The Family Court has given a 15-year-old child permission to have both breasts removed so she can feel more like a boy.
The decision is believed to be the first in which the court has approved major surgery for a child who wishes to change gender, before they have even started hormone treatment. The child, known in court documents as Quinn, was born female but has dressed as a boy since the age of four.
Unlike many children who have been diagnosed with gender dysphoria, she has not been taking hormones to suppress puberty, and has therefore developed large breasts, which the court has said should come off now, because once she starts taking testosterone, she “will develop a hairy chest and face (to go with) an E-cup”.
The court took evidence from a psychologist, who cannot be named, who said: ‘Society has begun to accept transgender individuals, however I am highly doubtful they would accept an individual with a beard, hairy chest and an E-cup bust.”
While there is no hard-and-fast rule on whether the court can approve such surgery for children, the decision would appear to be at odds with comments made by senior Family Court judge Steven Strickland, who told an international conference on family law last year that “surgery is not considered in patients less than 18 years of age”.
He also said: “Cross-sex hormone therapy is usually given from the age of 16 years (and) surgery is not considered in patients less than 18 years of age. This process for psychological and medical treatment of children and adolescents with gender dysphoria accords with national and international guidelines.”
The normal process for children diagnosed with gender dysphoria in Australia is for the child to start hormonal treatment to suppress puberty from age 14 or 15; and for parents to then seek the court’s permission for stage two treatment, where a child is given hormones of the opposite gender, from about the age of 16.
This allows a child to live as their preferred gender for a period of time, and to perhaps change their mind, before having surgery, such as the removal of the breasts or even the penis.
However, in the Quinn case, judge Judith Rees said the child, who is 15, wanted to have a bilateral mastectomy — also known as “top surgery” — to get rid of her breasts as soon as possible.
The court was told Quinn had “researched top surgery, and is following top surgery journeys of other transgender men on Facebook. He understands surgery will be painful and that it will have consequences, such as his ability to breastfeed if he could change his mind in the future”.
Quinn has also researched hormone treatment “and wishes to begin testosterone treatment within 12 months”.
The judgment makes passing reference to a psychiatrist who expressed “reluctance to encourage Quinn” in the endeavour, but provides no further information, other than to say Quinn was “disappointed” by that advice.
The court acknowledged international guidelines, which recommend that genital surgery should not be carried out until children have reached the age of 18 and “lived continuously for at least 12 months” as the opposite gender.
Chest surgery can be carried out earlier but “preferably after ample time of living in the desired gender role and after one year of testosterone treatment … to give adolescents sufficient opportunity to experience and socially adjust to a more masculine gender role, before undergoing irreversible surgery”. Justice Rees said the guidelines allowed for exceptions, “depending on an adolescent’s specific situation”.
The court was told Quinn’s situation was “unique, in that his large bust causes him both psychological and physical pain” and “even with binding (where a child’s breasts are taped down) his bust would be noticeable”.
A second psychologist told the court that Quinn’s mental health would likely improve after breast removal, as her “history of anxiety, depression and self-harm” was linked to gender dysphoria.