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00:00Hi, I'm Kumi Taguchi. On this episode of Insight, more young people are questioning their gender.
00:06Have we got the balance right?
00:08I kind of wonder if we've opened a Pandora's box that's going to be very difficult to close.
00:13In the last five years, the numbers have just grown exponentially.
00:17The vast majority of them were neurodivergent in some way.
00:21Transitioning young gave me the autonomy to decide how I present to the world.
00:25It's just the idea of being perceived as a woman. It just felt wrong.
00:28I was hoping maybe it was just a phase.
00:30If there was a magic pill, that would have made me happy to be a woman.
00:34But that doesn't exist.
00:39Sandy, you're here with your son Cairo.
00:42What was going through your head when Cairo started to question his gender when he was in his teens?
00:48I was unsure about what was happening. He was in a peer group at school.
00:54There was questions around not feeling right in himself, not happy with people looking at him as a female.
01:03The questions he was asking was around those sort of things, not feeling right.
01:08And I could relate being a tomboy and stuff in my younger days as well.
01:12So I sort of thought, well, maybe this is a phase.
01:16And then slowly just not really feeling happy about what she was wearing anymore.
01:22Just feeling uncomfortable, not wanting people to look at her.
01:25I wasn't sure what was going on, really.
01:29I noticed you use female pronouns for Cairo.
01:33What have been some of the things you've had to adapt to?
01:35Well, I'm still saying she a lot, and I know I've got to change that.
01:39And I did encourage Cairo to put the name on the driver's license that you just went for,
01:46and said I'll try and make an effort to say him.
01:48But it's still really weird for me to say him when that should be her to me in my mind.
01:56It takes a bit of time is all I can say to adjust and get your brain right with things.
02:01Cairo, how did it feel talking to your mum about your gender?
02:05It was scary.
02:07It was very scary at the start of just feeling everything and feeling how you feel.
02:12So when you're going to a parent to discuss how you feel and bringing it up to them,
02:18and essentially being told that they don't believe you, kind of,
02:25it was really hard.
02:28Because I'm more close to my mum than my other family members.
02:32So it was just, it was very hard having that one person who I thought was the closest to me
02:39tell me how I felt wasn't, like, really real.
02:41But I did have a good friend group, so I still had people to talk to it about.
02:48But it sucks when that's, like, your favourite person who you want to really connect with the most.
02:54And they don't see it the same way you do.
02:58But we're way closer.
03:00And, you know, she says my name here and there, says my pronouns here and there.
03:04Um, she helped me legally change my name and helped me do the forms and everything.
03:10It's just still more of an adjustment.
03:12And she's helping me with future, a future surgery that I'm getting.
03:16So there's still parts where it's very supportive.
03:19It's just, it's not that full connect yet.
03:21When did you first raise the prospect of being prescribed hormones to look more masculine?
03:27I was aware that once you're 16, your parents can give consent to give you hormones, essentially.
03:34So I was aware of that.
03:35So I think I bring it up to my mum around 15, 16.
03:39And it was kind of just like, well, you should wait, you should wait,
03:41you should really figure out how you feel.
03:44Internally, did you absolutely feel male?
03:47I feel like I am not the stereotypical man.
03:51Um, I have always been quite feminine and I'm gay.
03:55Like I like other men mostly.
03:57Um, but yeah, it's just the idea of being perceived as a woman.
04:01It just felt wrong.
04:02It felt so much disconnect from who I thought I was.
04:05There was just an imbalance with how people see me and how I saw myself internally, I guess.
04:10Sandy, why did you want Cairo to reach adulthood before starting hormones?
04:16Because I was hoping maybe it was just a phase, it was just going to settle down.
04:20Because I've heard that the brain is not really mature until 20, 25.
04:25So I just thought a bit more time, a bit more time, you know, just to, to let her really
04:31understand
04:31her body, understand people around.
04:34I mentioned, um, relationships and things like that.
04:37You won't really know what you're really into until you've had really good relationships.
04:43I've felt anyway, myself.
04:45Cairo, how did it feel to be told you couldn't take testosterone until you were 18?
04:51It was just that constant feeling of, well, no one's taking me seriously.
04:54I feel stupid.
04:55I don't feel comfortable even going outside and talking because my voice was so womanly that
05:01I just felt so uncomfortable.
05:03I didn't want to talk.
05:04So I didn't really talk.
05:06Yeah, it just, I felt constantly in like a limbo state of waiting and just
05:10uncomfortable constantly.
05:11And as soon as you turned 18?
05:13I ran to the GP.
05:14Yeah.
05:16You're there on the day?
05:17Um, probably like a month after, probably.
05:21Grace, you've identified as female from a very young age.
05:25What was your childhood like?
05:27My childhood was very, um, tormented for many different reasons.
05:34And I feel in regards to my gender, it was something that did take me some time to figure out.
05:40I was 12 years old when I came to the realization that I did want to become a girl and
05:48live my life
05:48as a girl for the rest of my life.
05:50And I was allowed to express my femininity, but I was also encouraged to explore with
05:56more masculine toys and dress ups too.
05:59I really had an open upbringing where I was allowed to express myself.
06:04You saw a documentary when you were 12.
06:06What was that?
06:08So this was a documentary about a girl of similar to my age at the time,
06:13who was going through puberty blockers.
06:15And it was explaining how puberty blockers are buying you time to prevent the permanent
06:22effects of the puberty that your body biologically wants to give you.
06:27And to me, I was just opened up to this whole new opportunity that I could really actually
06:35live as who I always felt I was.
06:38You were on puberty blockers for around two years before starting hormone therapy.
06:43What did transitioning young mean to you?
06:47Transitioning young gave me the autonomy as a woman to decide how I present to the world.
06:52And by pausing my body's natural process of going through male puberty,
06:58it allowed me to really pause and seek the help that I needed to really divulge what was going
07:05on in my head.
07:06And I now have the privilege of being able to walk through my life and not having people just
07:12know that I'm trans by looking at me.
07:14I also didn't have to watch my body morph into a man during my adolescence.
07:21And I knew that I was going to transition.
07:24I knew it in my soul.
07:25And so I was able to save myself a world of further trauma.
07:31Let's see what medical treatment available to transgender people under 18 looks like.
07:36Until puberty, male and female bodies are physically similar.
07:41As a child approaches puberty, the body releases hormones which stimulate physical changes.
07:48In males, testosterone production increases and females will see higher levels of estrogen
07:55and progesterone.
07:56Males will experience changes like facial hair growth and voice deepening.
08:02For females, puberty triggers changes including breast development,
08:06widening of the hips and menstruation.
08:09Medications, commonly known as puberty blockers,
08:13can be given to children with a diagnosis of gender dysphoria in the early stages of puberty.
08:19These temporarily stop the body from making sex hormones, preventing physical changes.
08:25Older teens and adults may be prescribed gender-affirming hormones,
08:30whether or not they've received puberty blockers.
08:33This means those assigned female at birth are prescribed testosterone,
08:38and people assigned male at birth receive estrogen.
08:41This initiates the physical changes of puberty that align with the individual's gender identity.
08:49Olivia, you're a psychologist who works closely with minors questioning their gender.
08:54How common is it for young Australians to identify as trans?
08:58It's a difficult question because we don't at this stage capture population-level data in the census,
09:05for example, around trans identity.
09:07But there has been some really great research in Australia on this.
09:10So most of that research is pointing towards a figure of around two to three percent
09:15during sort of adolescence or sort of up to age 25.
09:19And for adults over 25, they're looking at perhaps about one percent.
09:24There's been controversy around puberty blockers.
09:27Why are those drugs important to your patients?
09:31I love my job.
09:32And I see families like some of the people that are in this room and I see a lot of
09:37tears.
09:38But for me, a lot of the tears are from enormous relief.
09:43But when they get access to that pause button, as Grace was describing, they just shed tears of relief
09:49that they don't have to undergo their body changing into something that is not who they truly feel themselves to
09:56be.
09:57So it can be significantly life-changing in the moment.
10:01So, yeah, puberty blockers matter.
10:04Elliot, you began to medically transition when you were around 17.
10:08After you'd gone through puberty, what were your early teens like?
10:13Under the age of 12, I didn't really care much for gender.
10:17I didn't really think about it.
10:19And so being younger, it was more okay for me to do more things alongside my brothers
10:27or do more masculine things or just androgynous things in general without being ridiculed or criticised.
10:35And then when it came to 13 years and older and puberty started to kick in, I was a little
10:41bit of a late bloomer.
10:43But when that started to happen, my friendships changed, my relationships changed, my mental health started to decline.
10:51I really started to feel confused and distressed.
10:57And because there was not much of a conversation regarding trans adolescent health care,
11:03it was kind of something that you felt ashamed for feeling.
11:08So you had to keep it to yourself.
11:10And so you have this cycle of ruminating on what gender is inside your mind
11:16and then also being afraid to say anything regardless of your situation.
11:21Because of what I had heard from society in general and what I had heard from my school community,
11:30that made you think twice before being open and honest about expressing yourself that way.
11:35And because you began to medically transition when you were 17, it was too late for blockers for you.
11:42So you went straight on to testosterone?
11:44Yes, that's right.
11:46Olivia, many clinicians, including yourself, take a gender affirming approach to medical care.
11:52What does that mean?
11:54Gender affirming care to me has two fundamental principles.
11:59So the first is trans people are real.
12:02They exist.
12:03People whose gender and sex are incongruent.
12:05The second principle is that you don't pathologise gender.
12:09There's nothing wrong with anybody who is trans.
12:12And if you've got those two principles clear in your head as a health practitioner providing health care,
12:18you then move on to what is a very classic approach to health care called evidence-based medicine.
12:25You take the research, the literature, the knowledge base from all of the incredible people who do these studies all
12:30the time.
12:31You take your own qualifications and clinical expertise.
12:36And most importantly, you listen to the person who's in front of you.
12:40And together, we come up with a plan that can help them make changes in their life that they want
12:45to see for themselves,
12:46to improve the quality of their life or to head in a different direction, whatever the case may be.
12:53Can you explain the affirming part of that model?
12:57Affirming just means I'm listening to you and I believe you,
13:00and I'm here to work with you and find a way forward.
13:03But I'm still going to be using all of my normal assessment skills.
13:07I'm still going to be talking about research and risk and side effects and what's in the best interest, etc.
13:13Vanessa, you're a psychologist in private practice.
13:16Your industry body recommends a gender affirming approach.
13:20How do you feel about that?
13:22I see the gender affirming approach as it's put forth by the Australian Psychological Society as very problematic.
13:29As a body for psychologists, we're described as being evidence-based.
13:35And so the guidelines around gender care for young people don't fit that evidence base.
13:42When we're looking for working with people in any area, we really want to look at what is the highest
13:47level of evidence that's available.
13:48And so we now have systematic reviews that have been conducted around the world by independent countries and organisations that
13:56have really found that there isn't a good evidence base for gender affirming care.
14:02And in particular, the medicalised aspects of this for children in particular.
14:08So the APS doesn't, at the current position statement, excludes all of those things.
14:15When you work with patients, do you have one model of care that you generally work with?
14:21No. Typically a psychologist, I'm what we call a feedback informed therapist.
14:26So that means that people come in to me, I use my usual psychological skills to say what's going on,
14:33what's bringing you in.
14:34I don't have a model in my head.
14:37I have a range of models to pick from.
14:39And once I've got to know the person, once I've done that exploratory aspect, that finding out what's going on
14:46for the person, why they're coming in, what's the context of their life, I then pick the model that's going
14:52to work best for that individual.
14:54And this is quite different with the directions from the APS.
14:58They say you must use a gender affirming model.
15:00You've been seeing gay, lesbian and trans patients for nearly 30 years.
15:05What have you observed that shaped your perspective on this?
15:09So probably the first 20 years, I just definitely went into working with gay, lesbian, bisexual people and just that
15:18queer community in those early days.
15:20As a lesbian, as a gender non-conforming person, it's really important to have representation, I think, in those professions.
15:29Then about 10 years ago, I started to see a number of transgender individuals come in and they came in
15:36and said, I'm identifying as transgender.
15:38This is the issue that is going on for me.
15:41And at first it was a trickle.
15:43And then in the last five years, the numbers have just grown exponentially.
15:47The other thing I noticed was that the vast majority of them were neurodivergent in some way.
15:53So these were young people that were coming in or are coming in with a lot more complexity and with
15:59a whole range of backstories that were quite different from, I guess, the earlier cohorts that I was seeing.
16:05Olivia, do we know what proportion of minors who attended gender service receive blockers or hormones?
16:12The folks at the Royal Children's Hospital in Melbourne did an audit of 10 years of patients that they saw.
16:19And I think the figure was around a third accessed medical treatments.
16:24In 24 in Queensland, there was an independent evaluation and review of the gender service at the children's hospital.
16:30And they also found that it was around about a third had access to either puberty blockers and or hormones.
16:36Recently, Queensland and the Northern Territory banned medical treatment for transgender minors.
16:42We spoke with a mother and her 14-year-old daughter about what the changes in Queensland mean for them.
16:50We're not out in our community.
16:53No one where we live knows.
16:56In 600 metres at the roundabout...
16:58My daughter socially transitioned.
17:01She was the first kid at her school who ever transitioned.
17:05The school was really supported, but she was bullied in the playground by a group of boys.
17:11We're still paying the price in terms of the anxiety.
17:14That's never fully gone away and she got behind in our schooling because I was dealing with school refusal.
17:22I couldn't allow her to continue at that school.
17:25So we moved to a completely different area where we knew Noah.
17:28And she passes.
17:31She looks like a girl.
17:33And so puberty blockers are enormously important for my daughter's emotional wellbeing and I think for her physical safety.
17:41Can I have this?
17:42Oh, I guess so.
17:43She was just horrified at the prospect that she might have to go through male puberty.
17:48A deep voice faced her.
17:52It felt like I was going to tell her to somebody else I didn't want to be.
17:57It feels like my aunt living as a girl.
18:01Instead of being trapped in a body that I didn't want to be in.
18:05When we found out about the Queensland Government ban on gender affirming care, I was just furious because we were
18:14so close to getting her treatment.
18:16But I assured her that we would get treatment in the private sector.
18:21It's horrifyingly expensive.
18:23The first two times that she received the puberty blockers, it cost $739 each time and they only lasted for
18:31three months.
18:33My mother had to pay for them and I've had to pay her back.
18:37I've actually taken action against the Queensland Government.
18:41They didn't consult a single person who had any expertise with treating trans kids.
18:48And that to me is proof that the decision was not about the medical safety of my child.
18:53That was a decision that was based on ideology.
18:58Politicians should not be making decisions about kids' medical care.
19:03Olivia, you're a founding clinician at Queensland's only public gender service.
19:08What do these changes mean for transgender kids?
19:11I don't know that I can add more than what that mum has shared there,
19:14which is that if you don't have enough money to go to private care, you don't have care in Queensland
19:20anymore.
19:21And so it's created this real inequity.
19:23Vanessa, you also practice in Queensland.
19:26How do you view the changes there and in the Northern Territory?
19:30When we look at the bigger picture, this actually falls very neatly in line with countries around the world.
19:36So countries that we would call very progressive and that we would consider not at all outrageous.
19:43Countries like Sweden, Finland, Norway, the United Kingdom.
19:48And they're all following the same evidence.
19:51These high quality systematic reviews and meta analysis that are being done around the world.
19:57And that's been the conclusion that they've come to when they really look at all the evidence.
20:02And they move away from consensus based guidelines.
20:06The Queensland changes have actually fallen in line, not only with guidelines from around the world,
20:11but also the highest quality of evidence we currently have on this.
20:16Hugo, you began transitioning at 16.
20:19How do you feel about the debate surrounding young trans people and medical treatment?
20:24I think it's really complicated because it's not something that's black and white at all.
20:32I have a lot of empathy for young people who are seeking puberty blockers that have questions about their gender.
20:40I have a lot of empathy for the parents that are supporting them and feel powerless to do so.
20:48But at the same time, what I see as trans representation, a lot of the time I can't relate to.
20:57In what way?
20:58I see gender dysphoria as a disorder because it's something that causes a lot of distress.
21:04When something is impacting you to the point that your cognition is impacted, your mental health is impacted,
21:13your relationships and your ability to function in the world, that by definition is a disorder.
21:20And I can't sit here and say that I need medical treatment and also say that I don't have a
21:26medical condition.
21:26You had top surgery, a double mastectomy to remove your breasts at 17.
21:32Was that an easy decision to make at that age?
21:36No, it wasn't.
21:37And I don't think it should be an easy decision for anybody at any age at all.
21:42The ideal situation is if there was a magic pill that would have made me happy to be a woman,
21:48I would have taken that in an instant because that would have been the easiest, fastest, cheapest option.
21:55But that doesn't exist.
21:58And there is so much consideration that goes into deciding to get a double mastectomy.
22:05I thought about my entire life.
22:10How will I feel about it in five years, 10 years, in 50 years?
22:15It was a decision that was based on how much the gender dysphoria was distressing.
22:26That was the source of my pain.
22:29And it wasn't something to take lightly.
22:32It's not, you know, to me that's a last resort.
22:35It is rare for people under 18 to have gender affirming surgery.
22:40Was it fair to let you make that decision?
22:43I had a team of people that were there to support me and to make sure that it was fair
22:49for me to make that decision,
22:50that I was mature enough, that I was aware of the consequences of the risks.
22:56Because everything has a side effect.
22:59It's not just the magic solution.
23:00There are things you do have to sacrifice.
23:04And it's really important to accept that.
23:07And I think if you go into it thinking as this is something that's going to fix my life,
23:12and everything is going to be okay, that's a really dangerous mindset to make that decision in.
23:18Do you feel like it is the right decision for every young person?
23:23It would be very irresponsible for me to say that it's the right thing for everybody
23:28and that if you do it you're going to be happy because it's such a complex and nuanced situation.
23:35It needs to be approached from a really individual perspective.
23:38So I can say yes it worked for me, but I wouldn't go around and say that it's going to
23:44be okay for somebody else to make the same decision.
23:46Given your experience, do you think people under 18 should be allowed to medically transition?
23:52No, I don't think so.
23:53For all the best reasons in the world, you have adults in positions of authority over kids telling them that
24:01they can actually change sex, which they can't.
24:08Everything we do is competitive. As long as I win and he loses, I'm happy with that.
24:12Do you butt heads with one sister more than the other?
24:15You don't want enough.
24:17I do.
24:18We disagree a lot and we fight and scream.
24:21I tried to strangle him in Bangkok.
24:23The two year old tantrum with the teenage hormones.
24:25There's a 20 year age gap.
24:27to face the fat inductor to take off.
24:28Are you a baby's I feel the same Ш Harbor here?
24:35Michelle, you're the parent of a teenager who identifies as Trans.
24:40What was your child like when they were little?
24:44Oh, she was...
24:47...like just this burst of energy.
24:50confident, you know, strong-willed. But in year six, her mental health declined quite rapidly
25:02with her having a psychotic episode where she dissociated and harmed herself. And following
25:11the ER visit, we realised that we needed some professional help.
25:17You took your child to a public mental health centre. Your child then gave you a letter explaining
25:24that they're transgender. What did that letter say?
25:28It was a short letter saying that my daughter identifies as male. My daughter being 12, 13,
25:39my husband and I were both shocked but we told her we loved her and we supported her.
25:45But we didn't understand when she's stereotypically always been a girl and never experienced
25:54distress around her gender.
25:55And the mental health professionals your child had been seeing, what did you think about their response?
26:01It was disrespectful. They immediately affirmed the transgender identity. They would not enter
26:10a conversation about it with me other than to tell me that I needed to educate myself and
26:18they wouldn't have a philosophical discussion. My daughter will always be my daughter if she
26:25wants to wear boys clothes. That's fine. But for her to think that that means that there's something
26:32wrong with her that needs fixing is, I personally feel, damaging to her mental health. Especially
26:40considering she's experienced psychosis, hallucinations, anorexia, all things that are distorted beliefs.
26:49How did that anorexia diagnosis come about? Unfortunately, her GP, the psychiatrist and the clinic all missed
26:58it. I don't know if they even ever asked my daughter about her eating habits. As soon as gender
27:06was mentioned, it's just like, well, that must be the problem.
27:10Olivia, you're employed at a public gender service. How common are complex medical histories
27:15among the people that you see? I would say uncommon in the sense of what that mother was describing
27:21there. Across my career, which is both private and public, I would estimate I've probably seen
27:28around 500 trans and gender diverse and gender questioning young people and adults. The number
27:35that I've seen who also had a psychotic illness, I could count on one hand. So that is quite rare.
27:42Disordered eating, though, is more common. Do you see any cases of autism and ADHD?
27:47The research is very clear that there is a large co-occurrence of autism and gender
27:53incongruence, rather. We don't know what causes autism and we don't know what causes some people's
27:59gender to be different to their sex assigned at birth. However, research is indicating strong genetic
28:06influences in both of those presentations. So perhaps in the future, as research continues,
28:12we may have some answers around why there is that co-occurrence.
28:15Grace, your transition at 13 was managed at a gender service at a large public hospital.
28:20How would you describe your assessment and care?
28:23I would describe it as extremely thorough and very carefully done. I had to have many sessions across
28:31months before even the possibility of puberty blockers even came about. And while that was what
28:39I was seeking since the beginning, it really was quite a process that included a bone density scan to
28:46make sure that my body was able to go through this hormonal change. And then also multiple psychiatric
28:54evaluations, evaluations from psychologists, and as well as just the once-over of physical health as well.
29:02Was anything missed during those consultations?
29:06So I was recently diagnosed with ADHD and this is something that has impacted my life in
29:14so many ways. I have had treatment for this for just a few months and my life has already completely
29:23transformed in ways that I could never have even imagined.
29:26Elliot, what was your experience at the gender service you attended when you were 15?
29:32The first thing that comes to mind is open and understanding, but also incredibly thorough.
29:41In my situation, there was over a year and a half of psychological assessments and doctor's
29:48appointments, information sessions where I'd go through the pros and the cons, the risks, and also
29:56if there was things, side effects that were permanent that I would look forward to, like a deeper voice or
30:02facial hair. Most of those things that you discuss and you find out as you go through those sessions.
30:08I didn't feel like there was any stone left unturned in that situation.
30:12Do you feel like you were able to make an informed decision about the consequences of your treatment?
30:18Absolutely. So I elected not to get a bilateral mastectomy, which is top surgery. And in order to do
30:26that, but also still present as male in most cases, I still wear a binder. And so that is in
30:33itself
30:33restricting, but it is a choice that I've decided to make. And there are lots of trans people who have
30:39unique experiences, but there are still enough common experiences that we kind of all understand,
30:45like public bathroom usage and being misgendered and how to deal with that. And also always feeling
30:52like you need to prove yourself to other people.
30:55Kev, you transitioned in your mid twenties. What was that like for you physically?
31:01Shocking at first. I knew that I would have emotional changes. I knew that, that testosterone,
31:09basically that your hormones regulate or influence your emotions in a major way.
31:15I had anger issues at the beginning, which were kind of shocking because before I started testosterone,
31:22I was 26 when I started, so I was pretty settled into early adulthood and knew myself pretty well.
31:29So if I was angry before that, it was kind of more an intellectual exercise. Oh, that's really
31:36annoying. They should know better. And actually that's really rude. And you kind of work yourself
31:41into it more and more as you go along. It's not actually a physical experience.
31:46When I started taking testosterone, that changed pretty much straight away. And it would be a case
31:53of, you know, like my head would start getting super hot. My ears would be burning and I would get
32:01kind of just reactively angry while not really understanding why I was angry. It would just hit
32:07you out of the blue. Given your experience, do you think people under 18 should be allowed to
32:13medically transition? No. No, I don't think so. Which is kind of sucky. I appreciate that. But
32:21for all the best reasons in the world, you have adults in positions of authority over kids,
32:30telling them that they can actually change sex, which they can't. Like, you can alter your physical
32:37experience. You can present as the opposite sex, but you can't actually become the opposite sex.
32:43And because we live in our bodies, the kids at some stage are going to figure that out.
32:48And like, that would have to cause some pretty serious trust issues as time goes on.
32:56Like, I was 26 when I transitioned and I thought, I don't know everything about this,
33:01but I kind of trusted in my own ability to take responsibility for my own actions. And I kind of,
33:08you, like you think in your, in your youth, in your early twenties, even in your early thirties,
33:13you kind of have this sense that the you that is you will be the same, you know, projected throughout
33:18your life. And I'm 50 now, I'm halfway through my life or more than halfway through my life.
33:25And almost half of my life has been spent transitioned. And the way I feel about it now
33:33is quite different than what I did before. Like, you know, your life never ends up going the way
33:39that you think it will be. And you don't end up become the person that you think you will when
33:44you're 20 years old or 25 years old, you turn into someone completely different. Vanessa, why does
33:51starting medical treatment during adolescence concern you as a psychologist?
33:57There's a couple of things that, that really come to mind when I think about this. And the first is,
34:03our bodies are really complex ecosystems and natal sex hormones are a part of that. And so when we start
34:10to interfere with that process, when we stop a natal puberty, it has a flow on effects to the other
34:16parts of the system. So I often give the analogy of, you know, freshwater systems and saltwater
34:22systems. And so, you know, we are born with an innate system that is one of those systems,
34:28with, except with some very rare exceptions. And if we were to look at nature's systems and go,
34:34okay, we're going to turn this freshwater system into a, you know, a saltwater system,
34:38we would go, oh, that's going to have some really big flow on effects. It's going to have some
34:42intended effects, like puberty blockers are going to have stopped those secondary sexual
34:49characteristics of puberty, but they're also going to have flow on effects to a whole range of other
34:53things that we don't intend. And there are certain identities that develop across our lifespan that
35:00occur in a developmental sequence. And so sexuality is one of those. So gender, gender identity can occur
35:07at different points in our life. But sexuality occurs after we reach sexual maturity. So there's
35:14a real problem that if we don't reach sexual maturity, if we don't go through puberty, we can't actually
35:19know what our sexuality is. And so that, again, becomes very problematic. Should we give something up
35:25that we haven't experienced? Should we stop something that we haven't had an opportunity to explore?
35:34Hugo, we've been talking about medicine and science, but is it also about identity?
35:40I always struggle with that one because I don't really understand when people say,
35:47oh, so you identify as a man. I don't see it that way. I don't identify as anything. I know
35:55I'm not a man,
35:56but the only way for me to go about living my life as myself was to transition and to live
36:02as a man.
36:04At the same time, it is a part of my identity in the sense that it's my experience and all
36:11my experiences
36:12in life have made me who I am today. And they affect the way I see the world and the
36:18way I interact in
36:19the world. And I was once really ashamed of it. I've since learned to see the value in that.
36:30Have you noticed a shift in how many people seem to identify as trans?
36:36Yeah, that's something that I see a lot. And it does concern me because I, and this is firsthand
36:43experience of people going up to me and telling me things that it seems like some people have a very
36:51lighthearted approach to it. Thinking transition is something that you can just
36:57dip your feet into and see if you like it and pick and choose what effects you're going to get
37:02from
37:02the hormones. And then it's all going to be magically fixed and, and there's no consequences. But in
37:10reality, I don't know what the hormones are going to do to my body in the long term. And that's
37:16something
37:16that you need to accept. You mentioned earlier that you feel like you have a medical condition.
37:22Do you think other people understand that? When I've spoken to people that I have not
37:31met a trans person before and had quite a negative view,
37:37they've actually come around and understood that because they understand that it's not something
37:42I'm choosing. But I think a lot of people are offended by it being called a medical condition.
37:50I think it needs to be destigmatized because there's nothing wrong with having a medical condition,
37:56but it does mean that it's something that needs to be addressed. And if you're claiming that you need a
38:01medical treatment, that's because you have a medical condition. Otherwise, it would just
38:07make it something I'm choosing.
38:10Elliot, gender dysphoria is listed in the DSM, a guide to diagnose and treat mental disorders.
38:17How do you feel about classification?
38:20I definitely agree with the reality of the fact being that it is a medical condition that you get
38:25diagnosed with and the process of diagnosis is thorough. And I think that is definitely valid
38:32in terms of it being a medical condition. And I think also at the same time that there is this
38:38negative connotation that's associated with it being labelled as a medical condition, which needs to change.
38:45I am very comfortable acknowledging the fact that I have a medical condition. In fact,
38:50I probably have other medical conditions that have gone under the radar because of masking and because
38:56of needing to adapt to a society that doesn't like my honest expression. And I've needed to,
39:03as a survival mechanism, move past that. And this is a part of who I am. And that doesn't mean
39:10it's
39:11a bad thing. It just means that I'm something that is a little bit different. And that's okay.
39:17Vanessa, is there a distinction between transgender as an identity and gender dysphoria, the medical
39:24condition? Certainly. Gender dysphoria is a condition in the DSM and it's characterised by clinically
39:32significant distress around gender related concepts. So that clinically significant distress is really
39:39important. Being transgender has not necessarily, you don't have to have gender dysphoria to be transgender.
39:45This is an innermost sense or feeling or a belief about yourself. And I think they're very different
39:53sort of concepts. The issue though for therapists is that we are told that we have to work with one
39:59particular model for people with gender dysphoria and transgender people. And that's particularly
40:05problematic. And that's using only that gender affirming care model.
40:10Olivia, is it possible to interrogate someone's gender dysphoria without undermining their identity?
40:17Absolutely. Asking lots of questions about your physical health, your mental health,
40:22how you're getting along with folks in your family, social friends, academic ability, etc. So you're
40:29looking and making inquiries about all aspects of a person's wellbeing, but also what are things that are
40:34causing them distress? So you can most certainly make inquiries about whether or not clinical distress
40:40is present. And we don't just ask about clinical distress around gender. We ask about is it present
40:47in any area of life and take a thorough history, etc. Some governments around the world are winding
40:54back medical care for transgender minors, leading to court battles and reviews.
40:59In 2025, clinicians in Queensland and Northern Territory public hospitals were banned from prescribing
41:07puberty blockers and or cross-sex hormones to children for gender dysphoria. The United Kingdom has
41:14also banned new prescriptions in both public and private clinics, while New Zealand has signalled
41:21its intention to impose a similar ban, pending a judicial review. Several European countries have also
41:27announced a more cautious approach to medical treatments. And in the United States, care is
41:33polarised, with bans in place in over half the country. Many of these jurisdictions cite the so-called
41:40Cass Review in their reasoning for a changed approach to gender-affirming treatment for minors.
41:46The Cass Review was commissioned by the UK's National Health Service, following an exponential rise in
41:52children presenting at its public gender clinic. Its author, Hilary Cass, found no good
41:57evidence on the long-term outcomes of medical treatment, and said results are exaggerated or
42:02misrepresented on all sides. The Cass Review is not endorsed by Australia's peak medical bodies,
42:09and the Federal Government has called for the development of new national guidelines for the
42:13treatment of trans people under 18. Olivia, Australia has no national guidelines when it comes to medical
42:21medical treatment for transgender minors. How can you be so sure about your approach?
42:27I don't know that I would use the words that I am so sure, but one thing I'm sure of
42:32is that if after,
42:35I guess, 15 years of seeing hundreds of young people, there was some enormous hidden terrible risk that we are
42:45all
42:45unaware of. We may have seen a glimmer of it. We may have seen, you know, a patient lobby group
42:51with
42:52dozens or hundreds of people who've been to these clinics saying, I regret what happened or I've had
42:57terrible side effects that I don't want. We may see some of the Royal Colleges of Physicians and GPs and
43:04psychiatrists saying, stop gender-affirming care. But actually, it's the opposite. All of the major medical
43:10associations in Australia and in other countries are supportive of gender-affirming care. And in fact,
43:17in the UK, the Royal College of Paediatrics has criticised some of the government responses to the
43:23CAS review and made statements to the effect that they believe that it is harming children,
43:28some of the actions that have followed as a consequence of the CAS review.
43:32What about you, Vanessa? Gender-affirming care is considered best practice in many parts of the world.
43:38How can you be sure of your approach? Similarly, I think it's, you know, very hard to say, yes,
43:44I'm absolutely 100% sure. But again, we have to follow the evidence and we have to follow the
43:49evidence base of these systematic reviews that have come to the same conclusions that particularly the
43:55medicalised care of children and young people doesn't have a discernible benefit, not one that's
44:01reliable. And look, I am probably one of the very few psychologists in Australia who's had to defend my
44:07approach in court. And I've been questioned and cross-examined on the approach that I use.
44:14And in that instance, it was actually the preferred approach that was deemed to be the approach to be
44:20used by the court. Sandy, the medical professionals don't agree. How do you know what to do?
44:27You do what's best for your child. Cairo was going through some really hard times. I listened to Cairo,
44:34and we really discussed what was going on in depth. We have a good relationship, so that really helped.
44:42So yeah, at the end of the day, I think you just really got to be able to understand what
44:47they're
44:47going through. Do you think other people recognise the challenges parents face in this space?
44:53I don't think they do. In terms of the counselling, there was none for us as a parent. The only
45:02guidance I got was from Cairo, just explaining how they felt at the time. But no, I don't think
45:10there's enough education out there for parents that are going through it.
45:13If your parents work for the Uniting Church, were they supportive of your transition?
45:19There is a difference between reaction versus rejection. And I think it's very appropriate
45:25and expected for parents to react instead of reject.
45:34Michelle, you're the parent of a teenager who has mental health struggles. When you went looking for
45:39professional help, you say the focus moved towards gender affirmation and important mental health
45:46issues were overlooked. Your child is nearing 16. What are your concerns as they get older?
45:52My concerns are that where we live, she can access the gender clinic from 16 without my consent,
46:02which is terrifying. And because my daughter does have such a complex mental health history
46:08of psychosis, dissociation, autism, anorexia, she may be assessed as competent to make her own medical
46:17decisions. And if she does medically transition, there's the possibility of infertility. And I think
46:26the biggest one for me is the unknown risks. How has this experience impacted you and your family
46:34anxiety? Emotionally? It's all consuming. My husband and I, every time my daughter comes up,
46:41it's like, oh, what's she wearing today? Is today the day that she's going to demand that she be put
46:47on
46:47cross-sex hormones? There is a level of grief associated with her not wanting to be seen as my daughter.
46:57Obviously, you don't know what your children are going to be like when they grow up. But our relationship
47:04is not at all what I thought it was was going to be like. I was really not looking forward
47:10to her
47:10teenage years because I thought, oh my goodness, we're going to be like telling her, no, you can't
47:18wear that. Put some clothes on, you know. Didn't imagine that I'd be going, please put on a skimpy dress.
47:27Put on some makeup. Sandy, you didn't consent for your son Cairo to have hormone therapy before he
47:35turned 18. Was that the right decision? I think so. But on listening to Grace's example, I think there's
47:43there's variables, you know. It's different for everybody. It just depends on that person.
47:49Does your husband Cairo's dad feel the same way?
47:54About? About everything.
47:58He's very old-fashioned, I must say that. He's struggled with it. We both have. We thought,
48:03you know, what have we done wrong? Why is Cairo going through this sort of stuff?
48:07We doubted ourselves as a family. It was very hard. It still is. He, yes, really struggled and I guess
48:19it's made it harder for me to hold everybody together. Elliot, your parents work for the Uniting
48:26Church. Were they supportive of your transition? I'd say yes. There is a difference between reaction
48:33and rejection versus rejection and I think it's very appropriate and expected for parents to react
48:41instead of reject and there's a two-way street between you being the child that's come out as trans
48:48and the parent experiencing you coming out and or in some cases being let in and being told how you
48:59truly identify and my parents were very open-minded but there's only so much that you know until it's
49:07one of your own children and I think that definitely hit it a little harder for them being more on
49:13a
49:14personal level. My dad is more on the effeminate side in some cases and was bullied for it in some
49:20cases in school and my mum has always been a very outspoken, assertive woman who some people would
49:28stereotype as a mannish woman. So when it came to raising me and it came to raising my siblings we
49:36watched things like Star Trek, sci-fi TV shows that would openly engage in these kinds of conversations.
49:44So you know they they loved me very much and all they really cared about was that I was going
49:51to be
49:51healthy and that I was going to be happy and that I was going to be supported and educated throughout
49:57the whole process and the same for them. Grace you're 25, how's the future looking for you?
50:03I think the future is looking pretty bright and I think that transitioning it's not a cure all.
50:09You know we all have things no matter who we are that trouble us and life is hard sometimes for
50:16all
50:16of us and it can be really difficult but I think that when we all just come together and we
50:22all just
50:23are there for each other that is when we really can connect and really support each other and just
50:30uplift one another to a point where we can look positively to the future and also try and discern what
50:38some things that can be changed in order to make ourselves happier. Kev you've been living as a
50:44trans man for most of your adult life. If you had your time again would you still transition?
50:50I struggle with that one. It's worked for me, I've enjoyed it. I think though like how it is being
50:58viewed by younger generations like I kind of wonder if we've opened a Pandora's box that's going to be
51:05very difficult to to close or to deal with at all like it's creating some serious problems.
51:14Cairo you've been on testosterone for about a year. What's life like for you now?
51:20I feel so much more comfortable just existing. I again I'm more comfortable to talk now. I didn't
51:25want to talk before. I can go into the bathroom without being looked at weirdly like why is this
51:30little girl in here like what is going on? I just feel so much more confident and comfortable and I
51:35like
51:35my body more it's way more masculine it's just I feel like 10 times better so yeah. What are your
51:41plans for the future? I have my top surgery consult in November so I should be getting top surgery either
51:49end of this year or the start of next year so it's very exciting. Yeah you feel good about that?
51:54Yes.
51:55Thank you so much and thank you to you all for being here that's all we've got time for. I
51:59want to
51:59thank you so much for having such a nuanced and respectful conversation. Thank you for your company. I'll see you
52:05next time.
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