Australian Family Court Allows Cross Sex Hormones for Teen

[NotYourCisterinAus]

https://archive.is/y7tNF

Excuse me while I bang my head against the wall in frustration.

I've been following this conversation and I'm largely in agreement with you that pragmatism in the face of "people will do it anyway" is a reasonable way forward as a general principle.

However, first and foremost, children should not be included in this approach where the harms are unknown.

I also saw you say that ideally, no surgery (and I think you applied it to hormones too) should be available until 21, or preferably 25. I do support medically assisted transition as a last resort, if everything else has been exhausted via a fully neutral therapist approach, for people over 25 who remain distressed.

But.

It's not informed consent at all. Nobody can consent to an unknown impact on their brain development (puberty blockers) - by definition, if the impact is unknown, you're not informed. It's consent to be experimented upon at best. Equally, there is no body of evidence to support using cross-sex hormones in a risk/benefit sense, for either children or adults. So again, it's consent to be experimented upon. Someone who is experiencing mental distress in relation to a belief that they hold (they believe that they have a gendered soul that differs from their physical body) is in no position to be consenting to irreversible medical procedures where the full impact is still largely unknown. Add to this, therapeutic care is highly unlikely to be neutral as gender clinics seem to (all?) favour an affirmation model: social transition is not a neutral act. From the moment it's done, it changes the lens through which everything is viewed.

Given all the above, where a court is involved, the only pragmatic approach is to uphold the path of what is known: it is known that anyone following this route (cross-sex hormones) risks significant life-limiting and life-impacting physical and mental harm. It is also known that children are not fully capable of understanding the impact of decisions that they are making. This is why we protect them from making such decisions in most cases. Therefore, the only logical outcome from a court is to say no to any medical intervention for a child (where there is not clear medical consensus) or to push it back to doctors for a clinical decision. Judges are not qualified to weigh up medical evidence.

Edited to add...

I do think informed consent maybe why the clinical trials don’t happen.

I agree. And by extension, as informed consent isn't possible here, it's inappropriate for a judge to find in favour of active intervention.

I also saw you say that ideally, no surgery (and I think you applied it to hormones too) should be available until 21, or preferably 25. I do support medically assisted transition as a last resort, if everything else has been exhausted via a fully neutral therapist approach, for people over 25 who remain distressed.

That feels like a kind and compassionate final compromise when all else has failed.

But I'm not sure it is really.

Because how does that person live after surgery in a way that is not going to hurt them emotionally every day by reminding them they are still not what they aspired to be? They can't just be treated as if they were now interchangeable with the opposite sex, partly because that is not fair on the people who are that sex and have sex-specific needs explained so often on this board, and partly because it's going to be perceived as a reward and create an incentive to have the surgery in others.

So there are still going to be boundaries and limits that cause emotional distress. In which case, is it really better to live with distress AND the lifelong side effects of medical intervention?

"Because how does that person live after surgery in a way that is not going to hurt them emotionally every day by reminding them they are still not what they aspired to be?"

This is what we see reported constantly. It has also been reported in academic papers and in studies.

There is this, and then there is the final acceptance that they were attempting to seek a physical treatment for their emotional discomfort. The latest detransitioner in Switzerland has effectively said this too from what I remember.

www.swissinfo.ch/eng/identities/switzerlands-most-renowned-trans-person-no-longer-wants-to-be-a-woman/88696717

@OldCrone

From the article about the 2017 case:

In his decision Tree wrote: “As if the general turmoil and challenges which being a teenager in our modern world generates are not enough, the additional burden of requiring an already vulnerable and highly marginalised group to individually litigate to vindicate their identity seems inhumane."

*“No other group of adolescents is required to do so. Having already traversed a far more difficult path than many of their peers, it can only serve to further increase their burden.”

He's a genderist zealot. He shouldn't be allowed anywhere near these cases.*

How do you extrapolate "genderist zealot" from this excerpt?

Only a believer in genderism would talk about children with trans identities having to "vindicate their identity" since he must believe that these identities are somehow real. His decisions in this case and the one in the OP indicate that he is a zealot.

"Gender incongruence of adolescence and adulthood" is no longer listed with the Mental and behavioural disorders in ICD-11.
It's now considered a "Condition related to sexual health."
Or are you thinking of the mood elevating effects of testosterone, and assuming Ash might be depressed?
I'm no clearer on what exactly testosterone injections are being given to Ash for. What will be the (measurable) outcome that will demonstrate whether treatment has been successful?
I can't think of any other medical condition that is treated in anything like the same way.
Ash is a trans boy, soon he will be a trans man. This opens up to Ash a range of possible treatment options: testosterone injections, breast reduction surgery, full double mastectomy, hysterectomy, oophorectomy, vaginectomy, metoidioplasty, phalloplasty.
If Ash chooses none of these treatments Ash is still a trans boy (and in 2 years, man). So in what sense are any of these treatments indicated?
Is it Ash's desire to have the treatment that makes it necessary? (For Ash's mental health? To treat Ash's sexual health condition?)
So, because Ash wants testosterone it's the indicated treatment, medically? But mastectomy isn't, but would be, or will be if/when Ash decides he wants it?
Can anyone point me towards a disease / treatment process that works similarly in our medical system?

I'm really not trying to be obtuse here, though I realising I'm harping on about a rather obscure point from this case, that doesn't relate to the whole horror of a parent losing parental responsibility and the right to veto their child's unevidenced medical treatment.
But I'm really aghast that this judge doesn't balk at the fact that Ash isn't "true trans" (for want of a better term).
I know the academy has been bonkers since at least the 90s, and people in the trans community would hand around "correct" answers to enable them to get the hormones and surgeries they wanted.
But last I checked the professions were holding fast to a belief in True Trans. That this is a real medical condition that has a treatment pathway to be followed, like with any other medical condition. Something like "subconscious sex" that a poster here was talking about recently.
Ash doesn't have any subconscious sex of male, and the judge doesn't think that of Ash either. Neither of them balk at the idea of Ash being the egg-contributing parent to a child. That's not part of the true trans narrative.
I guess I've just never seen it laid out, this Queer Theory inflected take on what it means to be a trans child, outside of academia.
This is our federal family court system.
The rot's set in so deep I can't see us coming back from this.
I feel like I'll be living the way anti-vaxxers do, trying to exist alongside an establishment that I believe is complicit in harming children.
Twenty years ago I never would have believed that living in a backwards, conservative part of Australia would feel like a protection.

@BonfireLady thank you.

As I said cleverer people than me will decide on informed consent. Like you I think they will struggle to ever properly get informed consent.

However, where we are now WPATH, NHS, US medical professionals and insurers,,the Webberley’s etc have all overseen children (and adults) being given PB, cross sex hormones and surgery (US). Even WPATH agree informed consent is an issue I.e. they know it’s unethical but carry on.

My view is at the moment the way to minimise the number of people harmed is to have a judge make the decision. This is because it takes time, a lot of evidence from clinicians, psychologists etc. has to be gathered before it is presented as evidence. The time it takes should filter out those who haven’t thought about it, may have other medical conditions, may grow out of it etc. This reduces the number of people harmed. Without this legal process more people may get PB, cross sex hormones etc.

I haven’t seen all the evidence the judge has. Just the same as cases where judges are asked to remove life support the decision is what is right for this one person based on the evidence. I don’t have to agree with the decision to comprehend why the decision was made.

@TheCourseOfTheRiverChanged
As I have said I am not going to second guess Ash’s mental health. I have not spoken to them nor seen the evidence. This judgement is not about surgery not does not approve surgery.

Generally, I have said mental health is complex and maybe tied to physical health. That is just not in relation to gender dysphoria/incongruence but many aspects. Does the reclassification mean that no evidence has ever been found of any mental health aspects to gender dysphoria/incongruence? I suspect not.

I have also been very clear I DO NOT agree with anyone for any reason having unnecessary cosmetic surgery, Botox fillers etc. For clarity that includes all the operations you listed.

I broadly agree with the points you've raised here. However, on this one...

My view is at the moment the way to minimise the number of people harmed is to have a judge make the decision.

... I don't. I would have done in the past but I don't think it's that simple. As an example, when the Keira Bell judicial review case initially found that under 16s didn't have the capacity to give informed consent for PBs I was delighted. Then when that got overturned on appeal, I was gutted. It was overturned because the judges ruled that it needed to be a clinical/medical consensus, not a court decision.

Fast forward to now and the clinical/medical consensus (in the Cass Report, supported by the NHS, Tories and Labour) is that there is no evidence base that says they are safe for use in gender dysphoria, therefore their use is banned in this scenario.

During the time between the appeal overturning it and puberty blockers being banned for use to "treat" gender dysphoria, I had a conversation with Stephanie Davies-Arai. I wrote an article that she published on her website and we spoke about it in advance. During the conversation I said to her that I was really upset for both her and Keira Bell (and the children impacted) that "this failed". Stephanie said she didn't see it as failure at all because it was now in the public domain and it was a matter of public record that GIDS was told off for its woeful data keeping. She was looking at the bigger picture - the Interim Cass Report was already out when I spoke to her - and seeing the direction of travel that inevitably followed.

Another recent case in the UK seems to be going a similar way. The judge has ruled that a) a parent who objects needs to be listened to (a key precedent that now applies to any medicalisation of any child) and b) there needs to be a medical consensus on the correct approach for this child:

(NB the thread title incorrectly refers to PBs. The case is about cross-sex hormones.)

https://www.mumsnet.com/talk/womens_rights/5229250-high-court-appeal-by-mother-to-prevent-her-child-being-prescribed-puberty-blockers-privately-on-reaching-16

As much as I wish they would, owing to the poor evidence base, the court hasn't decided that the child shouldn't have cross-sex hormones. It has decided that an objecting parent, who holds parental responsibility, needs to be listened to and that nobody can override this. Not the other parent, the child or anyone else. That's massive. (It logically extends to social transition, beyond schools too e.g. if a parent objects to a social transition that a counsellor does privately with their child: the Cass Report has detrimined that social transition isn't a neutral act, therefore a parent presumably has a legal right to protect their child from this risk). The next step is for clinical consensus on the right outcome for this child. This is a similar kind of victory for safeguarding and common sense, which also acknowledges the limit of the court to make clinical/medical rulings.

@BonfireLady in this case the parents both love their child but disagree. So one parent supports cross sex hormones and one doesn’t.

Who decides in that case? A judge.

Cass review said cross sex hormones are an option at 16, with extreme caution. Ash is 16, a judge making the decision is in my view extreme caution.

I want medical professionals to have done, in my view, the bare minimum and done high quality data collection and analysis in longitudinal studies. They didn’t, they were negligent. I don’t like the fact Baroness Cass had poor data to work with.

At this point in my view this is a pragmatic solution which is a step on the path towards a total ban.

Australia is actually more woke than parts of America - none of this surprises me

@Harassedevictee "Does the reclassification mean that no evidence has ever been found of any mental health aspects to gender dysphoria/incongruence? I suspect not."
You said the reason Ash should be given testosterone injections is for Ash's mental health. So you are speculating about Ash's mental health.
There is currently, in the World Health Organisation's International Classification of Diseases (edition 11, we're up to) no mental health condition for which testosterone injections are indicated.
This family's situation looks very difficult. The younger sister has requested she live with neither parent, and the judge ruled both parents should lose PR in her case. Both parents allege they were victims of domestic violence at the hands of the other. Goodness knows what Ash has lived through, I wish both children nothing but the best.
Quite apart from whether Ash is competent to consent to treatment, or one parent should be able to veto treatment, or the other parent override that veto, I'm still no closer to understanding why Ash is being prescribed testosterone injections.

@Harassedevictee "I have also been very clear I DO NOT agree with anyone for any reason having unnecessary cosmetic surgery, Botox fillers etc. For clarity that includes all the operations you listed."
I think you misusnderstand what I'm saying. I'm not saying, "Isn't it terrible that a teenager who identifies as trans could have all these surgeries?" (Even though I might think that).
I'm saying, isn't is strange that we have this sexual health condition - of being a trans boy or man - and treatment for the condition is a kind of smorgasboard of surgical and endocrinological treatment options, none of which are considered necessary, but all of which should be made available if they're wanted (with or without age limits).
If Ash get to 18 and decides never to have any more hormone injections, never to have any surgery, Ash will still be a trans man. That's where the theory is at - Ash is trans on Ash's say so. It's no longer the case that Ash saying, I'd like to gestate and birth a child, means professionals say, hmm, doesn't sound like you want to be a man after all.
Does that make sense? What the judge's comments in this case have spelled out to me is that the "True Trans" narrative - a female person having all possible, safe interventions to render their body as similar to a male person's as physically possible - has completely given way to the Queer narrative - everyone is whoever they say they are, and a female teenager seeking hormones that will cause voice to drop, facial hair, male pattern baldness, who also wants to keep open the option of becoming pregnant (by securing access to donor eggs) is nothing to balk at, just a trans boy doing what trans boys do. No treatments are necessary i.e. will be given to all trans men. But those a trans boy/man feels he needs to have to treat whatever it is we're treating, should definitely be made available to him. No waiting tolerable.

@TheCourseOfTheRiverChanged
You are not the only poster on here to accuse me of saying something I haven’t said.

I have been very clear I have made no assessment of Ash’s mental health.

Where have said I agree with Ash being given any treatment.

What I have said is that in this case the judge is the right person to make a decision based on all the evidence. The decision is not out of step with the Cass review.

What I have said is that in this case the judge is the right person to make a decision based on all the evidence. The decision is not out of step with the Cass review.

I just found this article about the judge. I think it's about the same case.

Gender grind - by Bernard Lane - Gender Clinic News

“Part of the problem is that I’ve never read the Cass report because nobody has put it in evidence yet,” Justice Tree said.

Ms Lane [barrister for the parent opposed to hormone treatment] said that was what she was proposing; Mr Carstone [barrister for the parent supporting the child’s wish for hormones] objected.

So the judge admits that he hasn't read the Cass report, because apparently he's unable to read anything that isn't put in evidence, but at the same time he's willing to dismiss it as a political document. He also seems to have prevented the barrister from presenting the Cass review as evidence.

This judge is not a fit person to rule on this case due to his religious bias.

The decision is not out of step with the Cass review.

Yes it is. The Cass Report urges extreme caution on prescribing cross-sex hormones to under 18s. The judge has decided he knows better than this, despite having no medical qualifications on which to base this opinion.

From the article linked above (thank you @OldCrone )...

“Part of the problem is that I’ve never read the Cass report because nobody has put it in evidence yet,” Justice Tree said.
Ms Lane said that was what she was proposing; Mr Carstone objected.
Justice Tree said that whatever view he took of the Cass report, it would set no precedent and judges in future gender medicine cases could disagree with him.

...and....

As for the Cass report, the judge said he would allow Ms Lane’s line of questioning “but on a tight leash”.

... I think it's reasonable to conclude that (in addition to choosing not to read the Cass Report for his own general understanding of an internationally evolving discussion) the judge:

also seems to have prevented the barrister from presenting the Cass review as evidence.

... and therefore that...

This judge is not a fit person to rule on this case due to his.. bias towards an affirmation model of treatment, irrespective of the growing body of medical evidence which is questioning this.

@OldCrone thank you for the article. As I have said my comments were based on the article in the op.

The judge suggested it might reach the point where “the case for statutory intervention becomes overwhelming”—meaning law reform by federal parliament.

Something I would agree with. Whilst this is Australia not UK, I want clear legislation that is based on the evidence.

WRT evidence, as a Juror I was told not to google or research a case. I think it’s up to 2 years in prison if you do. The reason is to ensure only the evidence presented is used to decide the outcome.

I believe the correct process is to present the Cass review as evidence not for the judge to Google it

““Part of the problem is that I’ve never read the Cass report because nobody has put it in evidence yet,” Justice Tree said.”

What I can’t see in the article is the outcome I.e. whether or not it was admitted into evidence.

However, the judges remarks in the original article suggest it was admitted either in part or in full, along with evidence it was political. If it hadn’t been admitted the judge couldn’t quote it in his judgement.

What is interesting is the article states “In the 2017 re Kelvin case, the full Family Court agreed to wind back judicial supervision of treatment decisions involving irreversible cross-sex hormones, endorsing a claim by RCH Melbourne that advances in the medical science of gender dysphoria justified the change. Since that ruling, the court has only taken gender medicine cases where parents or doctors disagree.”

So in this case if the parents had agreed on cross sex hormones it would never have got to court. Ash would potentially have been on cross sex hormones (and possibly PB) since at least June 2024.

Requiring a judicial decision in this case delayed administration of the hormones back by at least 6 months and possibly longer.

@BonfireLady ialso seems to have prevented the barrister from presenting the Cass review as evidence.

If at least parts of the Cass Review were not admitted into evidence how did the judge quote from it in his judgement?

“extreme caution” is not never. Please define what steps in your view would meet “extreme caution” but not never.

My view is a judicial decision based on all the evidence is “extreme caution” and far more consideration that the Australian Guidelines the clinicians would have followed.

My view is a judicial decision based on all the evidence is “extreme caution” and far more consideration that the Australian Guidelines the clinicians would have followed.

Context is everything, and the Australian context must be quite something! So in your personal view even going to court at all counts as "extreme caution"; and yes the judge's decision might be based on "more consideration that the Australian Guidelines the clinicians would have followed"; but in my view the judge's decision is still "extreme recklessness".

When the alternative was to tell Ash to wait, what, 2 years to legal adulthood and the ability to make their own decisions about cross-sex hormones. Less by the time the case got to court. What was the urgency?

“extreme caution” is not never. Please define what steps in your view would meet “extreme caution” but not never.

1. if at least one parent has objections on the grounds of medical risk, no cross-sex hormones should be prescribed
2. if at least one doctor has objections on the grounds of medical risk, no cross-sex hormones should be prescribed

“extreme caution” is not never. Please define what steps in your view would meet “extreme caution” but not never.

1. if at least one parent has objections on the grounds of medical risk, no cross-sex hormones should be prescribed

Or

2. if at least one doctor has objections on the grounds of medical risk, no cross-sex hormones should be prescribed

Edited to add that this is an "or" situation. Extreme caution means that there should be no doubt from a medical risk perspective.

(I have no idea how that ended up duplicating?!)

@BonfireLady thank you,

@AmaryllisNightAndDay The Australian Standards of Care and Treatment Guidelines, just like pre Cass Review the NHS, followed WPATH guidance!

Court is the last resort not the first. By the time you get to court you should have boxes and boxes of evidence. This includes details of the whole clinical process the person has gone through, a clinical recommendation, psychological report and recommendation, guidance (in this case the Australian Standards of Care and Treatment Guidelines), parents views, the persons views and expert evidence e.g. Cass review,

I would much rather there were evidence based legislation that meant it was clear cut what the right clinical decision was and there was no debate.

The reality is the Australian Standards of Care and Treatment Guidelines apparently permit the prescribing of cross sex hormones.
So clinically it was approved.
It is only because one parent has objected that this has even gone to court.

The judge was considering whether or not to uphold the clinical decision based on all the evidence. I consider that to be extreme caution. It also had the benefit of delaying the prescription by 6+ months.