Was Lyle Shelton Right?

imageThe Australian and New Zealand Professional Association for Transgender Health (ANZPATH) have released a statement regarding the Australian Christian Lobby’s misrepresentation of stats on the ABC program Q&A.

The Conversation also addressed Shelton’s assertions

Australian and New Zealand
Professional Association for Transgender Health
6th March 2016

To: Mr Peter McEvoy
Executive Producer Q&A
Australian Broadcasting Corporation Melbourne VICTORIA

Dear Mr McEvoy,

ANZPATH (Australian and New Zealand Professional Association for Transgender Health) wishes to express deep concern in relation to misleading “facts” presented by Mr Lyle Shelton, managing director of the Australian Christian Lobby on the ABC’s Q&A program on Monday, 29 February 2016.

On the program, Mr Shelton stated that the suicide rate in people who had undergone sex reassignment surgery was 20 times higher than the general population 10 years after having had the surgery. The implication was that sex reassignment surgery was not an effective treatment for gender dysphoria. The facts quoted were from a study titled “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden” which was published by Cecilia Dhejne et al. in PLoS ONE, February 2011/ Volume 6 / Issue 2.

What Mr Shelton failed to state was the authors in their paper quoted several other studies “that suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria”. The authors went on to state “it is therefore important to note that the current study is only informative with respect to transsexual persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.”

A study by G. De Cuypere et al. Titled “Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery” published in Sexologies 15 (2006) 126- 133, the authors stated “although the suicide attempt rate dropped significantly from 29.3% to 5.1%, it was definitely higher than in the average population”.

The mental health problems associated with being transgender, including the higher risk of suicide, is not inherently due to being transgender itself but due to the stigma, discrimination, exclusion and disadvantage inflicted by society. Society’s views of transgender individuals is unchanged by an individual’s decision to undergo sex reassignment surgery, hence the high suicide rate in the Swedish study even post operatively. However, society’s negative views of transsexualism can be reinforced when misinformation and trans-phobic comments are broadcast on national television.

In support of his argument that sex reassignment surgery was not an effective treatment for transsexualism, Mr Shelton went on to cite the closure of the Johns Hopkins Gender Identity Clinic in 1979 by Dr Paul McHugh as support for his argument. Mr Shelton describes McHugh and his colleagues as “pioneers” in the field.

Sex reassignment surgery was being carried out in Melbourne, at the Royal Melbourne Hospital, in the 1960s. McHugh’s decision to close the Johns Hopkins clinic was based on research carried out in 1979 by Dr Jon Meyer, one of McHugh’s staff psychiatrists. The research is outdated and methodologically flawed. Despite the research showing that patients who had undergone sex reassignment surgery reported subjective satisfaction post operatively and a low regret rate, McHugh (a Conservative Catholic) decided to close the clinic on the basis that patients did not show “sufficient” improvement on socio-economic and other parameters.

McHugh’s views have been widely criticised as outdated. He ignores extensive research over the past 30 years which clearly shows the efficacy of medical and surgical interventions for gender dysphoria in children, adolescents and adults. McHugh’s view that transsexualism is inherently psychopathological is no longer held by mental health professionals working in the field. Many take the view that transgenderism is simply a reflection of nature’s diversity. Diversity is how we have evolved as a species but while nature loves diversity, society does not. McHugh’s support for “reparative” psychological treatment has been rejected outright by WPATH (World Professional Association for Transgender Health) and ANZPATH. In some countries such as Canada, this therapy has been made illegal.

Mr Shelton went on to criticise Minus18, a support group for LGBT youth, and described the “sexualised content” of their publications as “horrific”. We feel his language is emotive and he fails to understand the intense gender dysphoria that drives young birth assigned females (who identify as male) to bind their breasts and young birth assigned males (who identify as female) to tuck their penises. Minus18 does not encourage these behaviours but gives accurate advice to young people who feel compelled to follow these procedures to alleviate their intense gender dysphoria.

Mr Shelton argues that treatment for transgender children remains “contested”. Within the medical and scientific community this statement is untrue. Without treatment during childhood and adolescence, 50% of adolescents self-harm and 28% attempt suicide (Hillier 2010). In contrast, young people with access to puberty blockers and hormones during adolescence had significantly reduced depression and anxiety with their quality of life, educational and vocational outcomes being equivalent to that of the general population (De Vries 2014).

He cites research claiming that 80% of transgender children, if left untreated, reconcile with their birth assigned gender. This statement is also not a true reflection of the research as these studies looked at children showing “gender non-conforming behaviour” but whom did not necessarily meet the full criteria for gender dysphoria. These children were not necessarily living in supportive environments and sufficient follow-up studies have not been conducted. This figure, therefore, is likely to significantly under-estimate the number of young children who persist with their transgender identification into adolescence.

Once a child reaches puberty (usually at the age of between 9-12 years) studies show the persistence rate is as high as 99.5%. The experience at the Royal Children’s Hospital in Melbourne is that the majority of young children who satisfy the diagnostic criteria for gender dysphoria in childhood and who have the benefit of supportive home and school environments, persist with gender dysphoria into adolescence and adulthood.

Australian and New Zealand
Professional Association for Transgender Health
ANZPATH sincerely hopes that any further ABC television debates on this subject will be informed by accurate current scientific data presented by professionals who are expert in the field. It is regrettable that no gender health specialist or trans-identified person was represented on the Q&A panel discussion on Monday, 29 February 2016.

Yours sincerely,

ANZPATH Executive:
Dr Fintan Harte MA MB BCh Dobs DCH FRCPsych FRANZCP Consultant Psychiatrist
President, ANZPATH

Dr Rob Lyons MB BS (Hons) FRANZCP Dip (Psych) Consultant Psychiatrist
Vice President, ANZPATH

Dr Jaco Erasmus MB ChB MRCPsych FRANZCP Consultant Psychiatrist
Treasurer, ANZPATH

A/Prof Cindy Macardle PhD FFSc (RCPA) Consultant Pathologist (Science) Secretary, ANZPATH

Dr Michelle Telfer MB BS (Hons) FRACP Consultant Paediatrician
Executive Member, ANZPATH

Ms Kaete Walker RN BA (Social Welfare) Cert.Psych.Nursing Clinical Nurse Specialist
Executive Member, ANZPATH

About the author

Veteran gay writer and speaker, Doug was one of the founders of the UKs pioneering GLBTI newspaper Gay News (1972) , and of the second, Gay Week, and is a former Features Editor of Him International. He presented news and current affairs on JOY 94.9 FM Melbourne for more than ten years. "Doug is revered, feared and reviled in equal quantities, at times dividing people with his journalistic wrath. Yet there is no doubt this grandpa-esque bear keeps everyone abreast of anything and everything LGBT across the globe." (Daniel Witthaus, "Beyond Priscilla", Clouds of Magellan, Melbourne, 2014)