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What does the Cass Report mean for gender medicine in Australia?

  • 14 June 2024
  Gender medicine is the specialist field that cares for patients who are confused or distressed by the biological realities of their sex. Over the last decade, a few years later than for European colleagues, Australian doctors have seen a rapid increase in the number of gender-confused children and adolescents requesting medical attention. In the wake of the Cass Review in England, Australia's health establishment appears to be ignoring growing warnings from European countries that gender-affirming care endangers gender-confused youths compared with more traditional medical models. And throughout the 20th century gender medicine was a highly specialised field practised by a very small group of doctors in wealthy western countries. It involved the treatment of a handful of adult patients who were almost all born males who wanted to present as socially and physically indistinguishable from females. While today these patients would be described as transgender or gender diverse, the original diagnosis was transsexualism, which combined ideas of gender and sexuality in ways which are no longer used.

By contrast, in the 21st century there has been an exponential increase in the number of children and adolescents presenting to gender services with a wide variety of issues associated with gender confusion and mental illness. In place of the fear of discrimination and persecution that led transsexual patients to avoid scrutiny, today there is a highly organised network of trans rights activists who seek to influence legislators and administrators as they make laws and design health and social systems that affect the care and support of gender diverse minors.

At the same time as the number of gender confused patients has increased, the types of patients who ask for help has changed significantly. Unlike adult transsexual patients in the twentieth century, predominantly males wanting to be accepted as female, gender confused youths are now more likely to be born females who do not want to be perceived as female, although they also may not want to be perceived as male. As this may be difficult for many readers to understand, it is useful to consider a few of the many categories described as gender-diverse identities.

The main type of diverse gender identity is transgender, a person who wants to be treated as the gender opposite to their biological sex. Others include non-binary people who combine male and female characteristics without one type being dominant; gender fluid, where features of gender identity can change from moment to