Dr Jillian Spencer, Queensland child psychiatrist, advocates for caution in treatment of gender care

Dr Jillian Spencer, a senior staff specialist in the Queensland Children’s Hospital’s (QCH) consultation liaison psychiatry team, was suspended from clinical duties in mid-April after she raised concerns about puberty blocker use without an appropriate mental health assessment.  

Although the ethical principle of ‘do no harm’ underpins the entire healthcare profession, with patients’ wellbeing and sometimes even their lives dependent on this ethos, the treatment towards Dr Spencer by the QCH has “exposed a culture in which clinicians are unable to employ medical discretion or a neutral therapeutic stance and are bound by their employment to affirm children’s gender transition”. 

As Dr Spencer used her professional judgement and advocated for evidence-based practice, the public hospital removing her from duties following a patient complaint is a severe approach, and one which has been described as “unusual” by colleagues. Dr Spencer is reported to have lodged a complaint with the Queensland Human Rights Commission on grounds of her being prevented from adopting a neutral therapeutic approach due to the hospital’s own policies. 

The Queensland Children’s Hospital requires affirmation of preferred pronouns by staff, despite affirmation being considered an active treatment approach. The hospital also enter the patient’s preferred gender, rather than sex, into their medical records, despite this resulting in medical inaccuracies with sex-based measurements. 

It has also been reported that the nursing staff in the hospital teach breast (or chest) binding lessons for patients and public school nurses. Breast binding can cause a number of harms, including difficulty breathing, back pain, overheating, and skin irritation. A cross-sectional study of 1800 adults examining the impact of breast binding found that more than 97% pf respondents reported experiencing at least one of the 28 negatively associated attributes, with daily use resulting in greater negatives. Of these, 50 participants even reported rib fractures from binding. It is not known whether patients and school children are adequately informed of these risks by the hospital, or whether this information is provided as part of the training. As the intended recipients of these lessons are children and adolescents, who have still-developing bodies, there are likely to be additional negative health repercussions for this cohort, in addition to the risks present in the adult study. 

In the ABC’s Four Corners program, Blocked: The battle over youth gender care, Dr Spencer voiced concerns for the well-being of young same-sex attracted children and teenagers, who are disproportionately more likely to identify as transgender.

Dr Spencer stated: 

‘I worry about the harm to children and of concern is the knowledge that it is much more common for children who later will be gay or lesbian to show cross-sex identification and gender dysphoria in childhood. So, there is that worry there that we're changing the trajectory of those children’ (emphasis added).

In other interviews, she has spoken about the serious risks of surgery, both short-term as well as long-term, with adolescents underestimating how debilitating medical side effects can be. Due to the developmental stage of adolescence, which combines life inexperience with a brain that is still maturing, thereby downplaying risks and not considering long-term consequences, it is understandable to show caution in the face of decisions with life-long consequences. 

Dr Spencer instead supports the "watchful waiting" therapeutic model, which seeks to engage with the young person, their family and school, treat mental health comorbidities, and assist the young person to build connections with peers, develop their interests, and help them to feel good about themselves and their body.  

Suitable treatment options for transgender-identifying children and adolescents have been one of fierce international debate, with paediatric specialists who work in gender medicine voicing concerns in a public letter signed by 21 medical practitioners and researchers from 6 countries. This letter challenges the Endocrine Society’s claims that gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

Instead, these specialists state: 

‘Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret’ (emphasis added).

The use of puberty blockers has been limited in other countries, including Britain, Sweden, Finland and France, due to concerns around short- and long-term consequences, as well as the ability for children and adolescents to provide informed consent around these risks. 

LGB Alliance Australia has several members who are health practitioners that share the concerns voiced by Dr Spencer, as well as her peers internationally. We have concerns that an Australian public hospital is taking punitive measures against medical practitioners who follow the principle of ‘do no harm’ and voice concerns with the gender-affirmative treatment model. We hope that Dr Jillian Spencer’s bravery will encourage other medical and health practitioners to consider the risks and outcomes of such treatment models, particularly on the young people involved who will have to deal with the consequences of such decisions for the rest of their lives.