(THEME MUSIC PLAYS)
(CHEERING)
PATRICIA KARVELAS: There's a bitter war underway
PATRICIA KARVELAS: over the control of young people's bodies.
over the control (CHEERING)
SAPPHIRE: The body that I'm in, I don't want to be in this anymore.
ALISON: She was born with a boy's body,
ALISON: She was born and she has a girl's heart and mind.
What do we want?! CROWD: (CHANTS) Trans rights!
Transgender kids are at the centre of a polarising debate
over medical intervention to help deal with their distress.
The recognised treatment in Australia includes drugs to pause puberty.
It's not one session and you get hormones.
That's a total misconception about what we do.
That's a total misconception CROWD: (CHANTS) Trans rights!
Opponents warn CROWD: (CHANTS) Trans rights!
Opponents warn medication is dangerous.
Opponents warn Do you think there's ever a case
for an adolescent to transition medically?
for an adolescent My personal opinion
is that it would be good to disallow My personal opinion
is that it would be good to disallow the prescription of puberty blockers
is that it would be good to disallow to children with gender dysphoria.
Now the conflict is being played out in hospitals,
and at the centre is Westmead Children's in Sydney.
RENEE WILLCOCKS: We called Westmead Children's Hospital.
As empathetic as they were to our situation,
As empathetic they couldn't help us.
The waiting lists for gender care are growing.
ANNA: I'd have families emailing, calling, and saying,
"My child's so distressed, we need to do something."
"My child's so distressed, And it's the kids at risk.
LAUREN O'BRIEN: I was bargaining with God.
I wanted him to come back.
I was praying.
CROWD: (CHANTS) Trans lives matter!
All this against a wave of anti-trans sentiment sweeping the globe.
The left-wing gender insanity being pushed on our children
The left-wing gender insanity is an act of child abuse.
(HUBBUB)
We will not let you lie to our children.
Look at the Nazis! Look at the Nazis!
(INDISTINCT YELLING)
I want to understand
why medical interventions for young transgender people
have become such a battleground. why medical interventions for young transgender people
have become such a battleground.
Is it right to provide puberty blockers and hormones?
Is enough caution being exercised?
And is this model the lifesaver its supporters say it is?
I'm Brock Willcocks,
I'm a 14-year-old trans girl,
and I live in the western part of Sydney.
I started realising that I was different mainly in primary school.
I always, like, imagined myself
having long hair and putting on make-up and, like, wearing dresses,
and I would always be like, "Oh, I wish I was a girl."
But I would be disappointed to find out,
"Oh, you're a boy. You have to stay like this."
"Oh, you're a boy. (PERFORMS INDISTINCTLY)
Stop! (GIGGLES)
RENEE WILLCOCKS: I suppose the first thing that we noticed in preschool,
I'd come and pick her up and she'd be a princess and dressed up
and pushing a pram and wearing the fake high heels I'd come and pick her up and she'd be a princess and dressed up
and pushing a pram and wearing the fake high heels
and not really your kind of typical roughhouse boy.
As puberty kicked in,
the flamboyant, confident kid As puberty kicked in,
the flamboyant, confident kid became withdrawn and depressed.
BROCK WILLCOCKS: I tried going to therapy to try and explain this
and try to be like, "Why do I feel like this?"
It's not about going to therapy to fix it.
How do you know you weren't influenced?
I wasn't influenced by a trans person.
I did not know any trans person growing up at all.
Not one trans person. Not even anyone on any sort of social media.
Brock kept it to herself.
She knew that her mum was sceptical about transgender issues.
RENEE WILLCOCKS: I was hearing all these different things in the media,
and when the debate came up about, you know, a point, you know...
and when the debate came up about, ..with the pronouns,
and I...
..I kind of...yeah, and I...
..I kind of...yeah, I said, you know,
"Why should we be catering to these people if they're identifying?
"If I can see biologically they're a male,
"I'm going to say that they're a male."
In Year 8 Brock found the courage to tell her mum through a text message.
She opened my bedroom door
and I just saw that she was in tears
and she started and I just saw that she was in tears
and she started just apologising to me.
And the reason she was apologising to me
was because in the past
she wasn't the most accepting person of being trans.
She just was crying to me
and apologising for everything that she had said,
and apologising just everything and anything.
RENEE WILLCOCKS: It was the first time
that I'd really seen Brock show what she's been going through.
And it was just so hard to see
because it was just such raw emotion
and she just hates her body because it was just such raw emotion
and she just hates her body and can't stand to look at herself.
I was gonna try and get some and bring some home for you to try.
No. You wouldn't even try it?
Renee was determined to support Brock,
but she struggled to find help.
Do you want me to do different flavours?
We called Westmead Children's Hospital, they couldn't help us.
We called Westmead Children's So, even though Brock is a child,
they do draw a line in the sand for So, even though Brock is a child,
they do draw a line in the sand for certain developmental milestones.
In Brock's case, it was because Brock's voice had already broken.
In Brock's case, it was because Well, do you want to...
Renee turned to another NSW Health-run clinic,
Renee turned to another Maple Leaf House in Newcastle.
RENEE WILLCOCKS: Maple Leaf House in Newcastle.
RENEE WILLCOCKS: When I spoke to them on the phone
and they said that they could help me
despite the milestone that Brock had already achieved,
I broke down and cried, it was such a relief.
This feels wrong. It's, like, going under my nails.
A psychiatrist diagnosed Brock with gender dysphoria.
Gender dysphoria refers to the psychological distress experienced
by those whose gender identity doesn't match their biological sex.
Brock started treatment known as gender-affirming care,
which is an established medical practice across Australia.
It starts with a multidisciplinary assessment
and can progress to medical intervention.
Brock was prescribed puberty blockers
to stop her developing as a young man.
RENEE WILLCOCKS: Obviously you wouldn't want to rush into treatment
when you're just finding out that your child is transgender.
For us, it made sense.
The fact that Brock had been going to a psychologist for quite a while
was reassuring to know that, you know, it's not a phase, so to speak.
But when you're, you know, at that age of 13, development's fast.
Do you want to spray them with olive oil or something?
Doesn't say that in the TikTok.
(LAUGHS) Are we following a TikTok video?
Yeah. (LAUGHS)
That's where I got the recipe from. Oh, my gosh.
The Maple Leaf clinicians told Brock's family
The Maple Leaf clinicians the blocking effects are reversible,
but they warned the blocking effects are reversible,
but they warned about the potential side effects,
which can include reduced bone density.
RENEE WILLCOCKS: The fact that Brock is now 14
and won't have to be on blockers for a lengthy period of time,
I suppose that relieves a lot of concern that we had.
But it's definitely something that we've had to weigh up,
and we're OK with that, we're OK with that risk.
These are just all my rings and my earrings.
Brock will soon have her third injection of puberty blockers.
Brock will soon have her third She says she is relieved
she's stopped developing into a body that she doesn't identify with.
This jacket - love, love, love this jacket.
She no longer hides the clothes she wants to wear.
And it's just makes you feel rich and fashionable. (CHUCKLES)
(HUBBUB)
TEACHER: When I say go, (HUBBUB)
TEACHER: When I say go, I want everyone to act like
TEACHER: When I say go, you are an angry customer in a shop.
Go.
Thank you... Why is the coffee cold?!
Thank you... I 'm really into theatre and drama.
Do any of you work here? My coffee is cold.
You get to pretend to be someone else,
which is kind of almost like what I've been doing all my life.
(CHEERING, APPLAUSE) Thank you!
(CHEERING, APPLAUSE) (CHEERING, APPLAUSE)
TEACHER: Ladies and gentlemen, Brock!
TEACHER: (CHEERING, APPLAUSE)
BROCK WILLCOCKS: By November
I should hopefully be starting hormones,
which is really something that I feel I need.
which is really something Not want - I feel I need.
You have five minutes Not want - I feel I need.
You have five minutes to prepare your play.
Cross-sex hormones are often the next stage of gender-affirming care.
Cross-sex hormones are often the Daily pills or patches of oestrogen
would mean that Brock would slowly start looking more feminine
would mean that Brock would slowly and develop breasts and hips.
The physical changes from and develop breasts and hips.
The physical changes from cross-sex hormones are irreversible.
RENEE WILLCOCKS: The choice was
allow Brock to live a life in true authenticity,
potentially very happy life
and hopefully a long life.
When you weigh the prospect up, and what's the alternative?
When you weigh the prospect up, Potentially not having a child.
Brock was literally planning her death.
What choice do we have?
BROCK WILLCOCKS: I didn't choose to be born in this body
and then want to be born in another.
Like, that's not a choice that I just made.
Like, I didn't wake up one day and be like, "Yeah, I'm trans."
Like, I didn't wake up one day No.
It was years of dysphoria, self-hate...
..that it took me to find out, "You're not in the right body."
Referrals to Australia's seven publicly funded gender services
are ballooning.
Since it first opened 10 years ago
Melbourne's Royal Children's Hospital has had more than 3,300 referrals.
62 % of those were females assigned at birth.
62 % of those Last year they had 1,095 patients -
seven times as many
as the Westmead Children's Hospital gender service in Sydney.
Wait lists are long.
Latest figures show the gender service
Latest figures show at Queensland Children's Hospital
has more than 600 patients at Queensland Children's Hospital
has more than 600 patients waiting for a first appointment.
A feud over how to treat kids with gender issues
is playing out at Westmead Children's Hospital in Sydney's west.
It's a feud the hospital hierarchy has tried to keep under wraps,
It's a feud the hospital hierarchy but a few former Westmead staff
have been brave enough to help us tell this story.
They've told us there are deep divisions have been brave enough to help us tell this story.
They've told us there are deep divisions
over how to help kids with gender distress.
ASHLEY: When I started puberty, I got really depressed.
I was super anxious about myself, ASHLEY: When I started puberty, I got really depressed.
I was super anxious about myself,
how I was looked at by people.
It was a really hard time for me.
LANNEN DONNELLY: Westmead Hospital saw Ashley urgently
and prioritised consultation with him because he was self-harming. LANNEN DONNELLY: Westmead Hospital saw Ashley urgently
and prioritised consultation with him because he was self-harming.
His mental health had deteriorated rapidly.
Ashley was prescribed puberty blockers in 2015.
Ashley was prescribed His mother agreed
that he could be part of emerging research on gender distress
conducted by clinicians at the hospital.
It was this research that laid the foundation
for a series of peer-reviewed papers published between 2021 and 2023.
Recent frontline staff at the gender service were not involved.
It was really important to me
that we were able to share this experience with researchers
to be able to help with the way forward.
to be able to help Let's show that, you know,
trans kids are a natural, normal Let's show that, you know,
trans kids are a natural, normal part of every society on earth.
Ashley's mum, Lannen, never anticipated how events would unfold.
Ashley's mum, Lannen, never The Westmead research papers
would be weaponised by outside opponents to gender-affirming care.
In 2021 Westmead researchers published a peer-reviewed report
examining the clinical characteristics of 79 young people
seeking help at the gender service. characteristics of 79 young people
seeking help at the gender service.
amongst many of those reviewed.
They pointed to complex family trauma amongst many of those reviewed.
"High rates of adverse childhood experiences,"
including family conflict, parental mental illness
and loss of important figures via separation.
A history of maltreatment "was also common."
They stopped short of finding a causal link.
They argued going straight to the gender-affirming model is dangerous
and said, "a trauma-informed model of mental-health care"
should be included in all gender-care clinics.
They said, "Clinicians - including ourselves -
"are coming under increasing pressure including ourselves -
"are coming under increasing pressure
"to compromise their own ethical standards
"by engaging in a tick-the-box treatment process."
Genetic pathologist Dr Anja Ravine
was watching on from another part of the hospital.
was watching on As a transgender woman herself,
she was curious about the research
showing family trauma amongst young transgender people.
ANJA RAVINE: The implicit messaging that I read in this,
which actually wasn't said directly
but it was implicitly there and quite powerful,
is that these children -
the trans-ness and the presentation
with associated distress - the trans-ness and the presentation
with associated distress -
is really something that's emerged
out of a background
of early childhood traumas,
poor parenting practices,
associated impaired parent-child attachment patterns.
These papers have all the badges that you'd expect,
These papers have all the badges you know, they're credentialed,
and people look to those credentials.
So, how are you feeling about...
Ashley's mum, Lannen, read it as parent-blaming.
LANNEN DONNELLY: The report from Westmead seemed to allude
to kids are trans BECAUSE of their depression,
kids are trans BECAUSE of dysfunction in the home.
That was horrific to read, for me,
because we had dysfunction in the home and Ashley had depression
BECAUSE we weren't getting help with him being trans.
TRAIN ANNOUNCEMENT: This train will stop at Lidcombe.
TRAIN ANNOUNCEMENT: In late 2022
Anna started as a clinical psychologist
at the Westmead Children's gender service.
It was early in her clinical career,
and she was committed to helping young people who were in distress.
and she was committed to helping ANNA: I was very passionate
about helping these trans youth
that have, you know, about helping these trans youth
that have, you know,
one of the highest rates of suicidality and difficulties,
and, you know, social stigma still,
and difficulties at school.
And I wanted to be able to provide ongoing support
where I could really hear them, validate them
where I could really hear them, and help them through their journey.
TRAIN ANNOUNCEMENT: This station is Westmead.
But she was finding it hard to do her job.
ANNA: I didn't feel supported.
I felt that the environment was very difficult.
I think that, you know, one of the main issues
was the long wait list, the lack of staff.
Our model of care was being developed
to become a better, improved model of care.
to become a better, But it was never finalised,
it was never... no action was ever taken with that.
We were told that we had received funding for more staff,
We were told that we had received which would've been fantastic,
but, while I was there, there was nothing, no change,
but, while I was there, same huge wait list.
(MUSIC, CHATTER)
Ah!
SONG: # It was a clear black night A clear white moon
SONG: # It was a clear black night Yeah!
# Tryin' to consume... #
Noah O'Brien was on that waiting list.
Noah was 14 when he first told his mother he identified as a boy.
LAUREN O'BRIEN: We kind of thought
that maybe it was a friend influence or someone online
that maybe it was a friend influence or something like that.
But the longer that time went on or something like that.
But the longer that time went on
we just saw, no, it was definitely just him, who he was.
Noah asked to go to the GP to find out about puberty blockers.
LAUREN O'BRIEN: We didn't realise at that point that he was already
going through the beginnings of the eating disorder.
So, he was taking that matter into his own hands
So, he was taking that matter to stop his own periods
and stop his breast growth
through not eating.
We can't know for sure what exactly caused Noah's eating disorder,
but research has shown
that eating disorders are often but research has shown
that eating disorders are often associated with gender dysphoria.
that eating disorders are often Noah's food refusal got worse
and he ended up at Westmead Children's Hospital.
and he ended up He was discharged the next day.
LAUREN O'BRIEN: They thought it was not an eating disorder,
LAUREN O'BRIEN: They thought that perhaps it was gender-related,
and that they had put in his discharge papers
that our GP needed to make a referral for the gender centre.
The GP sent the referral last October.
Noah's family didn't know he would be pushed way down the waiting list
at the Westmead Children's gender service
because it deprioritises children who are well-advanced into puberty.
because it deprioritises children An insider has told Four Corners
it could have been a year before Noah was seen.
ROSE MARSH: Her child had a problem, it needed to be fixed,
ROSE MARSH: Her child had a problem, you know, so, Lauren rang places,
went to the doctors, you know, so, Lauren rang places,
went to the doctors,
tried everywhere to get help,
but it was just like doors were closing in her face, you know?
but it was just like doors There was just no...
Nobody was responding to her call for help.
As Noah struggled with gender issues,
his eating disorder also got worse.
He was readmitted to Westmead Children's Hospital
He was readmitted and treated for anorexia.
There was still and treated for anorexia.
There was still no gender-focused care for Noah
There was still apart from this...
So, this is the bag that was given to Noah apart from this...
So, this is the bag that was given to Noah
when he was in hospital, that was given to Noah
when he was in hospital,
and it had some print-outs from the internet,
medical guidelines for gender diverse and treatments,
there's stuff about gender-diverse musicians,
some stickers, about gender-diverse musicians,
some stickers,
a place in Blacktown that you can go to,
legal services
and a few little things in here,
but nothing that linked to the hospital,
nothing that gave us any sort of direction
nothing that gave us of where to go next.
And, again, it's paper,
it's not a person saying,
"This is what we're going to do to help. We're here with you."
Four Corners has learnt that it was a social worker from the gender service
Four Corners has learnt that it was a who visited Noah.
The social worker later wrote an email saying this:
But that discussion didn't go ahead.
A senior staff member from outside the gender service
told the social worker that she needed to:
Noah was effectively denied specialist gender support.
ROSE MARSH: It was very, very confusing.
It was almost like they walked in and said,
It was almost like "OK, this is a gender issue.
"Here, take this bag
"and go research and go from there."
After nearly four weeks in the eating-disorder unit
Noah was sent home.
His discharge summary included 'gender dysphoria'.
His discharge summary included He was still on the waiting list.
ROSE MARSH: I think Noah should have at least seen somebody
that could help him with his gender issues
and, you know, sort of set a course of action
that could be followed up and monitored,
that could be followed up but there was just nothing.
This year's summer holidays were drawing to a close,
and Noah was anxious about returning to school.
He would be wearing a boy's uniform for the first time.
I think he was just worried about how people would react
I think he was just to him presenting at school as Noah.
I think he felt like they would see him
as the person that had been in their class before as Lily
and that somebody might say something
or that they might think he's a fraud.
And then the unthinkable happened.
ROSE MARSH: About a quarter past 12
the phone rang, you know,
and I thought, "Oh, it's Lauren,"
you know, like, I...
So, I picked it up and went, "Hello?"
you know, sort of just, "What are you still doing awake?"
And that's when she said, "It's Noah."
And that's when she said, My husband gave him CPR.
And the ambulance and the police
arrived about four minutes after we called them.
And they took him to Westmead Hospital,
where he stayed alive until six in the morning.
where he stayed alive That was from about 11 o'clock.
So, we got seven hours to actually say goodbye.
I think Noah didn't want to be a girl,
but I feel like he didn't get any help or support
in making that transition to become a male.
I mean, we did all we could, Lauren did more than anyone ever could,
but we just didn't get any help from anywhere that could help us.
If there had been doctors from the gender service
If there had been doctors being able to see Noah,
do you think that would've made a difference?
I mean, we can't know... Definitely.
I think if they had have been speaking to him
and found out what he needed,
I think it definitely would've changed things.
It wasn't long before news of Noah's death
reached the frontline clinicians at the gender service.
ANNA: I think the core team was incredibly distressed
and felt completely helpless.
You know, I can't speak for them, and felt completely helpless.
You know, I can't speak for them, but I know I felt helpless,
and I felt just extreme angst and sadness
for this family that, you know, were on this wait list.
And it just kind of showed that, yes, it happens,
you know, the suicidal ideation is high
and sometimes it does eventuate into suicide.
In the wake of Noah's death,
a paediatrician at the gender service
asked Westmead Children's Hospital
to make changes to help high-risk patients,
to make changes but she saw no change.
ANNA: I think if that had happened
and there'd been a great change ANNA: I think if that had happened
and there'd been a great change in the service for the better
and we were able to help more people in a more timely manner,
that would've been great, you know, some silver lining,
that would've been great, but nothing changed.
So, we were just left but nothing changed.
So, we were just left feeling sad and helpless
and not able to make any positive changes going forward, really.
Westmead Children's Hospital
issued a statement, offering:
"Our sincere condolences to Noah's family.
"Due to patient privacy and confidentiality,
"Due to patient privacy "Sydney Children's Hospitals Network
"is unable to provide further information
"about his specific care."
For months they've declined to answer
specific questions about the gender service.
Four Corners has obtained Freedom of Information documents specific questions about the gender service.
Four Corners has obtained Freedom of Information documents
which show Westmead Children's gender service
is taking on very few new patients. gender service
is taking on very few new patients.
Up to June this year it's taken on just three compared to 88 last year.
The most recent data shows the Westmead service
The most recent data shows had 145 active patients last year.
Westmead Children's Hospital says it: had 145 active patients last year.
Westmead Children's Hospital says it:
Westmead's latest research paper was published in February this year,
and this one would have the greatest impact.
The paper highlighted increasing rates
of what's known as 'rapid-onset gender dysphoria',
particularly amongst a small subset of adolescent girls.
It's a contested concept.
The paper speculates it's caused by "some evolving social process."
If a young person has been exposed
to the ubiquitous, media onslaught
on both social media and the internet
on both social media and also, you know, in peer groups
at school, in rainbow clubs and so on,
there are the vulnerable young people
who will be drawn in to that sphere
of thinking that they're transgender.
Psychologist Dianna Kenny is an ambassador for Binary,
a lobby group which campaigns against so-called 'gender ideology'.
She treats adolescents with gender distress in her clinical practice.
The approach is essentially a psychotherapeutic approach
that helps the young person and his or her family
understand all of the complex dynamics
that have resulted
in the young person experiencing gender dysphoria.
in the young person It is not conversion therapy.
It provides a safe exploratory space
for children to look at themselves
and to gain a greater understanding.
One of the most controversial findings
in the latest Westmead research
relates to the concept of desistance,
and the rate of desistance relates to the concept of desistance,
and the rate of desistance
against gender-affirming care.
is often used as an argument against gender-affirming care.
The Westmead researchers define desistance
as the "disappearance of gender-related distress"
that brought the young person to the clinic.
They reported that gender distress
eventually disappeared for 22% of those they studied.
For the general public - "OK, the child's desisted...
"OK, they're no longer trans" For the general public - "OK, the child's desisted...
"OK, they're no longer trans"
would be what you would think, right?
But, when you read the papers,
there's actually But, when you read the papers,
there's actually a variety of definitions.
When you look carefully at where that 22% comes from,
it includes children who were originally assessed
and considered not to meet the diagnostic criteria,
so, they were never eligible for referral
for consideration of pubertal blockade.
And that was the majority of them, and there were others as well.
This particular way this data's been presented is an outlier. And that was the majority of them, and there were others as well.
This particular way this data's been presented is an outlier.
Actually, if you go to the data that's in the paper,
it's entirely consistent with the opposite conclusion -
it's entirely consistent that it's very rare
for actual young people
to completely decide to go back for actual young people
to completely decide to go back to the gender assigned at birth.
The report also stated that there was a 9.1% desistance rate
amongst those who were diagnosed with gender dysphoria.
The report concluded: amongst those who were diagnosed with gender dysphoria.
The report concluded:
When that last Westmead research was published, what was your reaction?
The researchers had taken the effort to really convey the issues at hand.
It became clear to me that they really wanted to try
and assist Australia to come to terms with this issue
by explaining everything.
And that made me happy
because I really wished that we would be able to talk about this
because it's a child-protection issue.
What happened inside the culture of the clinic
What happened after that paper was published?
I think there was a lot of distress. after that paper was published?
I think there was a lot of distress.
It felt chaotic
in that, you know,
instead of families calling about appointments,
they were calling to raise their concerns and their distress.
It was very difficult for the staff as well.
Two months after the final research was published
Two months after Anna decided to resign.
ANNA: I left feeling defeated.
I think there was so much I wanted to do
I think there was so much and it's such a high-need area,
these kids and these adolescents are struggling.
CROWD: (CHANTS) Trans is not a crime!
The Westmead research
landed amid an increasingly polarised The Westmead research
landed amid an increasingly polarised global debate
landed amid an increasingly polarised over gender-affirming care.
CROWD: (CHANTS) Trans lives matter! Trans lives matter!
At least 20 US states
are moving to ban or restrict
gender-affirming care for young people.
CROWD: (CHANTS) Trans rights are human rights!
Trans rights are human rights!
RON DESANTIS: This will permanent outlaw the mutilation of minors.
It will outlaw the surgical procedures
and experimental puberty blockers for minors.
and experimental puberty blockers (APPLAUSE)
The left-wing gender insanity (APPLAUSE)
The left-wing gender insanity being pushed on our children
The left-wing gender insanity is an act of child abuse.
In the UK
the long-running gender service In the UK
the long-running gender service at London's Tavistock Clinic
has been accused of rushing patients into taking gender-affirming drugs.
DIANNA KENNY: A number of clinicians who were working there
DIANNA KENNY: A number of clinicians became very concerned
about the treatment
that young people were receiving, about the treatment
that young people were receiving,
believing that they weren't being assessed properly
believing that they before being placed
on a medicalised pathway.
On the back of this,
the UK National Health Service
has restricted puberty blockers to children in clinical trials,
stating: has restricted puberty blockers to children in clinical trials,
stating:
What went wrong at the Tavistock clinic
is to get stuck in one particular point of view.
So, what happened? People working there simply said,
"It's more complex
"and we need to have services that understand that complexity
"and we need to have services "and also respond in real time.
"We can't just in a cookie-cutter way
"do the same thing for every kid."
It was not about that the approaches were intrinsically wrong.
It was not about that the approaches It was bad management
of the complexity of the kids coming forward.
And I think there's an important learning out of the Tavistock -
And I think there's an important how to do it wrong.
European countries like Norway, Sweden and Finland
European countries that once embraced puberty blockers
have also wound them back.
DIANNA KENNY: I've just returned from Finland,
from an international conclave
on the psychotherapy from an international conclave
on the psychotherapy of children with gender dysphoria.
on the psychotherapy And in 2020
they withdrew their support for gender-affirming treatment
as the first line of treatment for this group of young people
and have reverted to a psychotherapeutic approach.
The global scrutiny of medical intervention
is placing increasing pressure on Australian gender clinics
to show what they do is evidence-based.
Dr Stathis, thanks for agreeing to talk to us.
Dr Stathis, Thank you. It's an important issue.
Dr Stephen Stathis oversees the gender service
at the Queensland Children's Hospital,
which last year had 922 active patients.
About 80% of the research
on gender-affirming care
has been published
in the last 10 years.
So, the evidence base is emerging and it's changing.
And, so, we're constantly reviewing that evidence base
and adapting our model of care
to take into consideration the new evidence.
For instance, there's increasing evidence
that puberty blockers impact on bone mineralisation,
problems with the bones,
so, we're adapting our recommendations
so, we're adapting and our consent forms
to take that into account.
(WAVES CRASH)
Sapphire is receiving care
at the Queensland Children's Hospital's gender service.
(WAVES CRASH)
SAPPHIRE: I'm 10, I'm in Grade 5,
and I see myself
as a very energetic and joyful child.
I want people to see me as a proud transgender girl.
I want people to see me I'm a girl and that's who I am
and that's who I will always be.
ALISON: My youngest child
from a very early age
demonstrated what I now know as gender nonconformity.
demonstrated what I now know She was born as a male,
assigned male at birth,
and was always drawn
to stereotypically feminine clothing, activities.
SAPPHIRE: I knew that I wanted to be a girl and I was a girl,
but I didn't really know what to say or how to say it or if it was true.
Oop! I knocked it over!
Back then the family lived in Sydney.
In Grade 3 Sapphire was struggling Back then the family lived in Sydney.
In Grade 3 Sapphire was struggling because of bullying at school,
and her mum noticed she was becoming increasingly sad and withdrawn.
Alison sought help from the Westmead Children's gender service.
ALISON: There, in fact,
were no mental-health services available at the clinic,
were no mental-health services which was very distressing
and illustrated that the Westmead clinic
was not offering a complete model of care.
So, when I investigated the gender clinics in interstate,
So, when I investigated both in Melbourne and in Brisbane,
the comparison between the services is night and day.
Alison decided to move her family to support her youngest child.
ALISON: We were forced to relocate states,
we were forced to leave New South Wales for Queensland
in order to pursue affirming care.
SAPPHIRE: I'll be on puberty blockers soon,
SAPPHIRE: and that's just gonna be, like,
pausing, really, my body
from growing into pausing, really, my body
from growing into what I don't want it to be.
from growing into And I guess, throughout my life,
I've felt more and more like this isn't me,
the body that I'm in, I don't want to be in this anymore.
One of the critiques of affirming care
is that it IS too affirming, if I can be blunt,
is that it IS too affirming, it doesn't do enough exploration.
What's your response to that in terms of your lived experience?
What's your response to that I think that transgender children
are exploring themselves I think that transgender children
are exploring themselves on a daily basis
are exploring themselves and that level of introspection
is present every single day of their lives.
And that if they are provided with unequivocal love and support
then that inner dialogue that they have been having with themselves
they can then have with educated health professionals.
It is an ever-present issue that we face every single day.
It is the very core of my child's being
and it is unwavering.
How was your afternoon?
KIDS: Good. Here's some apple, darlings.
STEPHEN STATHIS: These families need our support.
Are you ready for netball tomorrow?
STEPHEN STATHIS: What the gender-affirming model says
is that we affirm where a young person is.
is that we affirm It doesn't mean
that we are locked in It doesn't mean
that we are locked in
to treating a young person
with puberty blockers or hormones.
It doesn't mean that we are stuck in some ideology.
What it does mean is that we're curious
and we're keen to explore the reasons why they've presented.
There is a high-profile case of a psychiatrist at your hospital
who is under review in relation to her views
on transgender care for children.
What's going on at this hospital?
Well, I can't comment on the specifics of that case.
What I can say is that I welcome open debate
across the psychiatry community
and with the consultants across the psychiatry community
and with the consultants in the hospital
and with the consultants about a whole range of views.
The Queensland Children's Hospital
has stood down a senior psychiatrist The Queensland Children's Hospital
has stood down a senior psychiatrist from clinical duties
pending an investigation over a complaint
pending an investigation from a young transgender patient.
Dr Jillian Spencer is contesting the allegations
and has lodged a complaint with the Queensland Human Rights Commission
and has lodged a complaint with the saying, as a doctor,
she should have a right to object to the affirmation model.
I can't comment on my own situation she should have a right to object to the affirmation model.
I can't comment on my own situation
because of the code of conduct,
but what I can tell you
is that I think the vast majority
of child and adolescent psychiatrists
have serious concerns about the affirmation model.
CROWD: (CHANTS) We will fight! We will win! Put the bigots in the bin!
We will fight! We will win! Put the bigots in the bin!
We will fight! We will win! We will fight! We will win!
Put the bigots in the bin!
Transitioning children Put the bigots in the bin!
Transitioning children is profound abuse!
(CHEERING)
When anti-trans activist Kellie-Jay Keen
held a rally in Canberra earlier this year
Dr Jillian Spencer joined her on the podium
to warn about gender-affirming care for young people.
JILLIAN SPENCER: Anyone's child, yours or mine,
will be encouraged at school, online,
will be encouraged during extra-curricular activities
by their friends during extra-curricular activities
by their friends and by health professionals
by their friends to contemplate their gender.
The hospital has told Dr Spencer
she allegedly broke the Queensland Public Service's Code of Conduct
she allegedly broke the Queensland through her public statements.
She contests this and says she was through her public statements.
She contests this and says she was speaking in a private capacity.
She contests this and says she was There are massive health risks
from these experimental medications and surgeries.
We must speak out about the harms we see being done to women and children
from gender ideology.
(CHEERING)
I think after the years of pressure
and not being able to express these concerns,
I just felt that I couldn't miss an opportunity to say them out loud.
I just felt that I couldn't miss It's a really hard thing as a doctor
to be in a position where you feel
that you need to do an intervention that you don't agree with.
And being able to speak aloud about it was...
And being able ..you know, a relief.
Dr Spencer is calling for a federal inquiry
into the gender-affirmation model for young people.
into the gender-affirmation model I worry about the harm to children,
and of concern is the knowledge I worry about the harm to children,
and of concern is the knowledge that it is much more common
for children who later will be gay or lesbian
to show cross-sex identification and gender dysphoria in childhood.
to show cross-sex identification So, there is that worry there
that we're changing the trajectory So, there is that worry there
that we're changing the trajectory of those children.
My main concern with puberty blockers
is that they stop the healing of the gender dysphoria
that naturally occurs through the course of adolescence
that we know from the old studies.
Dr Spencer points to the prevalence of other issues
Dr Spencer points to the prevalence like autism, ADHD and depression.
Rather than medical intervention,
she urges what's known as 'watchful waiting'.
she urges 'Watchful waiting' is a medical term
which tended to describe
taking time to see if a problem resolves before intervening.
But in terms of a watchful-waiting approach
But in terms for children with gender dysphoria,
that would involve engaging with them,
treating mental-health comorbidities,
and engaging them in therapy
and family therapy if need be,
optimising their school functioning and engagement
and trying to get them connected to peers and activities
that help them to feel good about who they are.
that help them There's no evidence
that exploratory therapy, simple psychological therapy, There's no evidence
that exploratory therapy, simple psychological therapy,
is a legitimate alternative to what is being offered
through most of our specialist clinics in Australia.
Exploratory psychological therapies,
family therapies instead, watchful waiting
family therapies instead, are not evidence-based.
They are the sets of intrinsic beliefs
of different professional groups.
There's a new front in the battle over gender-affirming care,
There's a new front in the battle and it involves detransitioners.
(CLAPS) Clap sync!
My name is Courtney Coulson,
a female to male to female detransitioner,
and on this channel we try to figure out what the hell is wrong with me.
On this episode - why did I want to be a man?
Courtney Coulson started testosterone treatment in her early 20s.
She shares her story on her YouTube channel.
COURTNEY COULSON: I think you can be pushed so far into a belief
that these things start to become real
and this other identity becomes real.
I just went right through the trans sort of production line there
and I stayed living as a man for five years. I just went right through the trans sort of production line there
and I stayed living as a man for five years.
COVID lockdown meant she couldn't go ahead with planned chest surgery
and eventually she stopped taking cross-sex hormones.
COURTNEY COULSON: I stopped taking testosterone,
and then my brain and body just sort of balanced itself out.
Whatever I was going through when I wanted to transition
I seemed to have outgrown and gotten over it.
DIANNA KENNY: We don't have good data
DIANNA KENNY: on the number of detransitioners,
but what we do know on the number of detransitioners,
but what we do know
is that there are an avalanche but what we do know of young people coming out
is that there are an avalanche of young people coming out
and talking about their experiences.
And people as young as 18, 19, early 20s
And people as young are warning their younger peers,
"Don't make the mistake that I've made.
"I'm going to regret this for the rest of my life."
Research on those who regret transitioning is still emerging.
Supporters of gender-affirming care put it at around 1%.
But the voices of those who regret medical intervention
are growing louder.
Before you commit to this thing for the rest of your life,
don't you want to see every perspective?
I should have been able to do that, and I didn't.
(BELL DINGS)
(TRAFFIC DRONES)
Melbourne's Royal Children's Hospital
pioneered gender-affirming care in Australia.
For the last few years leaders of the service have kept their heads down
For the last few years leaders of the as the anti-trans sentiment
became more ferocious and politicised.
They have decided they can't stay quiet any longer.
There's lots of misinformation out there
and it effects young people that we see.
We don't have anything to hide
because we're really strong on what we do and the evidence behind it.
Some of those who are critical of the gender-affirming approach
almost assume that we blindly only look at gender, and we don't. Some of those who are critical of the gender-affirming approach
almost assume that we blindly only look at gender, and we don't.
People are complex and we look at all aspects
and we do take a biopsychosocial history and a developmental history
and we do take a biopsychosocial and we really consider
what are the coexisting and we really consider
what are the coexisting physical and mental-health aspects
and what we try and look at addressing all of them
or what is the most prominent and urgent at that point in time.
So, we all know that our waitlist continues to be long,
and it's a kind of...
..difficult responsibility and burden that we all hold
and we're working really hard to develop supports
and we're working really hard for those on the wait list.
The multi-disciplinary team
includes psychiatrists, The multi-disciplinary team
includes psychiatrists, psychologists,
includes psychiatrists, paediatricians and nurses.
TRAM NGUYEN: It's not one session and you get hormones.
That's a total misconception about what we do.
People can come to us and it can be months and years,
depending on how old and what developmental stage they're at
before there is any medical treatment, if there is.
before there is any We talk through at length
with both a medical and a mental-health clinician
regarding reversible and irreversible effects.
We talk about fertility, we talk about regret,
We talk about fertility, we talk about changing your mind.
We don't shy away from any of those hard questions.
Paediatrician Ken Pang is leading long-term research
examining outcomes for young people attending the Melbourne clinic.
What we're aiming to do is to look at their long-term
What we're aiming to do mental- and physical-health outcomes
having received gender-affirming mental- and physical-health outcomes
having received gender-affirming care at our hospital.
We're also looking at things such as bone health.
We're looking again at things like mental health
We're looking again before and after puberty blockers,
before and after before and after puberty blockers,
before and after gender-affirming hormones
in the form of oestrogen and testosterone.
in the form There's a war on the actual research.
How do you navigate that and provide the best standard of evidence?
I don't feel like there's a war of research
when it comes to robust, evidence-based, rigorous research.
I think that in terms of the war of opinion,
as with many issues, lots of people have opinions,
but what's problematic
is that sometimes people who voice those opinions
don't actually have any expertise in the area.
There's been a lot in media and social media at the moment
that really doesn't align with our practice at the gender service.
Dr Tram Nguyen fears the needs of young transgender people
Dr Tram Nguyen fears the needs are being misunderstood.
She's especially worried by the impact of the recent research
She's especially worried from Westmead Children's Hospital.
Perhaps that's something from Westmead Children's Hospital.
Perhaps that's something that we can then bring
Perhaps that's something to the rest of the community
in terms of the education that we provide.
in terms of the education Dr Nguyen is one of seven
senior adolescent clinicians Dr Nguyen is one of seven
senior adolescent clinicians from around Australia
senior adolescent clinicians who have published a critique
rejecting the conclusions of the Westmead research.
We are not a group of clinicians or researchers who do this regularly,
but, for us, we just felt that there was a moral obligation.
These are senior clinicians who've done long-term research.
What makes you so sure that their conclusions are wrong?
A number that has been quoted in other media outlets
is 22% of young people in that study desisted, A number that has been quoted in other media outlets
is 22% of young people in that study desisted,
and 22% is a really alarming figure.
It's alarming to young people, to parents and clinicians
and clinicians who don't work in the field.
But, when we look at the raw numbers,
the 22% is actually incorrect.
You, alongside other doctors across the country,
signed a letter sharing your concerns about the Westmead research.
signed a letter sharing your concerns Why did you do that?
Because I believe that we need balanced research, Why did you do that?
Because I believe that we need balanced research,
Because I believe and I believe that in that article
there were flaws that need to be corrected.
Four Corners has tried many times
to put these concerns to the Westmead researchers,
but they've all declined to speak to us.
In a statement, the Sydney Children's Hospitals Network
said it's:
In 2021 the New South Wales Government allocated an annual budget
In 2021 the New South Wales of $1.5 million
to open a new gender hub of $1.5 million
to open a new gender hub for under 25-year-olds.
The service is to be run by Sydney Children's Hospitals Network
The service is to be run by and another health partner.
But, after two years and more funding, the service is yet to open.
NSW Health has told Four Corners it's "under development."
PARENT: The last item on the agenda
is a discussion about Westmead.
I know that the clinicians at Westmead
certainly were not partners in the research, and, in fact...
certainly were not partners These Sydney parents,
some with kids at the Westmead Children's Gender Clinic,
are worried about the future of their children's care.
are worried about the future The research
has brought down The research
has brought down an enormous amount of stress.
Consequently we've lost, you know, really important people
that have been a part of our kids' journey.
A paediatrician from the gender service left earlier this year
distressed over Noah's case
and the impact of the controversial research.
For some staff to be considering to be leaving
because they're not finding it to be a supportive environment
to do what they know needs to be done for trans youth
is really distressing for the families.
For the trans youth that desperately need that support,
For the trans youth what's going to happen to them?
Lannen's son Ashley eventually sought private medical care
to have chest surgery and cross-sex hormones.
ASHLEY: I'm 22, I'm a tradie,
and I want people to know ASHLEY: I'm 22, I'm a tradie,
and I want people to know that trans people are here.
We exist, and we have existed, and we'll continue to exist.
(ENGINE STARTS)
I'm not really into advocacy.
I just go to work, I do my job, I go home.
I just go to work, I do my job, That's my life.
I'll go out with mates on That's my life.
I'll go out with mates on the weekend, but that's really it.
I'm not an activist.
I'm not good with my words.
I'm not good with, you know,
persuading people about why they should change.
No, it's better left to people who are better at it.
Some people contest whether it should happen at all.
Some people contest They say kids are too young.
They say that it's gender activists pushing this stuff onto kids
and making them question their gender.
What's your response to that?
It makes me angry.
I've lost my child
because there was none of that support.
To say that it's gender activists pushing it onto children...
..again, why would children choose this if it is so hard?
Why would anyone choose something if it's so hard
but if it's not for them being authentic in themselves?
(FIRE CRACKLES, INSECTS CHIRP)
BROCK WILLCOCKS: As an adult,
I see myself to be happy, fully transitioned...
..healthy
and comfortable in my own body.
I see myself as a woman,
and hopefully by that time
a lot more people decide to come around
and see me as a woman as well.
(THEME MUSIC PLAYS)