Medical treatment for transgender children is cautious and evidence-based, but the conservative reaction has become increasingly hysterical

How children became the target in a rightwing culture war over gender

Evie is like many 14-year-old girls. After school she likes to hang out with her friends, or go home and watch Netflix. She says she would like to focus on her studies, but almost every day she has to fill out bullying reports.

At the age of nine she transitioned, saying she always knew she was a girl but was assigned male at birth.

Almost one year ago she criticised the prime minister, Scott Morrison, on TV for a tweet complaining about “gender whisperers” in schools.

In August, Evie returned to high school in Melbourne after six weeks filming a new TV show, First Day, in which she plays a transgender teen in high school. Finishing work on the show and moving back to school has been challenging for Evie. The recent media coverage of trans issues hasn’t helped, she says.

Facebook Twitter Pinterest Scott Morrison on Channel Ten’s The Project, when he was challenged over a tweet complaining about ‘gender whisperers’ in schools

Evie has had students using her pre-transition name (known as deadnaming) and asking why she is wearing girl’s clothes, or doesn’t use the boy’s bathroom.

“Most [kids at school] go home and ask their parents about all this stuff and they come back with a negative reaction,” she says.

News Corp newspaper the Australian has taken a particular interest in trans and gender diverse children, and legislation being debated in Victoria to allow people to change the sex on their birth certificate.

According to the ABC’s Media Watch, the Australian has published over 18 articles in the past month, mostly negative, on the topic.

Headlines have ranged from “Transgender project ‘out of balance’” to “Gender reassignment? They’re castrating children”.

The peak body for healthcare for trans and gender diverse people, the Australian Professional Association for Trans Health (AusPATH), called the Australian’s coverage “biased, emotive, and is not based on fact”.

The newspaper’s coverage has set the tone for other media outlets, such as Sky News and radio station 2GB. But as with many other issues that get caught up in episodic outbreaks of Australia’s culture wars, the reality of treatment for children is a long way from the headlines.

Evidence based, individualised care

Children like Evie are referred to the gender service at Royal Children’s Hospital in Melbourne (RCH), where, after assessment, they can go through social transition before puberty, and go on to have puberty blockers and hormone therapy as part of their transition.

Surgery does not commonly occur before a person turns 18, according to RCH.

RCH’s peer-reviewed guide, The Australian Standards of Care and Treatment Guidelines, was published in the Medical Journal of Australia last year, and later endorsed by The Lancet.

The guide endorses gender-affirming care, based on available evidence and clinician consensus. It focuses on offering individualised care and says not every child will go on to take puberty blockers or hormones. It says counselling on fertility preservation options should be provided to all children before puberty blocking or hormone treatment commences.

Facebook Twitter Pinterest The Australia Greens leader, Richard Di Natale, with supporters of the gender diverse birth certificate bill outside the Victorian state parliament. Photograph: James Ross/AAP

“I think the biggest difference for our guideline as compared to previous ones is not only have we involved children in writing the guideline and their parents, but also we have really tried to listen to them about how they want to be cared for,” gender service director Michelle Telfer told Joy.

The Australian has claimed the guide is “uncertain” and “contentious”, and argues there isn’t enough evidence about the long-term impact of the gender-affirming process RCH has in place, if people want to “detransition”.

The rate of people who have regret over transitioning is very small, Telfer said, between 0.3% and 0.6% according to a recent comprehensive Dutch study.

“When we are criticised by people who don’t really understand what we are doing they often say ‘what if these kids change their mind?’ and we can answer this risk is low,” Telfer said.

She said not providing treatment presents greater risk, including increased depression, increased anxiety and increased suicide risk.

People who work in the area say the massive increase in the number of children referred to RCH in the past decade is due to increased public awareness but those who say it is a cause of alarm call it a “social contagion”, a theory based on a study that has recently been discredited.

Facebook Twitter Pinterest Transgender advocate Georgie Stone with Royal Children’s Hospital’s gender service director Dr Michelle Telfer. Photograph: Melissa Iaria/AAP

Chief among those who subscribe to the theory is Western Sydney University paediatric professor John Whitehall.

Whitehall has published numerous peer-reviewed papers in paediatrics and child health, but none to do with gender dysphoria or trans healthcare. Whitehall told Sky News this month that, in 50 years in medicine, he has never treated a child for gender-related issues.

Yet Whitehall, who is a former deputy president of Fred Nile’s Christian Democratic party, is quoted four times more in regard to trans issues than experts eminently more qualified in the field, according to media analytics data provided to Guardian Australia by Streem.

As of 21 August, Whitehall has been quoted 61 times in major TV, radio, print and online in 2019, compared with just 14 collective mentions for Telfer, or GP and LGBTI health provider Dr Fiona Bisshop.

Whitehall received the most coverage from the Australian, Sky News, and Macquarie Radio – parent company of 2GB.

It aligns with a 2017 study that found Whitehall was cited nearly three times more than other medical professionals in Australian media.

A conservative lost cause

The first signs of this new culture war emerged during the postal survey on marriage equality. Instead of focusing on the arguments around marriage, the Coalition For Marriage’s failed campaign focused on gender. Mothers appeared on TV warning their boys were told they could wear dresses to school and a children’s book called The Gender Fairy by advocate and author Jo Hirst featured in their campaign.

Hirst, who actively monitors how trans issues are covered globally, told Guardian Australia the progression of the debate since then was familiar.

“Much of the media we are seeing here in Australia echoes the UK with the target firmly set on anyone who supports trans young people, parents of trans people, educators, support groups and clinicians,” she said.

Facebook Twitter Pinterest Cella White in a Coalition for Marriage ad claiming boys were told they could wear dresses to school

Many of the sources cited by the local critics are the same fringe sources quoted overseas. The submission sent to the health minister, Greg Hunt, calling for a national inquiry on the matter – and duly reported by the Australian – quotes the American College of Paediatricians – not to be confused with the medical association, American Academy of Pediatrics – among others. The group is classified as an anti-LGBT hate group by the Southern Poverty Law Centre.

Hirst said that she hears about new bullying incidents in schools daily as a result of the negative media coverage.

“Many parents are reporting that this is worse for them and their children than during the plebiscite for equal marriage at its height,” she said.

The chief executive of the LGBTIQA+ suicide prevention service Switchboard, Joe Ball, said calls to the service had been increasing in the almost two years since the postal survey, and the past two months had been tracking higher than the months of July and August last year. They said the media coverage had created an “authorising environment” for people to target gay and transgender people.

“There’s a confusion that there’s a freedom to create hate speech, that’s what it is encouraging,” they said. “We’ve had an increase in people who have contacted our service and have sent us hate messages.”

Hirst urged reporters to consider the negative impact of their campaign.

Evie said the journalists covering it have not walked in her shoes.

“They don’t know what it’s like to ever question their identity so instead of worrying about things that don’t concern them, just be kind,” she said. “Even though, almost daily, I deal with bullying, I try to live my life as best as I can.”