Louise Pratt (WA, Australian Labor Party) | Hansard source

I, along with the government, oppose this motion. It doesn't do a service to Australia's young people, transgender people and their families or to their need for health care and support. In our nation, each child, each family, whether or not they're transgender or gender-diverse children, should all have access to the care and support they need for the best possible health, now and into the future.

Unfortunately, this debate and this motion to the parliament to have an inquiry into young people and gender identity does not add to the supportive environment that they need. The matters contained in the proposed terms of reference question the expertise of clinicians who, in treating their patients, must be called upon to utilise their clinical judgement to provide appropriate support and care. But the motion before us is not about that, as Senator Hanson would like us to believe. The motion before us is, indeed, about giving a platform to people with extreme views who would do harm to a vulnerable patient group and their families and loved ones.

The mere fact of having a public debate on this matter can do and has done considerable harm. In fact, we've seen, for example, at Westmead a blowout in waiting times and a complete paralysation of their ability to provide much-needed care to young people seeking it—young people who are experiencing extreme bodily dysphoria and distress. That dysphoria may or may not mean that they grow to be trans. They could just be one of the many young lesbians out there who also struggle with their gender identity, the onset of puberty and their dislike of their body. But that is what these clinical services are there to do: to support young people who have a real need, who experience things like gender dysphoria and desire not to experience puberty and who are seeing the onset of things like anorexia.

Those who have sought to critique the service and purportedly do their own research have done so-called research that does not stand up to peer review, and we do not need a parliamentary inquiry to show us that.

The AusPATH board, which, indeed, is the professional board that has come together to provide services for transgender people—it was formed all the way back in 2009—have expressed their serious concerns about the misrepresentation of data presented in much of this research, as well as the choice of language used throughout the so-called clinical papers that have been put forward. They argue that the choice of language demonstrates a clear agenda of the research to undermine the provision of gender affirming care to transgender children and adolescents. They have done a good job of unpacking the data inside that.

Let's have a look at the methodology. A paper on gender dysphoria in the journal Children was entitled: 'Gender Distress: A Prospective Follow-up Study'. This particular study was arguing that children are getting inappropriate care. What I will show you really debunks the lack of evidence put forward in that paper. One of the arguments put forward is that 21 per cent of young people in the paper did not meet the diagnosis of gender dysphoria. They were calculated by the publishers as being a successful desistance from not wanting to transition—as if to say you can teach and show young people that transition is not the only path for them. Well, the simple fact of the matter is that those young people in ordinary clinical environments would not have met the criteria for having gender dysphoria. Therefore, they would not ordinarily be offered puberty blockers or gender affirming hormones in any case. So that evidence base should not even be included in this so-called calculation of desistance from gender transition. So the arguments put forward in this paper are actively misleading.

The authors used a subgroup of 68 young people who had met the DSM-5 criteria for a formal diagnosis, with two lots to follow-up. Three of the 66 people in the study stopped puberty blockers, with one of these younger people reaffirming their gender assumed at birth. So, again, one of the primary objectives of puberty suppression is to allow a young person time to get over their distress and to decide whether they are going to begin gender affirming hormones. Puberty suppression is indeed completely reversible, and so it should not be reported as an adverse outcome, as happened in this case. Of 66 people, three people ceased gender affirming hormones, and this more accurate statistic is not clearly reported in the paper in Children entitled 'Gender Distress'. All of those participants were considered in the paper put forward as desisters—as in, another successful attempt to say that your young person didn't transition, although none of those participants, when you dig into the evidence, were known to have reaffirmed the gender that they were assigned at birth. Again, AusPATH considered that those young people were incorrectly labelled in the paper as desisters from gender transition. As AusPATH correctly highlights, there are many ways to be transgender, and seeking gender-affirming hormone treatment as part of affirmation is just one. There are indeed a myriad of reasons that young people may choose to cease gender-affirming treatments.

Those putting forward the argument in favour of this motion draw on research that says that we must question what clinical specialists are advising. But the research is unfounded. For example, the authors of the research have not questioned why the young person might have ceased treatment or whether the young person involved regretted accessing treatment. The authors made statements about people regretting gender-affirming medical therapy, leading the reader to believe that all people who cease puberty blockers or gender-affirming hormones may regret starting them. These are complicated issues that AusPATH clinicians and people experienced in gender-affirming care are able to wisely step through with their patients.

Just because someone stops gender-affirming medication, for example, does not mean that they will reaffirm the gender assigned to them at birth. Based on the data presented in this study, only 1.5 per cent—that is, one out of 66 of the cohort—had indeed reaffirmed the gender assigned to them at birth after commencing at any stage of their treatment. This rate in fact is consistent with other studies, but this statistic is not highlighted or placed in the context of the wider literature. Instead, the authors focus on a concept of regret without having demonstrated in their research that these young people did indeed regret the treatment. These are some of the ridiculous notions and misinformed evidence that those putting forward this motion have sought to rely on in implying that there is some kinds of crisis or catastrophe going on in the care of our young people.

The authors of the study stated, for example, that they take a neutral therapeutic stance when it comes to working with young people on a transgender pathway, thereby allowing the reader to believe that their research is neutral in intent. However, as AusPATH points out, as with previous research released by the authors, the literature cited within the paper is indeed unbalanced with widely presented opinion throughout the text of the purported research. The research refers to literature that critiques the gender-affirming approach with little reference to the well described established and growing literature demonstrating the mental health and psychosocial benefit that hormonal intervention can have for this group.

I do encourage people to read what AusPATH has outlined in its response to the Elkadi paper, which is entitled Gender Distress: A Prospective Follow-up Study. It really highlights that those who purport to be doing peer reviewed evidence based research in this space needed to be critiqued as to their underlying agenda. There was a largely very good Four Corners television show back in early July that really highlighted the risks and the trauma confronting families and young people when they are not able to access the care that they need. I want to thank the young people and the families who spoke up in the course of that TV show.

There are a great many well-respected population health specialists—

Debate interrupted.