Grounding Gender Care in Biological Reality
Letter to RANZCP from a biologist in support of a return to Evidence Based Science.
RANZCP President Election and Grounding Gender Care in Biological Reality and Evidence-Based Science
Dear Dr. Moore and Dr. Tomar,
As biologist, clinical researcher in drug development, and someone who has had experience with the Australian psychiatric profession I am writing to express my deepest concerns. I apologise in advance for the length of my letter but in spite of this it still doesn't fully address my concerns.
I was deeply disturbed and distressed to find out that Transgender Health Australia is lobbying you to remove Dr Jillian Spencer's nomination for President-Elect. As the election process is meant to be democratic, I could not help but be concerned and lose faith in RANZCP as an organisation if lobbying by activists could unravel the democratic process. It would lead me to question what else is being driven by activists within the RANZCP.
Learning how trans activists are lobbying to remove Dr. Jillian Spencer's nomination for President-Elect, it prompts me to address various falsehoods that underpin the gender affirmation model, and how important therefore that we have leadership that is influenced by science over ideology.
As a biologist with over 2 decades of experience in clinical drug development I have become deeply concerned with the intersection of pseudoscience, science and medical care, I write to urge the RANZCP to reevaluate the ideological underpinnings of gender-affirmative care in favour of evidence-based, biologically grounded approaches.
The current affirmation model rests on a series of myths and misconceptions that not only undermine scientific integrity but also risk causing significant harm to vulnerable individuals, particularly minors.
Myth 1: "Gender Identity Is Fixed and Immutable"
One of the central premises of gender-affirmative care is the idea that gender identity is an innate, unchangeable aspect of a person. However, this claim lacks robust empirical support. Research shows that gender dysphoria in children often resolves naturally during adolescence without medical intervention. Studies have consistently found that 60-90% of children who experience gender dysphoria desist by puberty and go on to identify with their biological sex.
The affirmation-only model disregards this evidence, funnelling children into irreversible medical pathways that preclude natural developmental resolution. A biologically informed approach recognizes the plasticity of adolescent identity formation and prioritises exploratory therapy to address the root causes of distress. By prematurely medicalising gender dysphoria, the current model risks misdiagnosis and lifelong regret.
Myth 2: "Biological Sex Is a Spectrum"
Proponents of gender-affirmative care often argue that biological sex exists on a spectrum. While it is true that disorders of sexual development (DSDs) exist, these conditions are extremely rare and do not invalidate the binary nature of biological sex in humans. The overwhelming majority of individuals are unambiguously male or female, determined by chromosomal, gonadal, and phenotypic markers.
Conflating DSDs with gender dysphoria is both scientifically inaccurate and misleading. Gender dysphoria is a psychological condition, not a biological ambiguity. Effective care must differentiate between these phenomena and avoid using the rare exceptions of DSDs to justify broad, uncritical affirmation of gender identity.
Myth 3: "Puberty Blockers Are Fully Reversible"
Puberty blockers are frequently described as a "pause button" that allows children to explore their gender identity without permanent consequences. However, this characterisation is not supported by evidence. Puberty blockers interrupt critical stages of physical and neurological development, affecting bone density, fertility, and cognitive maturation. Emerging research indicates that these effects may not be fully reversible, particularly when puberty blockers are followed by cross-sex hormones.
Additionally, data show that nearly all children placed on puberty blockers proceed to cross-sex hormones, effectively locking them into a medicalised pathway. This reality contradicts the claim of reversibility and underscores the need for a cautious, evidence-based approach to these interventions.
Finally, the claims of "reversibility" are based on studies conducted on children with precocious puberty. They are ceased at an age to allow the child to progress through a natural puberty. There have been no clinical trials to assess the impact of ceasing natural puberty or to disrupt natural puberty only to follow with flooding the body with hormones of the opposite sex. When this is done in practice the follow up is inadequate and not equivalent to that which would be done under a clinical trial setting.
Perhaps you are also unaware that the Endocrine Society Guidelines cite an opinion piece by Florence Ashley, a trans-activist, as evidence of puberty blockers being "reversible". This is not science and it is certainly not robust clinical evidence of "reversibility".
Myth 4: "Affirmation Prevents Suicide"
Perhaps the most emotionally charged argument for gender-affirmative care is the claim that failing to affirm a child’s gender identity will lead to suicide. While it is true that individuals with gender dysphoria are at an elevated risk of mental health challenges, the simplistic equation of non-affirmation with suicide is both unscientific and harmful.
Studies on the relationship between gender affirmation and mental health outcomes are methodologically weak, often lacking control groups and relying on short-term follow-ups. Long-term data on the outcomes of gender-affirming care are scarce, and existing research suggests that mental health struggles often persist even after medical transition. This highlights the importance of addressing underlying psychological issues rather than focusing solely on affirmation.
The Impact of Ideological Gender Care on Effective Treatment
The perpetuation of these myths has profound implications for the quality of gender care. By prioritising affirmation over exploration, the current model disregards the complexity of gender dysphoria and its potential co-occurring factors, such as trauma, autism, and mental health conditions. This one-size-fits-all approach undermines the principles of individualised, evidence-based care and exposes patients to unnecessary risks.
A biologically grounded, multidisciplinary approach offers a more ethical and effective alternative. Such a model would prioritise thorough assessments to identify the root causes of distress, provide exploratory therapy as a first-line intervention, and reserve medical treatments as a last resort for carefully selected cases. This approach aligns with the principles adopted by countries like Sweden, Finland, and the United Kingdom, which have moved away from affirmation-only models in response to emerging evidence of harm.
A Call to Action
The RANZCP has a unique opportunity to lead the way in restoring scientific integrity to gender care. To this end, I urge the College to:
Critically Reevaluate Affirmation-Only Policies: Ensure that current guidelines are informed by rigorous, peer-reviewed evidence rather than ideological advocacy.
Promote Comprehensive Assessments: Mandate thorough, multidisciplinary evaluations for all patients experiencing gender dysphoria to identify underlying factors and tailor care accordingly.
Prioritize Non-Invasive Interventions: Emphasise exploratory therapy and psychological support as the first-line treatments for gender dysphoria, particularly in minors.
Advocate for Research Transparency: Support high-quality, long-term studies to better understand the outcomes of different approaches to gender care.
Educate Clinicians and the Public: Combat misinformation by promoting a biologically accurate understanding of sex and gender, as well as the risks and limitations of medical interventions.
Conclusion
Effective gender care must be grounded in biological reality and robust evidence-based science. The myths underpinning the gender-affirmative model have no place in ethical medical practice and risk causing irreparable harm to vulnerable individuals.
Dr. Jillian Spencer’s advocacy for cautious, individualised care represents a much-needed course correction. By supporting her leadership, the RANZCP can ensure that the future of gender care is informed by science, not ideology.
Thank you for your attention to this critical issue. I trust that the College will rise to the challenge of safeguarding both scientific integrity and patient well-being.
Sincerely,
[NAME WITH HELD]
The longer the beast has resisted challenge, the stronger it has become. The ideological basis for gender identity ( and its extension, to “ fluidity “) well deserves its overdue confrontation and acknowledgement as the social science cull de sac into which Medicine has been inexplicably lead. Linguistic manipulation of the social activists has been an effective tool , by taking their lead, as perhaps , as we recently might have seen suggested, replacing “ gender incongruity/ dysphoria “ with “ transgender ideation “ would be a good start?
To whom you are attracted sexually is purely subjective and therefore cannot reasonably be contested by an outside observer.
Where you decide to live your life on a spectrum of superficial, stereotypical male to female attributes (and we all do) is also purely subjective and similarly cannot be questioned.
However, your biological sex reflects an objective reality which cannot be changed by your subjective personal view and futile attempts to do so can result in serious health impacts to you as well as harms to members of the sex you are impersonating (primarily women).
Others who are grounded in objective reality should never be forced to accept your subjective version of your actual biological sex.
Finally, it's past time for the LGB community to separate themselves from the trans activists who are trying to take away the rights of women to fairness in sports and to privacy and safety in their restrooms, locker rooms and prisons. They also advocate for the chemical and surgical mutilation of children many of whom would grow up gay.
Their actions are evil and the
understandable negative reaction to the harm they are causing is spilling over to innocent people who are just going about their business, marrying and leading their lives.