Open letter: Australian clinicians call for Trans20 research data to be released

By Concerned Australian Clinicians

Open letter from Australian clinicians concerned that the Trans20 research study data is not being released

We the undersigned call upon the Melbourne Royal Children's Hospital Gender Service and their partner, the Murdoch Children's Research Institute, to publish interim outcome data from their Trans20 research study and make the data available to other researchers.

On 23 October 2024, a New York Times article [1] revealed that an influential doctor in the US, Dr Johanna Olson-Kennedy, had not published the findings of a National Institutes of Health funded study of puberty-blocking medications because the study did not show benefits, and she feared such findings might be used to support restrictions on youth gender treatments.

We seek to ensure that similar delays in publishing do not occur in Australia.

Since 2017, the paediatric gender service at Melbourne's Royal Children's Hospital has been collecting long term follow up data on 618 children and adolescents who used the service to commence sex change procedures. The study was funded by the RCH Foundation, NHMRC, Hugh Williamson Foundation and the Australian National Health and Medical Research Council—Clinical Trials and Cohort Studies scheme.

With 4-7 years of data now collected, we believe it's time for the Royal Children's Hospital to publish their preliminary outcome findings.

Puberty blockers and cross sex hormones are used by the Melbourne gender clinic to treat minors who don't conform to gender stereotypes and who experience distress about their biological sex - a condition known as gender dysphoria.

A number of systematic reviews support the conclusion that this is an experimental intervention, as there is a lack of good quality evidence of mental health benefits, and no justification for claims of an elevated risk of suicide if these treatments are not provided [2,3,4]. There are serious concerns about the long-term effects of these medical interventions on physical health, fertility, sexual function and brain development.

The data held by the Melbourne Gender Service could add to our collective understanding of how to - and how not to - treat paediatric gender dysphoria.

Trans20 study details are found here.

To date, there are four published studies related to the Trans 20 data. Three studies only utilise baseline data, which shows high levels of mental health problems, eating disorder symptoms and autistic traits in the cohort [5,6,7]. The studies do not provide information about mental or physical health outcomes for subjects over time. A fourth study considered the impact of a single session nurse appointment on rates of social transition, mental health and quality of life [8]. Of concern, A. Prof Michelle Telfer’s witness statement to the Royal Commission into Victoria’s Mental Health System suggested that data from the first year of Trans20 study showed improvement in mental health and quality of life [9], but without publication of data the reliability of this statement influencing public policy cannot be assessed.

In view of the critical importance of this topic to the health and wellbeing of Australian youth, we call for the urgent publication of interim outcomes data from the Trans20 study.

Signatories to the open letter:

• Dr Jillian Spencer MB.BS, BmedSci, FRANZCP, Cert. Child and Adolescent Psychiatry, Cert. Forensic Psychiatry, Grad Dip For Beh Sci

  Child and Adolescent Psychiatrist

• Dr Shannon Abeywardena MD, RACGP

  General Practitioner

• Dr Rachel Bradley MB.BS, RACGP

  General Practitioner

• Dr Cary Breakey MB.BS, FRACGP, DPM

  Child and Adolescent Psychiatrist (retired)

• Dr Alison Clayton MB.BS, MPM, B.Lit(Phil), Grad. Dip Infant Mental Health, FRANZCP

  Psychiatrist

• Dr Danielle Collins BMBS, FRACGP

  General Practitioner

• Dr Jacqueline Condon BMedSci, MD, FRANZCP, MHL, Cert. Forensic Psych, Grad Cert FMH

  Psychiatrist

• Dr Paul Burt MB.BS, BS, FANZCA, FCICM

  Anaesthetist

• Dr Andrew Firestone MB.BS, DPM, MRCPsych, FRANZCP

  Psychiatrist (retired)

• Dr Gerald Fogarty BSc, MB.BS, FRANZCR, PhD

  Radiation Oncologist

• Dr Dianne Grocott MB.BS, FRANZCP

  Psychiatrist

• Dr George Halasz MB.BS, BMedSc, MRCPsych, FRANZCP

  Child and Adolescent Psychiatrist

• Dr Christine Huxtable MB.BS, FANZCA, DipPOM, MRCS, DRACOG

  Anaesthetist

• Dr Aniello Iannuzzi BA, MB.BS, MMedSci, FACRRM, FRACGP, FARGP, FAICD

  General Practitioner

• Dr Mary Jessop MB.BS, FRANZCP

  Child Psychiatrist

• Dr Randy Juanta BMBS

  Medical Doctor

• Dr Richard Lennon MB.BS, FRACP, FACEM MBioeth

  Paediatrician and Emergency Medicine Doctor

• Dr Catherine Llewellyn BA Hons (Cantab), MB BChir (Cantab), AMC, FRANZCP, Cert. Child Adol. Psych. (RANZCP), Cert. Addiction Psych. (RANZCP), FASLM

  Child and adolescent psychiatrist

• Dr Deirdre Little MB.BS, DRANZCOG, FACRRM, GCBioeth

  General Practitioner

• Dr T. John Martin MD, FRACP, FAA FRS, AO

  Emeritus Professor of Medicine

• Dr Eamonn Mathieson MB.BS, FANZCA

  Anaesthetist

• A/Prof Peter Parry MB.BS, Ph.D, FRANZCP, Cert. Child and Adolescent Psych (RANZCP)

  Child and Adolescent Psychiatrist

• Dr Catherine Peterson MB.BS, FRACGP

  General Practitioner

• Dr Yekaterina Polyakova-Nelson MB.BS, BSc, AKC, MRCPsych, FRANZCP

  Child Psychiatrist

• Dr Nic Rosoman MB.BS

  Medical Doctor

• Dr Carl Scott MB.BS, FRANZCA, FCICM

  Anaesthetist and Intensive Care Specialist

• Professor David Torpy MB.BS, PhD, FRACP

  Endocrinologist

• Dr Guy van Hazel MB.BS, FRACP, FRCP

  Medical Oncologist

• Dr David Ward MBCHB, MRCPSYCH, FRCPSYCH, FRANZCP

  Child and Adolescent Psychiatrist

• Dr John Warlow MB, CHB, BIRM, FRANZCP

  Child and Adolescent Psychiatrist

• Professor John Whitehall BA, MB.BS, FRACP

  Paediatrician

References

1. Ghorayshi A. U.S. Study of Puberty Blockers Goes Unpublished Because of Politics, Doctor Says. The New York Times. 23 October 2024. Access:

   https://www.nytimes.com/2024/10/23/science/puberty-blockers-olson-kennedy.html

2. Council for Choices in Health Care in Finland (PALKO/COHERE Finland) (2020). Recommendation of the Council for Choices in Health Care in Finland (PALKO/COHERE Finland): Medical Treatment Methods for Dysphoria Related to

   Gender Variance in Minors. Lingua Franca Translations (18 May, 2022) Access:

   https://archive.iftcc.org/council-for-choices-in-health-care-in-finland-palko-coherefinland-2020-recommendation-of-the-council-for-choices-in-health-care-in-finlandpalko-cohere-finland-medical-treatment-methods-for-d/

3. SEGM. Summary of Key Recommendations from the Swedish National Board of Health and Welfare (Socialstyrelsen/NBHW). 27 Feburary 2022. Access:

   https://segm.org/segm-summary-sweden-prioritizes-therapy-curbs-hormones-forgender-dysphoric-youth

4. Cass H. The Cass Review: Independent review of gender identity services for children and young people: Final report 2024 Available from: https://cass.independentreview.uk/home/publications/final-report/

5. Engel L, Majmudar I, Mihalopoulos C, Tollit MA, Pang KC. Assessment of Quality of Life of Transgender and Gender-Diverse Children and Adolescents in Melbourne, Australia, 2017-2020. JAMA Netw Open. 2023 Feb 1;6(2):e2254292.

6. Tollit, Michelle A. et al. A comparison of gender diversity in transgender young people with and without autistic traits from the Trans 20 cohort study. The Lancet Regional Health – Western Pacific, Volume 47, 101084.

7. Kerr JA, Paine J, Thrower E, Hoq M, Mollica C, Sawyer SM, Azzopardi PS, Pang KC. Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. J Adolesc Health. 2024 Apr;74(4):850-853.

8. Dahlgren Allen S, Tollit MA, McDougall R, Eade D, Hoq M, Pang KC. A Waitlist Intervention for Transgender Young People and Psychosocial Outcomes. Pediatrics. 2021 Aug;148(2):e2020042762.

9. Royal Commission into Victoria’s Mental Health System. Witness Statement of Associate Professor Michelle Telfer. Access: https://rcvmhs.archive.royalcommission.vic.gov.au/AProf_Michelle_Telfer.pdf

Image credit: Gerd Altmann, Pixabay

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