously, it's 2026 and things have changed, shifted a bit, but I cannot convey how much fear has been present amongst the medical profession on this issue, how dangerous it has been to question it. And there has been no benefit in doing research which...
• 44:39
  which will destroy your career, label you as a transphobe. No one is signing up to do that research. And also with the gender clinics, it attracts those clinicians who are very deeply wedded to this model. And so they're the ones that have the opportunity to do the research. And unfortunately, what's happened is the research, the literature on this issue has been flooded with
• 45:03
  thousands of very poor quality small studies with high dropout rates, use of non-validated assessment tools, short follow-up timeframes. And then the researchers, I will say, have been biased, I'd say deliberately, to try and sell the model. And so they'll put very...
• 45:25
  definitive claims in the title and the abstract, which you can freely read, saying that this has shown that the gender affirmation model, you know, improves depression and et cetera.
• 45:36
  But then when you go into the study, which is behind a paywall, you can see that the study did not prove that, did not show that, that it's highly flawed. And that's why it must be confusing to people, because we know that there's so many studies out there from the gender clinics. But when you get these systematic reviews coming out, like the CAST review, or there's been quite a few of them now, they keep coming back with the same answer, which is this model, puberty blockers, lack evidence of benefit. Yeah.
• 46:02
  Cross-sex hormones lack evidence of benefit. And that's because when you do a systematic review, you grade the evidence and it's only high quality studies that will be convincing. And so none of the people have been confused about that, but that's why there's a whole lot of very poor quality studies.
• 46:19
  that you can't rely on. And then when it comes to something more objective, it's not present. G'day, humans. Well, if you've listened to this much of the episode, then you must enjoy it, presumably, unless you're just listening for masochistic reasons.
• 46:34
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• 46:58
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• 47:40
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