Dear Mr Peter Holmes,

I was passed a copy of Orange News in which my name came up with regard to gender dysphoria in children and I think it appropriate to reply.


First, while it is true I have not ‘treated’ anyone with such dysphoria, that fact is grist for my mill not for those justifying hormonal and surgical ‘affirmation’.  You see, I have had a long career in treating children: from 1967, in fact, and only became aware of this problem in May 2016 when I attended a session in a medical conference in which a paediatrician from the gender clinic in Melbourne spoke of its prevalence and the role of hormonal therapy. 

In consequence, I questioned 28 of my colleagues with a cumulative experience of 931 year if anyone had had any experience with such children. In all, 12 cases could be recalled: 10 because of the prominence of associated mental disturbance and 2 because of associated sexual abuse. 

Indeed, in those years, desire for change of gender was considered a warning sign of such abuse. In those years I had a very large involvement with children of all ages, being a paediatrician in private and public practice in association with 3 major hospitals that catered for children in the burgeoning Western Suburbs of Sydney. Regrettably, child abuse in various forms was not uncommon. So also were behavioural issues in children which concerned sexuality, including masturbation, insertion of foreign objects, and exploration with siblings etc.   Though these issues may have worried the parents greatly, they were freely discussed in a doctor’s surgery.

The point is: in all those years and in various countries, no-one ever complained their child was identifying with the opposite sex.  In my opinion, this was a rare phenomenon in those years, not one the parents were too embarrassed or otherwise disinclined to raise. This scarcity of the problem is confirmed by lack of appearance in then current medical literature. For example, in 1987Robert Kosky, leading child psychiatrist in Western Australia, reported 8 cases which had arisen in the years 1975-19801 and, in discussion, referred to 138 treated cases which had been ‘culled from the literature by KJ Zucker who was arguably the most experienced psychologist dealing with the problem in North America at the time2 Since then, as everyone knows, the prevalence of gender confusion in children has increased exponentially. Why so? Because, I believe, the identification and possibility of manufacture of gonado-trophin hormone (GnRH) and anologues (GnRHa) contributed a medical ‘solution’ to a ‘social contagion’ propagated by the coincidental explosion of internet communications and promotional media.

The cases that were being reported in those earlier years were largely comprised of young boys and, as Kosky’s report revealed, they were suffering undue influence of a dysfunctional mother who, in a kind of Munchausen disorder inspired by unhappy  relationships with men, found the little boy more attractive in a dress and he, in return, found compliance to be a good way to bring a smile to his mother’s  face. 

In those early days, counselling and psychotherapy were employed to help the child align feelings with chromosomal reality. To quote Kenneth Zucker,  the aim was ’to help the child feel comfortable in natal skin’. In eleven reviews of practice in those early years, the great majority of dysphoric children are recorded to have re-aligned gender with chromosomal sex without recourse to hormonal affirmationIndeed, such hormonal practice only became in vogue in the  late 90’s after pharmaceutical developments resulted in production of an analogue of the natural GnRH which could be injected with such regularity that the reproductive role of GnRH could be ‘blocked’. This puberty blocking became known as the Dutch Protocol after the country in which it was developed and from which its stages of social affirmation, puberty blocking, administration of cross-sex hormones and then surgery were adopted across, at least, gender clinics in the Western world. At this stage, it might be added that of the boys who realigned gender with chromosomes, many became homosexuals, causing some of that community to complain that affirmation of gender confused boys to femalehood constituted ‘genocide’ of homosexuals.

Anyway, with the passage of time, another phenomenon has emerged: later onset of gender dysphoria in adolescent females. Certain features of this disturbance have been recorded throughout the world: a very high association with prior mental disorder, and influence from the web, media, peers, teachers and even politicians that their troubles originated in being born ‘in the wrong body’. To this misdiagnosis was added the tacit assurance that transgendering was a relatively uncomplicated process that would re-order body to feelings, regardless of chromosomal direction, and ‘inner peace’ could be attained in the process. The phenomenon spread with all the epidemiological features of a ‘social contagion’

Why then is affirmation not simple? Surely it is just a matter of taking medicines to evoke the external characteristics of the opposite sex? Some understanding of the physiology is necessary. GnRH is produced in the hypothalamus within the brain to cause the nearby pituitary gland to release hormones that travel in the blood to the distant ovaries and testicles where they induce the production of eggs and sperm, and the secondary release of the sex hormones, oestrogen and testosterone, that promote the distinct characteristics of females and males, and the sex drive for reproduction. This arrangement is known as the ‘reproductive role’ of GnRH.But, there is a ‘non-reproductive’ role which is basic to the development and maintenance of function of neurons, including brain cells but also other nerve cells outside that organ.  This ‘non-reproductive’ role has been and is being confirmed by many, international research programmes. ‘Blockage’ of the reproductive role will prevent the production of eggs, sperm, secondary hormones that produce physical characteristics and those that induce sexualisation. How can a confused child work out whether he is a boy or a girl when ‘nature’s’ directing hormones are abolished? ‘Blockage’ will also interfere with brain development. The effect on sheep has been shown to interfere with structure and function of the limbic system which integrates cognition, external awareness, emotion, drive and memory into ‘executive’ decisions of identity and behaviour. How can sexual ‘identity’ be firmly established without the direction of formative hormones and proper function of the limbic system?Also, ‘Blocking’ the limbic system is associated with preference for the familiar over the novel, which might be explained as ‘fearfulness of change’. 

The importance of this phenomenon in transgendering children is that it provides biological explanation for the observation that almost all children on blockers proceed to the next step of ‘affirmation’: the administration of cross sex hormones. Finally, though blockers will stop the production of eggs and sperm, it is not known how well such production will proceed when blockers are stopped. In other words, how long will it take for blockers to induce permanent sterility? Certainly, it has been observed that the external features of puberty may return when blockers are stopped… but the assertion that their ‘effect is safe and entirely reversible’ is without scientific backing

Animal studies reveal sustained interruption of brain function. No-one knows the effect of prolonged suppression of the sex organs. In other words, administration of blockers is unregulated experimentation under the ideological conviction that, some how, it is in the child’s best interests. After blockers, the next step in ‘affirmation’ is administration of cross sex hormones (oestrogen to a male and testosterone to a female) in order to evoke the physical features of the opposite sexBut, two independent studies have revealed major changes to the brain which are not acknowledged by proponents of ‘affirmation’: the male brain on oestrogens shrinks at a rate ten times greater that ageing after only four months administration. The female brain hypertrophies on testosterone.

Also, normal ovarian and testicular function will be ablated in a process of chemical castration.The next step in transgendering is surgical ‘remodelling’ of parts of the body in the attempt to approximate the anatomical features of the opposite sex.  Male to female transformation involves removal of the testes (castration), then creation of a hole anterior to the anus into which the scrotum is ‘reversed’ in the attempt to manufacture a vagina. If its depth is not sufficient for penetrative sex it may be augmented by a segment of intestine. Sexual sensation will be sought by applying the end of the excised penis anteriorly to the ‘vagina’ as an ersatz clitoris. 

Female to male transformation is even more complicated and involves mastectomy, excision of the vagina, uterus and ovaries, and the creation of a flap of skin eg from the forearm, which is fashioned into a tube which will be affixed in penile position anterior to the site of the earlier vagina. A urethra will result from the creation of a tunnel up the ‘penis’ so urination can occur while standing up. Maintenance of sexual function will be attempted by affixing the clitoris to the end of the apparatus.What could possibly go wrong with these heroic surgical procedures? They include the closure of holes and tubes (the body is designed to heal penetrations), infection, loss of sexual feelings and incontinenceThere is also incompetence, not only may the ersatz vagina become too small, the limp penis will need to stiffened with eg a bone graft from Eve’s rib. And there is always regret: mastectomies preclude breast feeding.The real question is whether the process leads to ‘gold’ at the end of the hormonal and surgical rainbow? The reported fact that most child will revert to identification with chromosomal sex should reduce enthusiasm for social, hormonal, and surgical affirmation.  So should the growing number of people who have ‘desisted’ from their process of transgendering. And so should the very high rate of suicide and sustained mental illness: it is reported that the rate of suicide in transgendered adults is 19 times that of the general population. 

Affirmation of children should also be challenged by the processes of ‘ethics’ established after the Nuremberg trials at the end of WW2 emphasised the gravity of ‘experimentation’. Therapeutic trials on humans should be based on biological plausibility, confirmation by animal studies, supervised by external, indifferent processes and people, compared with adequate ‘controls’, based on widespread, dispassionate literature, and based on fully informed consent. 

The High Court of Australia, in Rogers vs Whitaker sets the principle that all possible negative complications (as rare as 1/14000) should be fully imparted and understood by recipients of medical procedures. ‘Affirmation’ of children challenges all these conditions. Even proponents of ‘affirmation’ admit its experimentation! And no transgendering clinics from Tavistok to Melbourne appear to inform their clients about the neurological effects of blockers and cross sex hormones.It is surprising therefore that elected representatives in all levels of Australian governments have inserted their influence and power into unregulated experimentation on children. None have done so as effusively as the government of Victoria with its ‘change and suppression Act which criminalises all attempts to encourage a gender confused child to align feelings with chromosomal reality as was observed to be the outcome in earlier studies.  It is hard to believe legislation can threaten up to 10 years in gaol for any practitioner (including by definition parents) who seeks to persuade a child from a process that includes chemical and surgical castration, while intruding on brain development.  

Psychotherapy is now a criminal act in Victoria. To the contrary, the Australian National Association of Practising Psychiatrists (NAPP) has recently promulgated guidelines for the examination of all factors associated with gender dysphoria and the amelioration of associated mental disorder. Governments of Sweden, Finland, Norway and other countries are all withdrawing from hormonal ‘affirmation’ of children in favour of treatment of co-morbid mental conditions. They are acknowledging the lack of knowledge of long term outcomes of life changing therapies, and recognising the growing number of desisters.

Finally, transgendering in minors is contagious. References to youth suicide in the media are restricted because of their known propensity for recruitment: they are socially contagious. Similarly, there are reasonable pleas for the media to forego advertising that features thin adolescent girls because of recruitment to ‘anorexia nervosa’ with its, at times lethal, but always disruptive characteristics.No council would, one way or another, promote thinness in female adolescents. Should any raise the possibility of changing gender?Three final things:Certainly, I am of Christian faith but my assessment of the gender issue in children is not based thereon. Unfortunately, whenever I am caused to diagnose a child with, say, breathing difficulty, I receive no ‘bolt’ of insight from Above or from the Bible below. I am trained to assess the physical issues through years of continued education to come to a ‘scientific’ conclusion and implement appropriate treatment in a compassionate way.

Being a Christian does, however, exert influence. The Bible teaches I am to practice ‘agape’ love…intelligent, knowledgeable, self-sacrificial commitment to the well being of my patient. It also teaches I am not to give up and take ‘my hands from the plough’ and, worse, it warns of consequences of hurting ‘little ones’ (think millstones around the neck and the deep blue sea). It is this ‘agape’ principle that has caused me to take the time to write to you.It is a cheap but continued attempt at denigration to raise my association with Fred Nile as if we are in accord on all matters. Certainly, years ago, he and I shared wonderful experiences in paediatrics…we organised a big conference on child abuse in the year of the child, bringing experienced police officers from Los Angeles to explain their role in prevention of such abuse. The conference involved local police officials, preceding their institutional involvement.

Then, in the Year of the Handicapped, we brought Mother Theresa as a keynote speaker to a big conference on affected children, highlighting the problem there and also in associated public events. Lastly, you have rightly declared I am employed by Western Sydney University but it must be emphasised I do not, therefore, represent that institution which embodies diverse opinion.I have not had the time to reference parts of this letter, but attach a recent publication of mine in Quadrant Magazine with appropriate references for interest.

Yours truly
John Whitehall
  1.  Kosky R. MJA1987, 146; June 1: 565-569.
  2.  Zucker KJ. Cross-gender identified childrenIn: Steiner  BW,  ed.  Gender dysphoria: development, research, management. New York:  Plenum Press, 1985: 75-174
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