Audio excerpt – Cheyne Anderson:

“And what kind of questions are your patients asking you at the moment? What are you hearing from them?”

Audio excerpt – Sophie:

“Whether I’m going to have to close the clinic, if I'm going to be moving away, if I'm still going to be their doctor?”

DANIEL:

This is a doctor practising in the United States speaking to our producer Cheyne Anderson. We can’t tell you this doctor’s name. But for three months now, her work has been under attack.

She provides medical care to trans and gender diverse young people – and she says since Trump’s executive orders came in, in January – providing that care has become much harder.

And she’s watched as her patients have suffered as a result.

Audio excerpt – Sophie:

“In fact a lot of my trans kids have opted to homeschool because the learning environment has become so hostile in our state. Books supporting LGBT lifestyles with LGBT characters have been taken out of the libraries. Teachers are not allowed to answer questions about these things anymore. And so it can be really scary to be a kid in certain states of the US right now.”

[Theme Music Starts]

DANIEL:

From Schwartz Media. I’m Daniel James, this is 7am.

Today, 7am’s senior producer Cheyne Anderson – on the ordinary people pushing back against Trump’s war on trans people, and how Queensland became the testing ground for bans here.

It’s Friday, April 25.

And just a warning - this episode discusses suicide.

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DANIEL:

Cheyne, you were able to speak with a doctor who provides health care to trans children and teenagers. We're going to use a pseudonym to protect her identity because her work is under attack right now. But tell me about her and what her work involves.

CHEYNE:

Yeah, so I got into this story because I was really interested in looking at Trump's executive orders three months on, now that the dust has settled from that initial blitzkrieg of orders back in late January. So I got talking to this doctor, let's call her Sophie for ease of convenience.

Sophie told me that she lives and mostly works in a red state in the Midwest. She’s married with a kid. And she initially trained to be an OBGYN, but expanded her practice when her son was little and he started wearing dresses to school, which is something that continued through until the second grade.

Audio excerpt – Sophie:

“And I found that there were no local resources for parents. So I started learning about it. Medical transition and treatments for young kids. Realised that estrogen and testosterone are things that I prescribe every single day and that it's very possible for me to be able to make an impact in my community and provide services.”

CHEYNE:

So, yeah, that's when she started getting into gender affirming care, that was about seven or eight years ago, and she's been doing that ever since.

But even before the executive orders came in, she says it was difficult for her to do her job. She would have to travel over the state line to a blue state to provide care for her younger patients. But now, since January, even blue states are feeling the effect of Trump’s bans and she said she’s incredibly alarmed.

DANIEL:

Understandably, can you tell me a little bit more about what exactly the executive orders are and how they affect her work?

CHEYNE:

Yeah, so the main one was signed on January 28th, it is titled Protecting Children from Chemical and Surgical Mutilation, as you can hear in the title it's emotive, it’s intentionally inflammatory and a gross mischaracterisation of what gender affirming care actually provides.

Audio excerpt – Unknown Person:

“The order states the the US will not fund, sponsor, promote, assist or support the so called transition of a child from one sex to another and it will rigorously enforce all laws that prohibit or limit these destructive and life altering procedures.”

CHEYNE:

So it's actually been challenged already in the courts, but this order from January 28th had enormous ripple effects on her ability to treat children.

DANIEL:

So how has that played out so far?

CHEYNE:

So the thing that Sophie explained to me is that the wording of the order leaves the door open for criminal charges for anyone providing gender-affirming care. It promises to, quote, rigorously enforce all laws, even though it's not really specific what those laws are. And so it's generated this atmosphere of fear and paranoia around potentially what could come next. So The federally funded clinic that she works for has just gone into caretaker mode. They're not taking on any new patients. Sophie said clinics are shutting down, pausing care.

Audio excerpt – Sophie:

“Many people's psychiatrists, many trans kids' psychiatrists drop them as patients. or stopped documenting gender dysphoria completely as part of their care, because they weren't afraid that they would be sued for aiding and abetting transition care for any particular patient.”

CHEYNE:

And she said that this extends to parents as well, being too scared to go to the pharmacy and pick up medication for their children and at the end of the day, she said the impact, particularly, you know, on children and families that don't have the means to work around all of these restrictions, it's been really significant.

DANIEL:

It sounds very scary for the families, for the people who are working around these limitations. What does it look like, is it still possible to have gender affirming care?

CHEYNE:

It is still possible. I specifically asked her what she is telling young people and their patients about how her ability to give them care is being impacted.

Audio excerpt – Sophie:

“I tell them that they should focus on being kids and let me worry about the legal stuff.”

CHEYNE:

But for adults, she has changed tack a little bit. For example, if someone is considering gender affirming surgery ,she's advising people to hold off on making a decision about these surgeries, just in case they lose access to those hormones over the next couple of years.

Another thing that I had heard a lot about was reports of people stockpiling medication. So I asked about whether or not she was giving people advice around that and she told me that actually the stockpile of medication is probably one of her biggest concerns for the safety of her patients.

Audio excerpt – Sophie:

“These medications aren't safe to use without labs and without physician supervision. So trans males can get blood clots in their legs. They can have a stroke if they're on too much testosterone.”

CHEYNE:

She said she's even seen patients this year where she's gotten the blood work back and found that their testosterone levels are putting them at risk of further serious health impacts.

Audio excerpt – Sophie:

“Now, if you were to ask me, What's the risk of, not being able to access testosterone at all, for example, versus being able to access it and having a small risk of having a stroke because you're taking too much, that's a really, really sad question to have to answer.”

DANIEL:

So Sophie's ultimately trying to keep doing her job, even though it's obviously risky to do that. Trump's executive orders threaten criminal charges for doctors. So what did she say to you about how she feels about taking on that kind of legal risk?

CHEYNE:

It's a huge risk and, you know, she's going into it with open eyes. Her clinics have engaged lawyers, she told me that the advice that they've gotten is that there's really no way to know what the consequences of these executive orders are until you're actually sued.

Audio excerpt – Sophie:

“My goal is to continue to provide the care as best I can. My goal is not to violate laws. I am prepared to be sued in my home state and have contingency plans if I lose my licence or if I'm incarcerated, we hope that it doesn't come to that. We're actually looking at moving to Australia should things get really bad. But it's difficult because you work in the US, you end up spending a lot of money to become a doctor. And so the thought of having to start over is intimidating, but these kinds of things make me incredibly angry. And so if I don't do something, then I go nuts inside.”

CHEYNE:

And she really stressed to me that really these decisions go beyond the legal considerations for herself as well - right, like when she thinks about what will happen to her patients, especially her younger patients if medical care isn’t available, she said it’s ultimately a matter of life and death.

Audio excerpt – Cheyne Anderson:

“And can you just spell out and really explain for me what happens to the young people that you can't treat?”

Audio excerpt – Sophie:

“If they have. a sense of hope in their lives that things will get better, or things can get better. And a lot of them end up finding that online these days. Then sometimes they can muddle through, but many of them end up attempting suicide and their lives fall apart and they die. So, we lose people all the time.”

DANIEL:

After the break - the Queensland kids facing healthcare bans.

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DANIEL:

Cheyne, Trump's executive orders are having a chilling effect on trans rights in the United States. We're also now seeing setbacks in other western countries too. But what is the situation in Australia.

CHEYNE:

Basically the same day as Trump's directive back on January 28th, Queensland state government put an immediate halt on all people under the age of 18 receiving puberty blockers and hormone therapies in the public system.

Audio excerpt – Dr. Eloise Brook:

“When the ban came in, it was a real shock…”

CHEYNE:

I spoke to Dr. Eloise Brook about this. She's the CEO of AusPath, which is a professional association for trans health.

Audio excerpt – Dr. Eloise Brook:

“We've been worried for some time that there was going to be an opportunity for some state governments and territories to remove gender-affirming care. Gender- affirming care is quite literally the safest and best way to support young people to get the best outcomes. So when that kind of gets closed down, everyone's shocked, everyone's horrified.”

CHEYNE:

We know that at the time the ban was put in, there were 491 young people on the waitlist for the Queensland gender service. And they really have two options now. They can go into the private system, which can be prohibitively expensive. We're talking, you know, multidisciplinary care with psychiatrists and endocrinologists and medication alone, which could be worth thousands of dollars every couple months, or they can just not get care, which comes with a big mental health risk.

So this had a pretty devastating impact, especially on families who were, you know, just weeks or months away from starting puberty blockers and Eloise actually shared with me a testimony from one of these families.

Audio excerpt – Dr. Eloise Brook:

“Our heart broke for our little person who was due to start blockers in the first week of March.”

CHEYNE:

This is a family who’d already sat on the wait lists and at the very last moment had had support disappear in front of their eyes. And Eloise described their distress at not being able to afford private health care and some of the options the mother was even considering.

Audio excerpt – Dr. Eloise Brook:

“All I could do was cry and have panic attacks about what this could mean for them. I thought at one stage that if I wasn't alive, my husband could use my super to pay for it.”

CHEYNE:

But the thing that really separates the situation in Australia from the situation in the States is how the federal government is responding. Mark Butler, the health minister, he immediately called on Queensland to pause the ban and he commissioned the National Health and Medical Research Centre to do a formal independent, scientifically backed review of the use of puberty blockers for children. And everyone I spoke to had a lot of hope that this review would follow what the science says, that these medications are safe and vital for good mental health outcomes for young people. But this review is going to take a long time. I think 2026 is when we'll expect to hear back from that.

DANIEL:

And in the meantime, how are people in Queensland trying to push back?

CHEYNE:

Well, there is one legal challenge that's just taken its first steps in the court. There is a mother who’s put in an application to the Supreme Court trying to get more information from the Queensland Health Director General about the decision-making that went into this snap ban.

Another initiative underway is called Project 491 which was launched by Dr. Eloise Brook from AusPath, and they came up with this Project which raises funds to bequeath to those families to get private treatment.

To this date they’ve raised over 100 grand and they've only just launched a couple of weeks ago on the 31st of March - transgender day of visibility - and so far they’ve helped support two families.

DANIEL:

I mean that is amazing, but it's also not something that will be able to help the hundreds of families that may actually need support as well.

So what does this say to you Cheyne, that we're in a situation where a state government is making a decision like this, and what is the likely impact for the future of gender-affirming care in Australia?

CHEYNE:

I think it shows that people are learning from what's happening in the States.

And speaking to everyone in the process of making this story I got the sense the lesson is that it's kind of everyone's responsibility to not let the trans and gender diverse community become this political football in Australia. And to not let this ideologically driven politics of the day stand in the way of a significant body of research showing the safety of puberty blockers and hormone therapy.

So the backlash to what’s happening in Queensland especially at the federal government level does make some people cautiously optimistic that maybe there isn’t that appetite for those kinds of politics more broadly in Australia to the same extent that it’s happening in the US and the UK.

And the community support that groups like Project 491 have seen are testament to that as well.

And so while there was a lot of cautious optimism there is also a warning to not get complacent.

Audio excerpt – Dr. Eloise Brook:

“So we really, really want people to keep focusing on how we support our young people. I’m looking forward to that point where Project 419 is no longer necessary but I’m not sure when that might be.”

DANIEL:

Cheyne, thank you so much for your time.

CHEYNE:

Thanks for having me on Daniel.

DANIEL:

If this episode has raised issues for you or if you’re concerned about someone you know, you can call Lifeline on 13 11 14. You can also call QLife on 1800 184 527. Support is also available at: Switchboard, Queerspace, Transcend Australia, Transgender Victoria and Minus18.

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[Theme Music Starts]

DANIEL:

Also in the news,

Most doctors say they won’t move to full bulk billing, despite promises by both major parties.

ABC News surveyed more than 800 GPs and combined their findings with data from the Royal College of General Practitioners.

90 per cent of doctors told the ABC they wouldn’t move to full bulk billing - with many saying the 8.5 billion dollar scheme pledged by Labor and matched dollar for dollar by the coalition shows a lack of understanding for how general practice works.

They warn the policy could incentivise shorter consults and compromise care.

AND

The prime minister says there is no place for violence after a series of incidents at pre-polling booths this week.

Yesterday, a teenager in Anthony Albanese’s electorate was charged over an alleged assault of a man at a polling booth. The man was wearing a MAGA hat.

Prime Minister Albanese stressed the need for respect at polling booths and wished the man a swift recovery.

I’m Daniel James, this is 7am. We’ll be back tomorrow with a full wrap of all the biggest political moments of the week. See you then.

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