One of Australia’s leading medical insurers has dumped cover for private practising doctors who initiate hormone treatment in adolescents with gender dysphoria, a decision that may put even more pressure on public hospital waiting lists.
MDA National said it will also no longer insure private doctors, such as general practitioners, from legal claims arising from the assessment of patients under 18 as suitable for gender transition treatments, such as cross-sex hormones and gender affirmation surgeries.
The Australian Professional Association for Trans Health (AusPATH), representing hundreds of health professionals who provide care to transgender people, is aware of some GPs who have already stopped gender-affirming care — a model that supports the child’s choices and can lead to medical interventions such as puberty blockers and hormone treatment.
AusPATH is concerned the MDA National decision will particularly affect trans youth living outside major cities, who struggle to access public gender services.
“It’s going to stop a number of children ever being able to access gender affirming care before they turn 18,” AusPATH president Professor Ashleigh Lin said.
The MDA National decision, effective from July 1, comes after the insurer reviewed the medico-legal risks amid what it described as “growing criticism globally of the research that underpins medical and surgical transition of children in response to gender dysphoria”.
It was made in response to “the risk of potentially high-value claims arising from irreversible treatments” provided to children and adolescents.
Gender-affirming hormonal therapies with testosterone or oestrogen may cause temporary or permanent infertility.
MDA continues to allow doctors to prescribe puberty blockers to treat trans youth.
While there is evidence of long-term side effect for puberty blockers such as reduced bone density, the effects on puberty are reversible.
“Children are not able to transition without relying on the assessments of medical professionals,” MDA National said in a statement to the ABC.
“This places doctors in a uniquely vulnerable position with respect to future litigation – particularly so, if courts take the view that the practitioner has influenced a child’s decision to medically or surgically transition and that there are limits to a child’s understanding and what they effectively consent to.
“This has led to our view that medical practitioners who assess children as being suitable for transition and/or who initially prescribe cross-sex hormones are at a heightened risk of receiving claims, irrespective of the strength of the consent process and the standard of care or the model of healthcare.”
MDA National describes itself as “apolitical” and says it does “not make any commentary on the appropriateness of the informed consent model of gender-affirming care”.
But it said: “Even though practitioners working in this space provide the very best healthcare and do everything that normally affords a robust defence in the face of a claim, ultimately, there is very little a practitioner can do to protect against claims from those, who, with the benefit of hindsight, believe their care should have been managed differently.
“As a doctor-owned organisation, we must act in the best interest of all our doctor members with respect to future claims, which are not paid for by the government, advocacy associations or the individual doctors that may be sued.
“The cost of these claims must be covered by the broader MDA membership, which is made up largely of private practising doctors.”
MDA National is one of six medical indemnity insurers providing cover to Australian doctors.
News of its decision to deny private doctors cover for assessing children and adolescents as suitable for gender transition and for initiating cross-sex hormone treatment to patients under 18 years of age comes amid huge demand on public hospital gender services.
As of May 9 this year, the Queensland Children’s Gender Service had 642 children and young people, ranging in age from four to 17, on its waitlist for assessment.
In 2022, the service provided care to 922 patients.
The ABC sought comment from the Australian Medical Association and medical colleges representing general practitioners, physicians, psychiatrists, and surgeons about the MDA National decision.
Only the Royal Australasian College of Surgeons (RACS) responded, describing gender affirmation surgery as complex and involving “a multi-disciplinary collaborative consultation and management among various specialists, including psychologists, endocrinologists and surgeons specialising in plastic surgery, urology, colorectal surgery, and gynaecology”.
“While RACS supports the training of gender affirmation surgery, it is important to note that the limited number of cases and the highly specialised nature of this field requires specific focus for a limited number of surgeons,” it said in a statement.
“We therefore recommend that surgeons interested in pursuing expertise in gender affirmation surgery seek additional post-fellowship specialty training through specific national or international fellowships in gender affirming procedures and management.”
The Australian Medical Students’ Association (AMSA) was critical of MDA National’s policy change, describing it as “not being grounded in comprehensive consultation with leading clinical experts and peak bodies for transgender health in Australia”.
“AMSA stands for accessible gender-affirming care for all transgender and gender diverse people,” AMSA’s Dineli Kalansuriya said.
“This policy change by MDA substantially impacts the provision of gender-affirming medical therapies in the community. Ultimately, their decision restricts the accessibility of these services for a medically and financially marginalised group of young people who are already underserviced by the healthcare system.
“Hospital gender clinics simply do not have the resources to treat the overwhelming number of referrals they receive annually.”