GCN global briefs

One for the ages

International | The new “rapid-onset” subtype of gender dysphoria should be recognised in the diagnostic manual DSM, according to a paper by clinical psychologist and researcher Dr Ken Zucker. In the European Journal of Developmental Psychology, he argues there is “emerging evidence” of this new pathway to gender dysphoria, never mind politicised attempts to cancel the 2018 study in which Dr Lisa Littman first described the phenomenon of rapid-onset gender dysphoria (ROGD).

Dr Zucker contends that the age-of-onset of gender dysphoria may point to factors, such as sexual orientation, that help elucidate the causes of this condition, as well as indicating the likely desistance rates for each subtype.

Fluid billings

America | In a settlement with the Trump administration’s Department of Justice, Ohio’s Cleveland Clinic Foundation (CCF) has agreed to commit $2 million to provide healthcare for detransitioners. The American Civil Liberties Union declared itself “deeply saddened” by this “anti-trans settlement”. The CCF also agreed to pay $308,000 to resolve claims—which it disputes—that false billings were used to secure insurance coverage for paediatric medical transition. Last month, Texas Children’s Hospital (TCH) became the first in the US to pledge a detransitioners’ clinic.

Writing in The New York Post, endocrinologist Dr Roy Eappen of the watchdog group Do No Harm said “the heartbreaking plight of today’s ‘detransitioners’ may be among history’s worst examples of deliberate medical neglect.”

“They shouldn’t have to go to Texas or Ohio to get the care they deserve. They should be able to get treatment and find healing at the hospital that hurt them in the first place,” Dr Eappen said.

TCH also agreed to make a $10 million payment to finalise contested allegations of false insurance billings, as part of a settlement reached with the Department of Justice. Whistleblower surgeon Dr Eithan Haim, who in 2023 told journalist Christopher Rufo that TCH was still engaged in gender medicalisation of children despite its promise to stop such procedures, said the $10 million figure represented the second largest healthcare fraud settlement involving an American children’s hospital.

“A question worth asking is how does such a tiny clinic generate $10m in Medicaid fraud claims, especially when those claims exclude private insurance entirely?” Dr Haim said. “The disparity between patient volume and billing volume raises another question: how could so few physicians submit so many allegedly fraudulent claims unless the improper billing practices were the standard practice in the clinic—and how was this not identified [by] the leadership earlier?”

A report from Do No Harm documents the activist promotion of incorrect billing codes in the US. “By misrepresenting the medical procedures they are performing, providers can pass off transgender medicalization as, for example, routine endocrine care unrelated to pediatric medical transition,” the report says.

“These ‘loopholes’ may enable providers to get paid for procedures which otherwise may not be funded. In some cases, such practices may even be outright fraudulent or a means of evading state-level restrictions on child sex change interventions.”

Mount Sinai Health System has joined another Manhattan provider of paediatric gender medicine, NYU Langone Health, as the subject of investigation by the Trump administration, which is seeking patient records. “The government has said it is acting on the behalf of patients and families as it investigates whether health providers and drug companies have illegally promoted off-label use of medications or used fraudulent billing practices to secure insurance coverage for gender-related treatments to minors,” The New York Times reported.

Rhode Island Hospital has also resisted handing over records to the US Department of Justice. A 2023 paper showed 94 per cent of gender patients in the hospital’s adolescent and primary care clinics were given the false diagnosis of “endocrine disorder, unspecified,” a diagnosis supposedly “less stigmatising” than the term “gender identity disorder”. Records showed both diagnoses for 44 per cent of these patients.

Schtum!

Singapore | If the belated media coverage by The Straits Times is any guide, Singapore’s cautious new treatment guidelines for youth gender dysphoria did indeed take effect on May 5 when the Ministry of Health’s alert, with guidelines attached, went out directly to doctors and hospitals.

The news report makes no mention of the fact that the guidelines disappeared from the Ministry’s webpages within days of their upload; there was no reply to questions from GCN. The Times, once known as the “Thunderer of the East”, does cite the Ministry as acknowledging “conflicting schools of thought” on how best to respond to dysphoric youth.

Closed for business

Colombia | The elite Valle del Lili Foundation hospital in the Colombian city of Cali has closed its paediatric gender clinic, according to a Washington Stand interview with neuropsychologist and pro-family congressional adviser Liliana Castañeda, who has campaigned for a legislative ban on the gender medicalisation of minors. She said the closure followed “intense public pressure” generated by a documentary “Colombia: Factory of Trans Children”. The documentary featured a detransitioner, Laura, who underwent hormonal treatment as a minor, and has launched a legal claim against the hospital.

In response to news of her claim in November 2025, the hospital defended itself as “an academic and scientific institution committed to training, research and high-quality care, guided by the principles of medical ethics and international standards”. GCN sought comment from the hospital about the status of its gender clinic. Laura’s lawyers, it is understood, have confirmed that gender medicalisation for minors is no longer offered by the hospital.

In 2018, the clinic’s director, Dr Mario Angulo Mosquera, cited the “compelling results” of foundational Dutch research on medical treatment of youth gender dysphoria. “[I]n all aspects assessed there is a very significant improvement compared to the untreated population, and the most striking finding is the suicide rate, which stands at 40 per cent in the untreated population, whereas in treated patients this rate drops to zero per cent,” he said. These dramatic claims are not supported by the scientific literature.

We have to talk

International | “It is no longer acceptable for academic events to be obstructed, or for professionals to be discredited or silenced, not on the basis of scientific argument, but under ideological or activist pressure. Science advances through rigorous examination of hypotheses, critical evaluation of practices, and openness to debate and disagreement.” That is from a communiqué issued by the French watchdog group the Little Mermaid, the Society for Evidence-based Gender Medicine, and the Clinical Advisory Network on Sex and Gender.

“We emphasize that gender medicine for adolescents raises major clinical, ethical, and scientific questions that are widely debated internationally. In this context, preventing discussion, restricting dialogue, or delegitimizing certain viewpoints ultimately undermines the quality of medical decision-making and, ultimately, the protection of young patients.”

Rogue or routine?

United Kingdom | An independent investigation of WellBN clinic, a Brighton primary care practice, has found that 78 children and adolescents—53 with “possible neurodevelopmental issues”—were potentially harmed by prescriptions of puberty blockers or cross-sex hormones. The patient safety report, commissioned by the National Health Service, said: “Puberty blockers and gender-enhancing medications were prescribed without a comprehensive bio-psychosocial assessment (in 22 cases without even face-to-face appointments having taken place), without essential baseline and ongoing investigations and in 75 cases without referrals to paediatric endocrinologists.”

Meanwhile, the British Medical Association (BMA), a doctors’ trade union widely cited for its criticism of the 2024 Cass Report, has eaten its words. The BMA council had dismissed Dr Cass’s findings as “unsubstantiated”. Now, after their own review, the BMA declared Dr Cass’s recommendations to be robust, although it still opposes the UK government’s puberty blocker ban.

London is about to host a two-day conference on “Rethinking Youth Gender Medicine”. The July 5-6 meeting is a collaboration between the Society for Evidence-based Gender Medicine and the Clinical Advisory Network on Sex and Gender.

Caution discriminates

France | The Lyon District Court has ordered health insurance funds to pay damages to four trans-identifying females, whose “gender-affirming” mastectomies the funds had declined to cover, Le Figaro reports.

“The health insurance funds had refused to reimburse the costs of mastectomy operations—which involve the removal of the mammary glands—on the grounds that the criteria for coverage under the long-term illness scheme had not been met, particularly in the case of one of the applicants, who was a minor at the time of the events,” the newspaper said. The funds had also concluded that trans medical interventions failed to meet the criteria for coverage as “an exceptional procedure”.

The judges in Lyon ruled that the requirement for medical documents violated these patients’ privacy. The court also found it discriminatory for the fund to insist on the agreement of an endocrinologist, surgeon and psychiatrist before a trans mastectomy, as well as a two-year psychiatric follow-up after the procedure. Under European human rights law, the funds could not make trans mastectomy more difficult to access than a mastectomy to treat breast cancer.

Systematically misleading

America | A 2025 study from the state of Utah has come under scrutiny during the June 3 US Senate committee hearing on paediatric gender medicine. The Utah study, which found hormonal treatment to be safe and effective, has been cited internationally to counter the more cautious recommendations of the UK Cass Review and the Gender Dysphoria Report from the US Department of Health and Human Services.

The Utah study has been miscast as a systematic review; were it indeed a systematic review, its “safe and effective” conclusion would be startling. That conclusion is at odds with multiple systematic reviews, independently commissioned in countries such as the UK, Sweden and Finland, all finding a lack of good evidence for puberty blockers and cross-sex hormones.

At the Senate committee hearing, the expert witness Dr Kurt Miceli of Do No Harm was sharply critical of the Utah study. He said it was “anything but” a gold-standard systematic review. The Utah researchers had not undertaken a synthesis of the evidence.

“When you do a systematic review, one of the key parts of it is to synthesise the evidence to look at not just the risk of bias, but the variation that’s within studies, to look at studies based on their study size, to analyse them fully,” Dr Miceli said. “None of that is done in the Utah report whatsoever.” He said 60 per cent of the clinical studies in the field had not been analysed, making the report “a complete data dump”.

Nor was there an assessment of the risk of bias in clinical practice guidelines. Instead, Dr Miceli said, the Utah study authors had accepted “as gospel” the guidelines from the World Professional Association for Transgender Health and the Endocrine Society. More here from Dr Miceli’s testimony.

Commentator Leor Sapir, writing for City Journal, noted a striking omission during the June 3 Senate committee proceedings. LGBTQ lobbyist Shannon Minter had not invoked the authority of the World Professional Association for Transgender Health (WPATH). Nor did any committee members sympathetic to “gender-affirming care” make reference to those supposed experts. Sapir said the likely reason was the string of scandals and damaging leaks involving WPATH. Meanwhile, Reduxx magazone reports that WPATH has disabled a feature allowing a search of health providers affiliated with the organisation.

The methodology of the Utah study has been checked and found wanting by the Society for Evidence-based Gender Medicine (SEGM). In March this year, unpersuaded by the Utah study, lawmakers in that state opted for caution and enacted a permanent ban on hormonal treatment of gender-distressed minors.

Less than systematic: Sapir discusses evidence-based medicine with SEGM’s Zhenya Abbruzzese

Pride in PR

Austria | The Transgender Centre Innsbruck has enjoyed uncritical media coverage as it pitches a Pride Month story in which judicious gender clinicians declare an “Access to care problem in Austria”, according to Faika El-Nagashi, a former Green politician and founder of the Athena Forum. With 800-900 patients, about a third of them under age 18, the Innsbruck clinic’s claims—that puberty blockers are reversible, hormones reduce depression and suicide, and treatment regret is only 1-3 per cent—were not challenged in reporting by the daily tabloid Heute nor by the public broadcaster ORF.

In Heute, parents were advised to be open and supportive when a child “asks whether they are living in the wrong body”. This media promotion brought a sharp rebuke from Daniela Karall, President of the Austrian Society for Paediatrics and Adolescent Medicine. Speaking to a Catholic-affiliated bioethics institute IMABE, Dr Karall said open debate had to include the risks and shortcomings of potentially lifelong medicalisation.

The author of the IMABE article wrote: “The term ‘sex reassignment’ inadequately describes the reality, emphasises Karall. Biologically, the sex remains the same; healthy organs are removed, and the surgically created equivalents—neovagina or neophallus—are prostheses that can never functionally match the original, not even in terms of sexual sensation.”

Judicial activism

New Zealand | The courts must resist the ideological capture seen in society’s other institutions and respect decisions by democratically elected ministers, according to Auckland barrister Deborah Chambers KC. The context for her opinion article was the judicial review launched by a lobby group, the Professional Association for Transgender Health Aotearoa Incorporated, against the November 2025 decision of NZ Health Minister Simeon Brown to ban new prescriptions of puberty blockers for gender-distressed minors. That ban is now on hold.

Writing in The New Zealand Herald, Ms Chambers said Mr Brown’s decision, which followed an evaluation of the evidence, “was a classic exercise of executive power delegated by Parliament to the Minister”. She acknowledged judicial review as a vital safeguard, but said it “has become an increasingly easy vehicle for well-resourced pressure groups to challenge and stall democratically made political decisions on largely procedural grounds.”

“While due process matters, when unelected judges intervene on technicalities in highly contested policy areas, a decision taken by elected politicians, with access to policy units, scientific advisers, cabinet processes and a public mandate, can be placed in indefinite limbo,” she said. “The risk is that persistent pressure groups may effectively capture the judicial review process.” The NZ Court of Appeal is scheduled to hear argument in the puberty blocker case next month.

Gender Gilead

Iceland | Eldur Smári Kristinsson, international liaison for LGB Alliance Iceland, calls his country “Gender Gilead”, a reference to its wholesale adoption of gender ideology. In an interview with journalist Julie Bindel, Kristinsson says the Gender Autonomy Act “led to an exponential surge in numbers of ‘trans children’, most of whom were young girls from upper-class backgrounds, many of them under the ‘neurodivergence’ umbrella”.

Bindel says: “The statistics bear him out; by 2025, 0.5 per cent of Icelandic children had changed their sex markers with the National Registry—approximately 13 times the per-capita rate of neighbouring Denmark.” Kristinsson, a gay man, has been targeted for expressing concerns about the medicalisation of children.

Into the fray

Australia | Clive Hamilton, who founded progressive think tank the Australia Institute and serves as professor of public ethics at Charles Sturt University, has joined the gender medicine debate as a principled sceptic. Writing independently on his Substack, Professor Hamilton surveys the Australian scene, noting the mistreatment of dissenting psychiatrists Dr Jillian Spencer and Dr Andrew Amos; the overweening influence of trans rights lobby ACON; the “highly partisan” role of the Australian Human Rights Commission as an “enforcer of gender ideology”; and the “craven” conduct of universities.

Meanwhile, in Queensland, the only Australian state to restrict hormonal treatment of gender-distressed minors, a tribunal has allowed a discrimination complaint against the ban to proceed as a quasi-class action. This originated with a patient at the Queensland Children’s Gender Service who was yet to receive puberty blockers. In June 2024, the clinic had 491 patients on its waiting list.

In Adelaide, the Coalition for Advancing Scientific Care will hold its second Gender Healthcare Summit on October 9-10. Speakers include psychotherapist Stella O’Malley, who founded Genspect.

The first step in reforming the Australian Health Practitioner Regulation Agency (Ahpra) is to make sure that its capture by the gender-identity worldview becomes widely known and understood. For this reason, we should welcome the recent series of articles in The Australian newspaper shedding light on this dark corner of trans activism where the regulator allows trans activists to misuse its complaints process. There must be an end to the persecution of health professionals who in good faith challenge the gender-affirming model of care for young people.

The trans movement isn’t about supporting individuals who, for a range of reasons, believe they would be happier living as the other gender. Transsexuals of previous times were mainly men who wanted to live as women. They didn’t believe they changed sex, even though they underwent what was called sex-reassignment surgery. They simply wanted to blend into society and live their lives in peaceful anonymity. These are the trans people I worked with, and I had no problem with helping them live their best life as transgender women.

The modern version of trans activism is a very different kettle of fish. It has a broader agenda than the cause of individuals who are unhappy with their lot in life as men or women. There is an insidious core at the heart of modern trans activism. Queer theory, which has the stated aim of demolishing all societal norms for sexuality and gender, is now the foundation of trans aims and strategies.

No boundaries: UK therapist James Esses sees ruination in queer theory

Who benefits?

In plain language, queer theory claims that all forms of gender and sexual expression are equally valid, and gender identity is whatever the individual wants that to be. The question is, who benefits from this? Certainly, there are female and male adults who, like those of earlier times, just want to live their lives quietly in their preferred gender role. However, the push for legalising self-ID gender has opened the door for adults with other motivations.

Now, it is essentially a male-rights movement, preferencing the wants and desires of males who are exhibitionists, voyeurs, transvestites, indeed any male with a paraphilia no matter how bizarre, whether it is claiming to be a lesbian and demanding access to lesbian groups, being aroused by acting like a baby including wearing nappies and being bottle-fed (infantilism), or wearing prosthetic breasts and female clothing in public. The list is endless.

Children and women are collateral damage in this drive for control. The sudden explosion in “trans kids” gives legitimacy to—and distraction from—the adult wants and behaviours. Any woman who challenges the loss of long-held sex-based rights, such as single-sex changing rooms and sports, is accused and punished as a transphobic bigot.

Under this ideology, sex is not acknowledged as binary and immutable. Its role as the reproductive strategy of our species, where males produce small and mobile gametes (sperm) and females produce large and immobile gametes (eggs), is rejected as “bio-essentialism” in a way that isn’t ever explained. And now we are presented with an infinite spectrum of sexes with no defined purpose other than self-satisfaction and pleasure. It is here that so many health professionals have abandoned their science-based professionalism and, in my view, their moral compass.

This deconstruction of sex has created a new world removed from any tethers to biological reality and spawned an ever-growing new language. This jargon paradoxically attempts to remove any hint of human biology while at the same time enforcing an “inclusive language” based solely on body parts and functions. Thus, a woman is not an adult female human but “a person with a cervix”, or one who menstruates, and so on. This raises some interesting questions: can a person with a cervix produce semen? Can a person with a penis have endometriosis or ejaculate ova? Or are there two distinct sets of biological characteristics that don’t overlap? Wouldn’t it be helpful if there were a noun to identify the individuals who belong to one of these biological categories, and not the other?

Instead, gender ideology requires health professionals to believe not only that there are more than two sexes but also that it is possible to change sex. Disorders of sexual development (DSD) are framed as normal variations. At the heart of these claims lies the pretence that there is no reliable way to distinguish the sex of an individual, such that a man who claims to be a woman is a woman.

Informers

Health professionals who are fierce advocates of this ideology and its offspring, “gender-affirming care”, are ever ready to take what they seem to believe is the high moral ground and “dob” on any colleague who dares to express doubt about this out-of-touch-with-reality rewriting of human biology.

For me, it is beyond bizarre that any health professional would deny biological reality. Despite their rigorous training in evidence-based practice, these “gender-affirming” health professionals rely on a tortured pathway of circular reasoning to believe that a man can be a woman (“Trans Women are Women”), and a woman can be a man (TMAM).

The argument goes like this: many of the human characteristics that are influenced but not determined by sex overlap, so there is no absolute way of distinguishing a woman from a man. Therefore, any characteristics that are determined by sex can equally belong to either sex, so a woman can have a penis, a man can have a womb, which means that a person with female sex characteristics can be a male, and a person born with male sex characteristics can be a female.

In an attempt to make this make sense, advocates of gender ideology refer to the existence of individuals with a DSD, which used to go by the misnomer “intersex”. And so, we are told that because it is difficult to identify the sex of some people, it is problematic to identify the sex of any individual. Surely, all health professionals should know that a disorder is a disruption in normal form and function, not a normal variation, but we live in interesting times.

If it were just a fringe element of society pushing these claims, it would be easy to dismiss them as uneducated conspiracy theorists, but almost every health professional association worldwide endorses these beliefs and requires members to adapt their practices accordingly.

Irregular rule

Ahpra is a cross-jurisdictional statutory authority responsible for the regulation of 16 health professions in Australia. While responsibility for regulation sits with 15 independent National Boards (such as the Nursing and Midwifery Board of Australia), Ahpra provides day-to-day services such as managing registration of—and notifications (complaints) against—practitioners on behalf of the National Boards.

Ahpra acknowledges that it works with Pride in Diversity, an arm of the transgender lobby group ACON, to participate in the Australian Workplace Equality Index (AWEI). Ahpra quite openly demonstrates its commitment to LGBTQIA+ inclusion, with the stated aim to embed inclusive practices into their culture, policies, and the wider National Scheme. The problem is made more serious by the recent refusal of the National Health Practitioner Ombudsman—supposed to be the watchdog over Ahpra—to investigate a credible complaint about the regulator’s exposure to ACON’s influence.

Ahpra told The Australian it “rejected any suggestion that engaging with community organisations [such as ACON] creates bias in our regulatory processes”.

The opportunity arose for me to test this assertion by comparing the result of two complaints to Ahpra.

Case 1

A colleague attended a workshop on working with trans and gender-diverse clients. He went in good faith, wanting to gain a better understanding of what the controversy was all about. As is usual practice, feedback forms were issued to all the participants. My colleague answered honestly and outlined his concerns about gender-affirming care.

A few weeks later he was stunned to receive a notification that a complaint had been made to Ahpra alleging that he had “expressed professional views not consistent with evidence-based practice” and “behaved in a disrespectful manner and used disrespectful language” on the feedback form.

After several stressful months, during which time he spent hours consulting with his indemnity lawyer and producing a detailed response, the complaint was disallowed.

Ahpra said: “On thorough review of the material and information, we are satisfied that the practitioner has met the requirements of the guideline and appears to be advocating for an open-minded approach to clients and their individual needs.”

This might seem like a win for my tired and distressed colleague, but as has become obvious over recent years, complaints against practitioners who are critics of gender-affirming care aren’t necessarily meant to succeed but to harass and to warn others to stay silent.

In this case, the practitioner was asked for feedback, which was seen only by the workshop organisers. The complaint generated was ultimately found to have no substance, yet my colleague was put under intense pressure to justify his comments.

Case 2

I am deliberately obscuring any details that might identify the medical practitioner in Case 2. However, the views expressed by this person are held by many Australian health professionals, so it is an object lesson to demonstrate a broader issue.

Some months ago, I came across an article in an open-access health journal that focussed on the specific needs of mothers and their children in the event of a natural disaster. A medical practitioner in the Australian state of New South Wales (NSW) wrote a letter to the editor, complaining that relying on the definition of women as “adult female people”, and the use of words such as “mother” and “breastfeeding”, was “trans-exclusionary rhetoric”.

Apparently trans people are harmed if sex-based terms are used instead of the politically correct terms such as “birthing parent”, “cervix haver” and “chest-feeding”.

What concerned me about this letter was that it demonstrated the medical practitioner’s strong commitment to the tenets of gender ideology, in particular that there is no reliable way of identifying the sex of any individual, that biology does not define a person’s gender, and that a person born with male sex characteristics is a woman if he says he is. This sense of entitlement is supported by the legal right in all Australian states to change the sex marker on a birth certificate, in some states as many times as the person wants.

This raises what should, in my view, be very troubling issues. It seems clear to me that a medical practitioner who:

• claims to be unable to identify the sex of an individual puts some patients, but especially an unconscious patient, at risk if the intervention indicated by the presentation shows the need for a sex-based treatment;

• denies the biological definition of a woman and insists that all women change their internal sense of being a woman to include males who self-identify as a woman, thereby fitting the criteria for an unethical “conversion practice”.

In reality, there are distinct, sex-determined characteristics that clearly identify the sex of an individual, notwithstanding individuals born with a DSD.

These are not trivial issues. If a trans-advocate doctor genuinely cannot identify the sex of a patient, they should lose their registration. If they can distinguish the two sexes, they must acknowledge that gender ideology is based on nonsense premises.

If these practitioners insist that the biological definition of a woman is wrong, do they support sanctions against women who insist that a man can never be a woman, as in the Australian court case of Tickle vs Giggle and the fight by the Lesbian Action Group to exclude men who identify as a lesbian from their public events? Do gender-affirming practitioners support female athletes being threatened with expulsion if they protest about competing against males who identify as women? And what about nurses who don’t want to undress in the presence of a transwoman?

All these scenarios meet the criteria for an unlawful “conversion practice” because they aim to force women to change their deeply held sense of being a woman as an adult human female, such that they must include males who claim to be women. And sanctions are imposed if women don’t fall into line.

Anti-conversion law in NSW

• “(1) In this Act, a conversion practice means a practice, treatment or sustained effort that is—

• “(a) directed to an individual on the basis of the individual’s sexual orientation or gender identity, and

• “(b) directed to changing or suppressing the individual’s sexual orientation or gender identity [Emphasis added].”

Given the serious nature of my concerns about the gender-affirming doctor’s letter, I submitted a complaint to Ahpra. Complaints against medical practitioners in NSW may be lodged with Ahpra but are dealt with by the state Health Care Complaints Commission (HCCC) or the Medical Council of NSW.

Section 144 of the Health Practitioner Regulation National Law (NSW) outlines the specific grounds for making a complaint against a registered health practitioner. These grounds include criminal convictions, unprofessional conduct, lack of competence, impairment, or failing to be a suitable person to hold registration.

In my complaint, I argued that the medical practitioner lacked competence in the most basic requirement of the medical profession, that is, to be able to identify the sex of an individual by visual examination. I also argued that, by supporting a conversion practice against women, the medical practitioner endorsed an act which is criminal in NSW.

No response needed

I wasn’t so naïve to expect that my complaint, while made in good faith, would result in any disciplinary action against the health professional, but I did hope that there would be an acknowledgement that a woman is an adult female human, and that women have the right to rely on this definition as their deeply-held sense of being a woman.

And I did expect that the doctor would be required to explain and justify their beliefs, as has been the case for every health professional who has had a complaint to Ahpra about their criticism of the gender-affirming treatment model.

Instead, this was the response from the NSW HCCC—

“We did not require a response from Dr [X] as the information available to the Commission was sufficient to adequately assess the complaint. As Dr [X] is a registered medical practitioner, we shared the information obtained during the assessment process with the Medical Council of NSW, and consulted with them in order to reach an informed decision in relation to your complaint [Emphasis added].

“Outcome of Assessment

“After carefully considering the available information, the assessment process has concluded with the following findings:

“Medical practitioners are entitled to express their professional opinions within the scope of their expertise, and such opinions are not subject to review by the Commission [Emphasis added.]

“Any concerns regarding their published contributions are assessed against codes of conduct, not individual disagreement.”

Ahpra, please explain

Compare Case 1 to Case 2. One health professional who provides the requested feedback after a workshop is put through the wringer. Another, who promotes gender ideology in an open-access journal, is not even required to respond to a complaint.

Was the doctor even informed of my complaint? Why was this person given a free pass, while my colleague who aired his views in private feedback was put under enormous pressure and was significantly distressed by the whole process?

Was Dr Michelle Telfer, who led Australian adoption of the gender-affirming treatment model for minors, required to submit an extensive response to the complaint against her?

If the NSW medical practitioner I have discussed in Case 2 is entitled to their opinion, why did Ahpra not apply the same courtesy and respect to Dr Andrew Amos, a psychiatrist ordered by the regulator to cease his social media critique of the gender-affirming model? Another critic of that model, child and adolescent psychiatrist Dr Jillian Spencer, has been reported to Ahpra for a social media post sharing The Australian’s coverage of the regulator’s silencing of Dr Amos. Will Ahpra acknowledge Dr Spencer’s right to express her professional opinion?

If the concerns of practitioners such as Dr Spencer and Dr Amos had been acknowledged and properly considered from the outset, it is unlikely the situation would have escalated to the disturbing debacle that now exists.

Ahpra has access to the information I have provided here. All they have to do is ask me for details to identify the two cases. It is time for the board of Ahpra to acknowledge that they are compromised by their involvement with the Pride in Diversity program.

Dr Sandra Pertot retired not long ago after 50 years of practice as a clinical psychologist specialising in human sexuality, including sexual dysfunction, sexual orientation and gender diversity.

Signs of capture

Officials in Australia have been dismissing complaints about gender-ideology bias while sending emails with “she/her” pronouns and a hyperlink to a radical trans website run by the lobby group ACON.

The Brisbane father of a trans-identified child who has mental health problems and autism wrote to the National Health Practitioner Ombudsman (NHPO) to allege bias and harm in a regulator’s decision silencing psychiatrist Dr Andrew Amos, who is a prominent critic of the “gender-affirming” treatment model.

In March, the Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board imposed “immediate action” restrictions on Dr Amos’s registration, including a ban on his social media critiques of puberty blockers and hormones for minors.

In his complaint to the Ombudsman, the Brisbane father criticised not only AHPRA’s extraordinary intervention against Dr Amos, but a system-wide failure to enable proper oversight of paediatric gender medicine.

“I believe gender-affirming care in Australia has not been given the robust scrutiny that it deserves, or that other similar treatments receive within the medical and health professions,” the father wrote.

“The perception I get is that there is some sort of bias that has allowed, and continues to allow, gender treatments to continue without debate—and any concerns about these treatments are being suppressed by the very body [AHPRA] that is meant to protect the public.”

No investigation

On March 23, an NHPO official emailed the father to say she had decided not to investigate his complaint.

“While you have expressed broader concerns about impartiality and potential systemic issues, the information provided does not demonstrate a system-wide problem that would meet the threshold for an own-motion investigation by this office,” the Ombudsman’s official wrote.

Her email signature block included—

“She/her” pronouns, which signal the belief that humans may be unable to distinguish between male and female without knowing these pronouns;

A statement that the “NHPO celebrates, values and includes people of all backgrounds, genders, sexualities, cultures, bodies and abilities”;

A link to ACON’s TransHub website which, apart from encouraging pronoun use, promotes puberty blockers and cross-sex hormones without acknowledging the weak evidence base and serious risks to health.

Gutenberg dysphoria: Psychiatry professor Kris Kaliebe on old and new collisions of technology and society

Unreliable guide

Contrary to the law, ACON’s TransHub used to advise 16- and 17-year-olds that they could start hormones via the fast-track “informed consent” model “overriding any parental objections or misgivings”, according to evidence in the 2020 Family Court case re Imogen.

“This judgment confirms the existing law is that any treating medical practitioner seeing an adolescent under the age of 18 is not at liberty to initiate stage 1, 2 or 3 treatment [puberty blockers, cross-sex hormones or trans surgery] without first ascertaining whether or not a child’s parents or legal guardians consent to the proposed treatment,” Justice Garry Watts said in his re Imogen ruling.

“If there is a dispute about consent or treatment, a doctor should not administer stage 1, 2 or 3 treatment without court authorisation.”

At the time, ACON indicated it was correcting the inaccurate legal advice in the light of the re Imogen case, but today the TransHub webpage devoted to “Under 18s’ rights” still encourages minors to bypass parents.

“It makes sense that you may want to see your doctor about medical affirmation without your carers, or guardians knowing,” TransHub says, implying that minors should shop around to find a doctor who will protect their “medical privacy”.

TransHub’s brochure “How do I start hormones”, which targets under-18s as well as adults, claims: “Hormonal affirmation is relatively simple, can create a lot of change from a small amount of input, and our communities have been doing it for a long time, so we have a good understanding that it’s effective and safe”.

In fact, the evidence base for hormonal treatment of minors with gender dysphoria is very weak and uncertain, according to multiple independently commissioned systematic reviews, which are the “gold standard” for assessing the quality of evidence said to justify a medical intervention.

Teen talk

Immediately after its claim that cross-sex hormones are “effective and safe”, the TransHub brochure says that general practitioners (GPs) in primary care “are able to initiate and continue gender-affirming hormonal therapy for people [of] age 16 and above”.

This misstatement of the law is qualified three pages later with a reference to the need for parental consent.

But the brochure’s “16 and above” claim still misrepresents the legal position, which requires a formal diagnosis of gender dysphoria and a multi-disciplinary assessment before anyone under 18 can be prescribed hormones, according to emeritus professor of law Patrick Parkinson, who is an expert on the gender dysphoria cases decided by the Family Court.

The TransHub brochure makes a single, vague reference to “dysphoria” and frames the involvement of medical specialists as a personal choice.

ACON did not answer GCN’s questions about the accuracy of TransHub’s legal advice for minors and its unsupported claim that hormones are effective and safe.

In a statement, an ACON spokesman said TransHub was “a trusted online resource” offering “general information and resources” on health, while users of the website were “always encouraged to seek further professional advice pertaining to their circumstances”.

Dropping ACON

At some point since early May this year,1 the National Health Practitioner Ombudsman (NHPO) asked its staff to cease using the TransHub/ACON weblink in their email signature blocks. Now, complainants curious about the Ombudsman’s pronoun use are directed to the Queensland Human Rights Commission.

The NHPO did not answer GCN’s question whether the TransHub weblink had been abandoned because the Ombudsman recognised it created an apprehension of bias in the case of complaints in the domain of gender medicine.

However, after my June 1 news report in The Australian, the NHPO updated its website, which now says the pronoun weblink was changed “after hearing some concerns about how we describe why we use pronouns”.

“[W]e do not consider that the use of pronouns, or providing links to information about the use of pronouns, conflicts with our ability to handle complaints independently and impartially,” the Ombudsman’s webpage says.

The pronoun rationale of the Queensland Human Rights Commission also reflects gender ideology.

“Pronouns are connected to a person’s gender identity, which is often an invisible attribute—something you can’t always determine by appearance,” the commission says.

It offers the neo-pronouns “xe/xem/xyr”, “ze/hir/hirs”, and “ey/em/eir”. And the commission implies that “wrong” pronoun use may cause “harm”.

Who guards the guards?

Last week, the NHPO dismissed a prominent psychiatrist’s complaint about the gender-ideology capture of the Australian Health Practitioner Regulation Agency (AHPRA). The Ombudsman, which is the watchdog over AHPRA, shut down the complaint without disclosing its own link to ACON.

Professor Philip Morris, president of the National Association of Practising Psychiatrists, had argued that AHPRA’s association with ACON called into question the regulator’s impartiality in the fierce controversy over paediatric gender medicine.

On May 27, Professor Morris was sent a four-page letter explaining the NHPO’s decision not to investigate. The letter made no mention of the fact that, like AHPRA, the Ombudsman’s office also has a connection to ACON’s fee-for-service Australian Workplace Equality Index (AWEI).

The Ombudsman’s “Work with us” recruitment webpage boasts that Victoria’s Department of Health—which employs the staff of the independent Ombudsman’s office—“is recognised as a bronze [now silver] employer for lesbian, gay, bisexual, transgender and intersex (LGBTI) workplace inclusion as part of Pride in Diversity’s Australian Workplace Equality Index”.

Under the AWEI, employers pay fees to ACON’s subsidiary, Pride in Diversity, and enact pro-trans workplace policy, such as “all-gender” bathrooms and annual leave for gender-affirming treatment.

Employers compete for platinum, gold, silver and bronze ratings on the AWEI, and then promote themselves as “inclusive” winners for “LGBTQ+ people”. In this way, employers such as Victoria’s Department of Health pay to implement a lobby’s wish list of policies.

The Ombudsman cites its independence from the Department, but does not dispute its promotion of ACON’s AWEI on its own website which, together with the ACON-linking emails, has created an apprehension of bias in the minds of complainants with concerns about gender medicine.

Last Friday, at the ICC Grand Ballroom in Sydney, ACON’s Pride in Diversity celebrated a sold-out event launching the 2026 Australian LGBTQ+ Inclusion Awards, with a 10-seat table for AWEI members priced at $4,399.

‘Safe regulator’

“I acknowledge your concern about AHPRA’s association with ACON,” an Ombudsman official wrote last week in reply to Professor Morris’s complaint.

“However, I am not satisfied that there is currently sufficient evidence that this association would undermine confidence in AHPRA and the [Medical] Board’s role of impartially regulating medical practitioners,” said the official, with “she/her/hers” pronouns in her signature block.

“AHPRA and National Boards [such as the Medical Board] are committed to being a safe regulator for LGBTIQA+ health practitioners along with contributing to health equity and access to safe healthcare for LGBTIQA+ people,” she said.

ACON not only promotes gender ideology and risky medicalisation through TransHub but also offers cross-sex hormone treatment to minors at its Kaleido Health Centre in Sydney.

‘Not transparent’

Professor Morris told GCN he was “very concerned” to learn that the Ombudsman had a link to ACON and had not been “transparent” about it.

“So, that raises with me the question of whether [at the Ombudsman’s office] they have a potential conflict of interest, in the same way that I’m concerned about the potential bias of AHPRA and the Medical Board,” he said.

“We would want anybody who goes before the Medical Board, or who makes a complaint to the Ombudsman, to feel confident that they will be treated fairly,” he said.

Professor Morris’s National Association of Practising Psychiatrists advises a cautious, psychology-first treatment approach to youth gender dysphoria, rather than the medicalised immediate-affirmation model.

In a statement to GCN, the Ombudsman said it did not comment on individual complaints but stressed that it took “allegations of bias or conflicts of interest in decision-making seriously”.

The Ombudsman said it was “not a member of, or otherwise affiliated with, ACON or its Pride [in] Diversity AWEI program”, despite that program being promoted on its own recruitment webpage as a benefit of working for the Ombudsman’s office.

Under the heading “We are courageous”, the Ombudsman’s service charter states: “We will not compromise our independence or impartiality. We will not let challenging subject matter prevent us from listening to and considering all perspectives.”

On a webpage devoted to “Our values”, the NHPO says: “Our commitment to respect was recently demonstrated when we sought to ensure everyone who visited our new office space felt welcome.”

“We now proudly display the rainbow pride flag representing the lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) community, along with the Australian and Aboriginal and Torres Strait Islander flags.”

The Ombudsman told GCN that it encouraged staff to display pronouns in their emails because this “helps avoid the misgendering of our staff”; “fosters an inclusive, safe and supportive workplace”; and signals “that we will respect an individual’s pronouns”.

Asked whether pronoun use showed adherence to gender identity ideology, the NHPO said this practice “does not influence, compromise or otherwise impact our ability to manage complaints in accordance with our office’s policies and our values of being fair and independent”.

Dissent and debate

In March, AHPRA and the Medical Board ordered psychiatrist Dr Andrew Amos to cease his social media critiques of gender-affirming treatment for minors. The Australian newspaper has cited documents reportedly showing AHPRA to be “hopelessly compromised” by its ACON affiliation.

In a 750-word joint statement, AHPRA and the Medical Board claimed The Australian’s coverage had “the potential to undermine trust in the role we as regulators play”.

The statement, which made no mention of AHPRA’s links to ACON, said the right to free speech was “constrained if a practitioner comments, or supports comments, that can cause harm to groups or individuals. Typically, the harm pertains to racism and discrimination.”

AHPRA is investigating another psychiatrist, Dr Jillian Spencer, who has spoken out against puberty blockers. It is the Ombudsman’s office that would hear any complaints against AHPRA by these medical practitioners.

Not-so-free speech

In his April 29 complaint to the National Health Practitioner Ombudsman (NHPO), Professor Morris also raised concerns that AHPRA “had imposed limitations on the freedom of speech and clinical practice of a well-known psychiatrist [Dr Amos] for no other stated reason than that he had engaged in public communications about the prescription of puberty blockers and cross-sex hormones to minors of which the decision-makers disapproved”.

“The complaints process under AHPRA has been weaponised against other health professionals in a similar way.”

The Ombudsman’s official, who said she had “carefully assessed” Professor Morris’s complaint before deciding not to investigate, said she was “not satisfied that there is evidence that the [Medical] Board is limiting practitioners expressing professional and respectful views in relation to this issue”.

She claimed the Board took action over social media posts only “when it believes that a practitioner has stepped beyond engaging in fair and reasonable public debate and using or endorsing harmful language”. Trans activists frame criticism of gender medicine as harmful because it makes them “feel unsafe”.

The NHPO official said she had “decided not to investigate [the Morris] complaint having regard to all the circumstances”. If a complaint is not finalised early after an assessment, the investigation stage can take 6-12 months.

The Ombudsman’s service charter claims it “champions fairness by taking every complaint seriously and shining a light on systemic issues to effect positive change”.

Professor Morris emphasised in his complaint that the treatment of gender-distressed minors was an “area of clinical practice [that] remains the subject of active, good-faith professional debate”.

“Many clinicians support a more cautious, psychosocially focused approach. Notably, more restrictive or cautious policies have been adopted by authorities in the United Kingdom, parts of Scandinavia, several United States jurisdictions, and by governments in Queensland and the Northern Territory.

“In this context, practitioners who publicly advocate for a cautious approach, and who are subsequently referred to AHPRA or the Medical Board for investigation, may reasonably question whether their views and conduct will be assessed with full impartiality while the regulator maintains a formal relationship with an organisation [namely, ACON] that actively promotes the opposite clinical position.”

Guidance vacuum

In her May 27 letter to Professor Morris, the Ombudsman’s official argued that ACON’s involvement with AHPRA and the Medical Board would not undermine confidence in the regulator “because the Board has not published specific guidance about gender-affirming care”.

She noted that the National Health and Medical Research Council was developing new national treatment guidelines for “trans and gender-diverse children and adolescents”, a project to be completed by 2028.

However, ACON and other trans rights lobbies have successfully campaigned for punitive laws in Australian jurisdictions prohibiting so-called “LGBTQ conversion practices”.

The effect of these bans is to discourage any non-invasive therapeutic alternatives to the gender-affirming model, with the result that young people are denied help with open exploration of the causes of their distress and risk becoming lifelong patients on hormone drugs and their side effects.

ACON’s TransHub website claims it is an unethical “conversion practice” for practitioners to use the cautious approach of “watchful waiting” rather than immediately affirming a child’s self-declared gender identity.

Skin in the game

Although ACON says Sydney’s Kaleido Health gender clinic is a separate entity, the new clinic’s interim chief executive officer Michael Woodhouse is also ACON’s CEO. A 2024 media statement by Kaleido said the clinic would “be established by ACON”, with $4.2 million in taxpayer funding.

The clinic, with most of its budget paid for by the centre-left Labor government in the state of New South Wales, “provides no information on the website about parental consent requirements, minor-specific assessment protocols or age-differentiated risks”, The Australian reported on May 29.

A Kaleido website audit, run by AWW executive director Catherine Anderson-Karena of the advocacy group Active Watchful Waiting Inc, suggests the clinic may have breached Australian Consumer Law and the Health Practitioner Regulation National Law by prominently advertising gender medicine without disclosing known material risks.

A Kaleido spokesperson said its clinicians “discuss all risks with patients prior to getting consent. [I]nformation on the Kaleido website does not, and should not, form part of the consent process. The place for discussions about risks, benefits and alternative treatment options is the consulting room, not a website.”

LGB Alliance: ‘Trans ideology is convincing young gay people that they shouldn’t be in their biologically sexed bodies’

Last year’s model

ACON’s Australian Workplace Equality Index was based on the UK Diversity Champions Programme of Stonewall. Like Stonewall, ACON is a former gay rights body turned trans rights campaigner.

Since 2019, LGB Alliance groups have been established in many countries, reflecting the view that the Trans/Queer program—self-declared “gender identity”, medicalisation of minors, and “no debate” with dissenters—is reckless and damaging to the interests of same-sex-attracted people.

Past data and current anecdote suggest that some proportion of teenagers would outgrow their gender dysphoria in a world without puberty blockers, and emerge as young adult gays or lesbians in healthy bodies.

From this LGB perspective, gender clinics may be guilty of a form of conversion therapy when they use medical and surgical interventions to turn gender non-conforming young people into trans heterosexuals.

England’s National Health Service and other agencies withdrew from Stonewall’s Diversity Champions Programme during the 2020-24 UK Cass Review, which found “remarkably weak” evidence for the hormonal treatment of gender-distressed teenagers promoted by LGBTQ lobbies.

The BBC left in 2021, citing “questions about whether it could be impartial on issues that [Stonewall] was campaigning about”.

Last month, the ABC was forced to exit the AWEI after reporting by The Australian newspaper showed the broadcaster tailoring its “queer” journalism to attain platinum status within ACON’s trans-inclusivity league.

A short version of this article appeared in The Australian on Monday. GCN does not dispute that gender-affirming clinicians believe their treatments benefit vulnerable young people.

Opinion | Australia has been promised interim advice on puberty blockers by the middle of 2026. Are these drugs effective for gender distress? Is it safe to suppress the natural puberty of teenagers?

Will this new treatment advice mirror the UK, which has prohibited routine use of blockers for gender-distressed minors, or Germany, which recently issued a “gender-affirming” guideline encouraging such medicalisation?1

Australia’s federal Health Minister Mark Butler had the UK in mind when he sought urgent advice on the safety of blockers from his health bureaucrats, according to documents obtained under Freedom of Information law. This fact is not well known.

Mr Butler, from the centre-left Labor party, asked for this advice on 13 December 2024—one day after news that his UK Labour counterpart, the then Health Secretary Wes Streeting, had imposed an indefinite ban on routine prescription of blockers following the 2020-2024 Review of gender dysphoria care led by the distinguished paediatrician Dr Hilary Cass.

In the House of Commons, Mr Streeting said: “The Cass Review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are safe or beneficial.”

“That evidence should have been established before they were ever prescribed for that purpose. It is a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.”

The cautious UK position is based on “gold standard” systematic reviews of the evidence base for youth gender dysphoria. Such reproducible reviews—independently commissioned in countries including the UK, Sweden and Finland since 2018—have found the evidence for blockers and hormones to be very weak and uncertain. In other words, gender clinicians have no firm basis for recommending this hormonal treatment as beneficial for minors with gender distress. And these drugs come with known and unknown risks of harm.

In Germany, however, the guideline development group of clinicians decided not to persist with a full systematic review assessing the quality of the evidence for treatment. They would have been acutely aware that such an assessment would weaken any advice recommending blockers and hormones for minors.

And so, the German guideline was downgraded. It was not to be evidence-based after all, but consensus-based, meaning merely the opinion of some selection of experts. The gender-affirming members of the guideline group, already in favour of these hormonal treatments, agreed with one another. Two members worried about the poor evidence—prominent psychiatrists and researchers Dr Alexander Korte and Professor Florian Zepf—resigned from the guideline group in protest.2

The German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) registered a detailed dissent from the guideline. “[T]he question is raised ‘How should the right to self-determination and the underlying ethical principle of promoting autonomy be weighed against the protection of minors from treatment decisions that extend far into their future and have potentially fatal consequences?’ One searches in vain [through the guideline] for answers to such and many other relevant medical-ethical questions…”3

Yes, Minister

In January 2025, Australia’s Minister Butler announced that the National Health and Medical Research Council (NHMRC) would develop new national treatment standards and undertake “a comprehensive review” of the current, de facto national guidelines. The latter, first issued in 2018 by the gender clinic of the Royal Children’s Hospital (RCH) Melbourne, have been misleadingly promoted as “Australian Standards of Care and Treatment Guidelines for Trans and Gender-Diverse Children and Adolescents”.

Like the RCH Melbourne guidelines, Mr Butler used language unhelpful for an open-minded inquiry into the unprecedented spike of minors seeking hormonal treatment. The minister’s statement was headlined, “Health care for trans and gender-diverse children and adolescents [Emphasis added]”. As Dr Cass emphasised, there are many potential pathways into and out of gender distress, and a minor’s declaration of a trans identity should not foreclose ethical consideration of underlying causes or non-invasive treatment alternatives. Consistent with the minister’s narrow, identity-politics framing of the task at hand, the NHMRC says it is developing “National clinical practice guidelines for the care of trans and gender-diverse people under 18 with gender dysphoria [Emphasis added]”.4

However, Minister Butler’s announcement did have reassuring elements. He stressed that “vulnerable” young people were entitled to “the best medical advice and care available”. The new guidelines, he said, would be developed in accord with NHMRC standards and the international GRADE system for rating the quality of the evidence said to favour treatment advice.

Those NHMRC standards require “well-conducted systematic reviews” of the evidence base. Every credible systematic review since 2018 has confirmed the poverty of the evidence base relied on by paediatric gender clinics.5 At a media conference in January 2025, Butler said the NHMRC had described the gender dysphoria field as “contested and evolving”.

Surely, therefore, the NHMRC project is bad news for the gender medicine lobby? Yet the Australian Professional Association for Trans Health (AusPATH) has stated its opinion that the NHMRC is “best placed” to review the RCH Melbourne guidelines, which AusPATH itself had fulsomely endorsed as if they were rigorous national standards.

In January 2025, Butler’s then deputy minister, Ged Kearney, put a rather different spin on the job assigned to the NHMRC. Ms Kearney said it was not a “national inquiry”—the great fear of gender clinicians—but simply an update of the “excellent” current guidelines. And this update, she said, had been requested by AusPATH and the lobby group Transcend, both of which would be consulted by the NHMRC.

She made no reference to any input by Genspect or the Society for Evidence-based Gender Medicine, both of which are critical of the risk-to-benefit profile of gender medicalisation for minors.

What explains the muted response of trans activists to an NHMRC project which will potentially confirm the lack of rigour in the RCH Melbourne guidelines—the very document that entrenched the gender-affirming treatment model in Australia without any firm foundation in scientific evidence? Should gender clinicians in our children’s hospitals steel themselves for NHMRC-endorsed guidelines that apply the GRADE system, confirming the evidence for their treatment regimen of blockers and hormones to be of “low” or “very low” certainty?6

The chosen

The key body driving the new NHMRC standards is the Gender Guidelines Development Committee. Part of its role is “prioritising topics and questions for a systematic evidence review”. This committee is to develop draft guidelines for public consultation, consider the feedback and put a final draft to the NHMRC Council, with the chief executive officer to issue the complete, approved guidelines in 2028.

What should this guideline development committee look like? It should “[b]e composed of an appropriate mix of expertise and experience, including relevant end users”, according to NHMRC standards.

Of the 18 members of this committee, four were appointed because of their “lived experience of accessing gender services”. There is also a Gender Guidelines Reference Panel “to provide a diversity of perspectives on topics and priorities relevant to the end users of the guideline”. However, this reference panel does not have decision-making authority.

“Lived experience” can be a mask for gender-affirming groupthink. I asked the NHMRC if the Gender Guidelines Development Committee, the key decision-maker, included anyone who had desisted, detransitioned or decided that puberty blockers or cross-sex hormones were not necessarily the right response to gender distress.

The NHMRC’s answer blurred process with outcome, and the key guideline development committee with the less consequential reference panel: “NHMRC engaged directly with individuals with a variety of personal experiences of seeking gender services while under 18 in Australia, including those who have continued, paused, or discontinued aspects of their care, as well as their parents and carers. There is a range of experiences amongst the lived experience members of the Gender Guidelines Development Committee and the Reference Panel.”

Were those with lived experience contrary to the claims of the gender-affirming model, confined to the reference panel?

What about the balance of expert appointees? Of those 14 committee members, there is not a single clinician or researcher known to be sceptical of the gender-affirming model.

There is no counterbalance to Dr Ken Pang. On the NHMRC guideline webpage, he is described as a “Consultant paediatrician and research lead at the Department of Adolescent Medicine, Royal Children’s Hospital Melbourne [and a] Senior Principal Research Fellow and Transgender Health Research Group Leader, Murdoch Children’s Research Institute”.

No mention of the RCH Melbourne gender clinic, Australia’s most influential.

If you go to that clinic’s website, you will see Dr Pang’s photo with the following description: “Ken joined the Gender Service in December 2015, and brings to the role a strong clinical focus on child and adolescent mental health and extensive research experience. Ken is excited to assist and learn from children, adolescents and families dealing with gender issues, and is leading the service’s research efforts…”

The RCH gender-affirming clinic and its de facto national treatment guidelines are at the dead centre of a highly contested debate about the ethics and evidence for puberty blockers, cross-sex hormones and trans surgery offered to minors.

On the NHMRC guideline webpage, Dr Pang’s profile lists 14 potential conflicts of interest, including co-authorship of the RCH Melbourne guidelines; multiple grants from the Medical Research Future Fund, the NHMRC, and RCH Melbourne; receipt of an NHMRC Leadership Fellow award; and membership of gender-affirming lobby groups, both the World Professional Association for Transgender Health (WPATH) and AusPATH.7

True, Dr Pang is just one among 14 experts on the guideline development committee, but it is reasonable to suppose he will have an outsized influence as a subject matter specialist. And the committee will, in effect, have to evaluate the record of Dr Pang, the RCH Melbourne clinic and its sub-standard treatment guidelines.

Tipping the balance?

I asked the NHMRC if it believed the guideline development committee was balanced. A spokeswoman said: “NHMRC recognises the importance of incorporating a diversity of perspectives and experiences as part of a robust guideline development process.”

“Members were not selected based on their personal views but for their expertise, experience, and ability to contribute to rigorous, evidence-based decision-making. Including a wide range of expertise also helps to minimise the risk of any one member’s bias or influence.

“As part of NHMRC’s commitment to transparency, disclosures for committee members have been made available on the website and will continue to be updated should new disclosures arise throughout the process.”

Recall that Minister Butler gave the NHMRC two jobs: to review the RCH Melbourne guidelines and to develop new, truly national guidelines. I searched the NHMRC gender guideline webpages but couldn’t find any reference to the RCH review.

Was the “comprehensive review” going ahead?

“A review of the [RCH] Australian Standards of Care and Treatment Guidelines for Trans and Gender-Diverse Children and Adolescents will form part of a review of existing guidelines and evidence that will inform the new guidelines,” the NHMRC spokeswoman said.

A missing review

How are Dr Pang’s multiple conflicts of interest to be managed? What does his record show about the tension between the gender-affirming worldview and evidence-based medicine?

The RCH Melbourne treatment guidelines, with Dr Pang as a co-author, cite no systematic review of the evidence base; such a review is a necessary foundation for a trustworthy guideline.

And yet Dr Pang was among the researchers who ran a pioneering 2018 systematic review of hormonal treatment for gender-distressed adolescents, undertaken with money from the RCH Foundation. Was this review intended to be part of the guideline development process at the RCH gender clinic—until its disappointing results proved inconvenient?

The review appeared in a leading journal, Pediatrics, and was promoted as the “first systematic review” of its kind. Its conclusion: “Low-quality evidence suggests that hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact [is] generally lacking [Emphasis added].”

There are serious questions about how the arguably experimental gender-affirming model became routine treatment at RCH Melbourne and thereafter the de facto national standard in Australia for responding to gender-distressed minors.

In 2019, Dr Pang was co-author of a planning paper for a longitudinal study of RCH gender clinic patients. That paper declared “an urgent need for more evidence to ensure optimal medical and psychosocial interventions” with this group of gender-distressed minors.

In 2022, the RCH gender clinic stated that the effect of puberty blockers on the still-developing adolescent brain was unknown. This was not a public acknowledgement; it was confined to a clinic newsletter for patients and families.

Although the RCH treatment guideline is badged as Version 1.5, suggesting updates have kept it up to date, it still claims puberty blockers to be a “reversible” treatment that allows children “time to develop emotionally and cognitively” before embarking on lifelong cross-sex hormones. No mention of the possibility that blockers interfere with critical windows in adolescent cognitive development. (In late 2024, the webpage of the RCH clinic abandoned its previous, confident claim that puberty blockers were “reversible” in their effects. This was changed to “largely reversible” without explanation or further detail.)

The knowledge gap about blockers and the brain has been on the public record for some time. In October 2019, I reported that Dr Pang had advertised a PhD project with the pitch that puberty blocking typically lasts “several years, and provides an opportunity to learn how the teenage brain develops in the absence of sex hormones [which are suppressed by puberty blockers].”

In April 2025, Family Court judge Andrew Strum highlighted evidence that RCH “has only recently employed a PhD candidate to study possible effects [on the brain] despite blocking children’s puberty for several years”. Justice Strum made orders that “Devin”, a 12-year-old gender non-conforming boy, be protected from proposed puberty blocking at the RCH gender clinic.

Cass controversy

And yet, when later researchers—for example, the University of York authors commissioned by Dr Cass—followed Dr Pang in applying systematic reviews to the field of paediatric gender medicine, he rallied to the defence of the evidence base he had found threadbare just a few years beforehand.

He has put his name to gender-affirming polemics against Dr Cass’s 2024 report, which found the evidence for blockers and hormones to be “remarkably weak”. Dr Pang should have been the last person to be surprised by such a finding, given his publications from 2018-19.

In a 2024 amicus brief for America’s landmark Skrmetti case, which involved a challenge to a state ban on paediatric medical transition, Dr Pang and other gender clinicians claimed that the University of York’s systematic reviews, critical to Dr Cass’s conclusions, were “unreliable, inter alia, because they arbitrarily exclude much of the evidence showing that gender-affirming medications are safe and effective treatments for gender dysphoria. Indeed, researchers have found that the York [systematic reviews] inappropriately exclude nearly half of studies on puberty blockers and more than a third of studies on cross-sex hormone treatments.”

“The Cass Review commits another fundamental error by holding this area of medicine to an evidentiary standard that is not required or typical in pediatrics.”

Dr Cass has rejected this claim as misinformation. “There has been the question of ‘Have we set a higher bar for this systematic review [of paediatric gender medicine]?’ And we absolutely haven’t,” she told Scotland’s parliament. “These young people should get the same standard of evidence in their care as every other young person.”

As for supposedly arbitrary exclusion of evidence, the Cass criterion was the quality of the research. Low-quality studies with a high risk of bias were excluded from the synthesis. It’s true there were very few high-quality studies in the field but, as Dr Cass told the BBC, there were “quite a number of studies that were considered to be moderate quality, and those were all included in the analysis. So nearly 60 per cent of the studies were actually included in what’s called the synthesis.”

In an interview with The New York Times, Dr Cass said: “I can’t think of any other situation where we give life-altering treatments and don’t have enough understanding about what’s happening to those young people in adulthood.”

Speaking to the BBC, she said: “Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view that is unforgivable.” She did not dispute that some patients appeared to have benefitted from blockers and hormones. “But what we need to understand is what’s happening to the majority of people who’ve been through these treatments, and we just don’t have that data,” Dr Cass said.

“I certainly wouldn’t want to embark on a treatment where somebody couldn’t tell me with any accuracy what percentage chance there was of it being successful, and what the possibilities were of harms or side effects.”

It’s worth keeping in mind that Dr Cass also commissioned a peer-reviewed evaluation of treatment guidelines, including the RCH Melbourne document authored by Dr Pang and his gender clinic colleagues. The RCH guideline was rated 19/100 for the rigour of its development, 14/100 for editorial independence, and judged not fit for use.

Medical politics

Dr Pang was also a co-author of the so-called Yale white paper critique of the Cass Review. Its complaint was partly political. “In the short time since its release, the [Cass] Review has been used to justify restrictions on healthcare for transgender youth [in Republican-run US states]. In March 2024, [England’s National Health Service] announced that it would deny puberty-pausing medications to those under age 18 outside of a research setting,” the 2024 white paper says.

And, again, the gender-affirming focus is on the sheer number of studies favouring hormonal treatment, not their inconveniently poor quality, as if clinicians could go forth and recommend these medical interventions more confidently when there are 100 badly designed studies, as opposed to 10 badly designed studies.

“Amongst our author group, we have 86 years of experience in caring for more than 4,800 transgender youth and have published 278 peer-reviewed studies, 168 of which are in the field of gender-affirming care. The holistic care that the clinicians among us provide is rooted in decades of research; it is not controversial in the world-class pediatric health centers where we practice,” the white paper says.

This white paper was not peer reviewed and although it involved two Yale academics (one of them a lawyer), it lacks the university’s imprimatur. It does not appear on the NHMRC webpage listing Dr Pang’s declaration of interests. The Yale white paper itself has been critiqued in a peer-reviewed article published in 2025 and co-authored by a veteran psychiatrist in the gender dysphoria field, Professor Steven B Levine.

Which Dr Pang has been appointed to the NHMRC guideline development committee? The version who was one of the first to run a systematic review and acknowledge the lack of good evidence for the medical transition of minors, or the version who has more recently talked up the strength of the evidence in a political context?

The NHMRC did not directly answer GCN’s question about how it would handle the conflict of interest created by Dr Pang’s role as co-author of the RCH treatment guidelines.

But the spokeswoman said: “NHMRC has a range of conflict-of-interest management strategies in place for meetings and discussions regarding the evidence, including review and consideration of declarations of interest at each meeting. Management strategies will be determined where required, in line with best practice in guideline development.”

“Being affiliated with certain organisations did not automatically preclude appointments, however types of positions, such as board membership, constituted a higher risk of bias.

“Declarations of interest from potential candidates of the Gender Guidelines Development Committee were assessed by the Gender Guidelines Governance Committee using an established risk rating matrix.”

What, then, is the purpose of the governance committee? The NHMRC webpage says this committee was “established to provide advice on the composition of the Gender Guidelines Development Committee, including reviewing disclosure of interest declarations of prospective members, and to advise NHMRC on approaches if governance issues arise during the guideline development process. The Gender Guidelines Governance Committee includes four experts in bioethics, health law, and systematic reviews.”

Is this a case of who guards the guards? One of the governance committee’s four members is the editor-in-chief of the Medical Journal of Australia (MJA), Professor Virginia Barbour. The issue is the institution, not the person.

In 2018, under a previous editor-in-chief, this journal published a peer-reviewed version of the RCH gender clinic guidelines with Dr Pang as a co-author. The peer reviewers and journal editors let through the startling RCH claim that, “The scarcity of high-quality published evidence on the topic prohibited the assessment of level (and quality) of evidence for these recommendations.”

I put this formula to a pioneer of the evidence-based movement in medicine, Gordon Guyatt, who was also central to the development of the GRADE system for rating evidence. For Professor Guyatt, the claim that evidence could not be rated was enough to conclude that the RCH guideline was untrustworthy. After all, GRADE ratings range from “high” and “moderate” certainty to “low” and “very low” certainty, with certainty meaning the level of confidence that the reported treatment effect is close to the true effect.

Everything about us

On Professor Barbour’s watch, the MJA published an October 2024 critique of the Cass Review, with Dr Pang as a co-author. This article complained that Dr Cass’s “Review team were explicitly selected for their absence of experience in trans health care, supposedly to avoid bias. Remarkably, in the era of nothing about us without us, no Review authors were trans people.”

The structure of the Cass Review was consistent with the UK tradition of an independent inquiry run by someone reputable with no skin in the game. But the Cass team did have various engagements with gender clinicians, setting up a Clinical Expert Group involving experts in child/adolescent development, gender-related issues, physical/mental health, safeguarding, and endocrinology. Dr Cass took responsibility as the author of the report, but during the Review her team also listened to the accounts of trans-identifying young people.

Another complaint in the 2024 MJA article was that the Cass Review “appeared to misunderstand the young person’s primary goal of puberty blocker treatment, which is to prevent progressive irreversible incongruent pubertal changes. It did not acknowledge the benefits of prevention of breast development for trans males, and prevention of facial masculinisation for trans females. Instead, the Review focused on secondary mental health outcomes.”

Is this a shifting of the goalposts, now that the shoddy state of the evidence base for the mental health promises of gender clinics has been exposed by multiple systematic reviews? The “transition or suicide” narrative can hardly be satisfied with only the predictable physical effects of blockers and hormones. In May 2022, the US assistant secretary of health, Dr Rachel Levine, expressed the orthodox view succinctly: “Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives.”

Could it be that the NHMRC advice on puberty blockers and cross-sex hormones will try to compensate for the weak evidence by valorising a teenager’s “autonomy” in the medical pursuit of subjective “embodiment goals”?

And yet Dr Pang is not alone among gender clinicians in seeming unwilling to totally abandon the origin story of improved mental health. In September 2024, The Conversation website—with its motto “Academic rigour, journalistic flair”—published another gender-affirming polemic by Dr Pang and colleagues.

They cited an unnamed systematic review and plucked from it the only high-quality study (van der Miesen et al, 2020) which, in the account of Dr Pang and his co-authors, “found significantly improved psychological outcomes. Puberty blockers reduced suicidal thoughts and actions in transgender adolescents compared to those who had not accessed the treatment.”8

However, The Conversation article by Dr Pang and his University of Sydney co-authors omitted a crucial limitation acknowledged by the 2020 Dutch study. Psychiatrist Dr Anna van der Miesen and her Amsterdam colleagues had warned that—

“[T]he cross-sectional design of this study with different participants in the groups before and after puberty suppression may potentially limit the results with participants being different on characteristics not measured and controlled for.

“The present study can, therefore, not provide evidence about the direct benefits of puberty suppression over time and long-term mental health outcomes.

“Conclusions about long-term benefits of puberty suppression should thus be made with extreme caution, needing prospective long-term follow-up studies with a repeated-measure design with individuals being followed over time to confirm the current findings.”

The Australian authors of The Conversation article, which also appears on the website of the Murdoch Children’s Research Institute, not only cherry-picked the van der Miesen study but also overstated its explanatory power, thereby misleading readers.

And The Conversation article did not own up to the origin of the systematic review it invoked to promote puberty blockers. Readers would have to click on the hyperlinked words “2024 systematic review” to discover that this was one of the reviews assigned to the University of York by Dr Cass; the same reviews that Dr Pang and other gender-affirming figures had elsewhere dismissed as unreliable and arbitrary.

The Conversation’s readers were also not told about the York review’s overall conclusions (Of 50 studies on puberty blockers, 24 low-quality papers were excluded from the synthesis of the review).

“No high-quality studies were identified that used an appropriate study design to assess the outcomes of puberty suppression in adolescents experiencing gender dysphoria/incongruence,” the York review says. (Dr van der Miesen and her colleagues had conceded the weak explanatory power of their cross-sectional design.)

The York review also said there was “insufficient and/or inconsistent evidence9 about the effects of puberty suppression on gender-related outcomes, mental and psychosocial health, cognitive development, cardiometabolic risk, and fertility”.

“There is a lack of high-quality evidence to support the use of puberty suppression in adolescents experiencing gender dysphoria/incongruence, and large well-designed research is needed.”

The NHMRC webpage acknowledges Dr Pang’s foray into America’s health politics as a potential conflict. Why not also declare his MJA polemic, and the cherry-picked and misrepresented article for The Conversation?

Can gender-affirming care and evidence-based medicine be reconciled?

GCN does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable young people. GCN sought comment from Dr Pang.

Vanessa Spiller

After 24 years of membership, I have left the Australian Psychological Society (APS), Australia’s peak professional body for psychologists. The recent release of the APS position statement, “Supporting the mental health and wellbeing of transgender and gender-diverse people”, made it impossible for me to continue my membership without compromising my professional integrity and feeling like a financial accessory to the “deception by omission” of psychologists and the general public.

This comes after five years of my good-faith engagement, including with an APS panel, multiple presidents, the CEO, and dozens of emails and phone calls, all requesting consideration of change and explaining data-driven reasons why it is needed. Despite providing a plethora of high-quality research and assuring the APS that we share the mutual goal of providing gender-diverse and transgender people, particularly children and adolescents, with high-quality evidence-based care, the APS has departed from widely accepted evidence-based practices and contributed to shutting down good-faith debate, silencing the voices of many psychologists who care deeply about the mental health and wellbeing of gender-diverse, gender non-conforming and transgender young people.

What does it mean to “affirm” in the context of the APS position statement? Affirming in the Gender-Affirming Care (GAC) model proposed by the APS is not just about being compassionate, respectful, and client-centred. It is not just about being supportive and listening to people’s unique perspectives and beliefs. Affirmation within GAC requires that psychologists adopt the gender-based beliefs of the client, and unquestioningly agree that any person, including a child, who says they are transgender, is, based solely on their feelings and “innermost sense”.

Psychologists must agree that this innermost sense is an immutable, unchangeable fact, uninfluenced by anything else. Furthermore, psychologists are required to agree that if a child wants to transition socially (e.g., by adopting new pronouns or clothing), legally (by changing their name, driver’s licence or birth certificate), medically (by taking puberty blockers and/or cross-sex hormones) and/or surgically (by removing breasts, penis or testicles) based on this innermost sense, the psychologist will support, promote, advocate, advise parents and write letters of support and/or referral to the medical services needed to achieve this, without exception.

This includes no exceptions for being four years old and not yet being able to distinguish fantasy from reality, or for being an adolescent, one of whose main developmental tasks is to explore identities separate from their parents. No exceptions are made if you have a history of abuse and neglect, and hate and feel unsafe in your body. No exceptions if you have autism, cognitive rigidity, intense reactions to change, special areas of intense interest, sensory issues, including with your own body, impaired executive and social functioning and never felt like you quite fit in. No exceptions if you have an eating disorder, depression, anxiety, self-harm, a brain injury, an intellectual disability or even psychosis.

No exceptions if other people in your friendship group have declared a similar identity, or you have no friends except online. No exceptions if your parents say they are concerned and saw no gender non-conformity or discomfort in your past, or they are worried you haven’t really thought things through. No exceptions if you spend hours online every day watching TikToks or Instagram reels about transition or have fallen down the porn rabbit hole.

No exceptions if you are being bullied for being odd or gay. And unless the child initiates it, there is no, “Let’s think about this carefully and slowly”; no, “Let’s see if anything changes when your body and brain finish growing, when your sexuality becomes clearer”; no, “Let’s focus on resolving some of these other issues first”; no, “Do you think some of these other issues may be impacting your feelings about yourself, your body, your identity?”

No exceptions. Psychologists must support all forms of transition, in all circumstances, with all young people. This is what GAC for minors is. The APS position reinforces this, stating that any exploration must be “client-led and initiated”, meaning that even if the above-mentioned factors are present, they can’t be explored unless raised by the client, a requirement not imposed on other forms of psychological treatment, such as for anxiety, depression or disordered eating or even relationship counselling. Exploring these other factors in therapy-as-usual is considered standard, essential and best practice. To raise these factors in GAC risks accusations of “conversion therapy”.

Neither GAC nor the APS position statement is truly evidence-based for the same reasons. This was my key concern when I first wrote to the APS about these issues. Five years later, this concern remains, despite the publication of nearly 20 new systematic reviews on the topic, the highest level of research evidence available. As each new piece of research was published, I felt sure that the APS, as an advocate for evidence-based psychological practice, would adjust its position statement to reflect the weak, contradictory evidence base.

After the UK Tavistock gender clinic failed to replicate the positive findings of the original Dutch Protocol by providing gender dysphoric youth with puberty blockers; and after the World Professional Association for Transgender Health (WPATH), author of the “gold” Standards of Care for transgender people (SOC-8) was caught engaging in unethical research practices and suppressing the publication of its systematic reviews when outcomes didn’t support their guidelines; after all this, I thought that the APS would have to alert their members that a mistake had been made and that the certainty of GAC as an approach for children and adolescents had been overstated.

At the very least, I imagined that the APS would concede that the science had moved on, necessitating a softening of their unequivocal support for GAC and advising more caution. But none of this happened. With the release of the new position statement in April 2026, APS members remain uninformed about the basic facts of GAC, including the weak evidence of benefit, and how early affirmation may lead to further medicalised treatment and poorer psychological outcomes for some individuals, as well as physical health outcomes such as lack of adult sexual functioning, bowel and bladder problems and infertility.

The release of the APS draft position statement in 2024 gave me momentary hope that the Society was moving slowly and cautiously towards a position statement that better reflected the evidence, but that hope was misguided. After the publication of the final statement last month, I barely recognised it. It had been gutted from the draft version. None of the nearly 20 systematic reviews was included, and no developmental distinction was made between the needs of young children and older adults.

Gone was the balance, caution and any acceptance of responsibility should psychologists find themselves in a legal situation. I immediately emailed the APS to express my profound disappointment and confusion, and to register concerns about the consultation processes used, which ultimately led to the final position statement. An APS Board member and representative responded in a series of emails that only magnified my concerns, leaving me wondering whether the APS itself is still fit for purpose.

Detransition: “My parents and I were directly told that it was ‘transition or die’—those were my only two options”

Follow the data

My concerns have focused extensively on the selection and exclusion of scientific literature for the APS position statement as well as inconsistencies in that process. Fair and reasonable data selection is essential to providing a balanced, accurate and evidence-based position statement. Other concerns focused on the editing process following the release of the draft position statement and who was allowed to do this. In this article, I will walk you through how the APS board has responded to the concerns I’ve raised, using their own words received through email correspondence issued by their nominated representative.

Response 1: After I emailed my concerns about the position statement to the APS president and CEO, a board representative responded. This response led with the argument best summarised in the statement, “Everyone else is doing it.” The board representative wrote: “If you believe that the APS is significantly out of step on this issue with our fellow Australian medical bodies such as the [Australian Medical Association] or the [Royal Australian College of General Practitioners], or our international colleagues in the [American Psychological Association], the British Psychological Society, and the European Federation of Psychologists’ Associations, I would be keen to know where we deviate.”

The APS email continued: “If you wish to resign because you differ in opinion from the conclusions accepted by our fellow mainstream medical bodies and international psychology colleagues, that is your choice. But unless our position is shown to be discordant with our fellow mainstream medical and psychological bodies, then it is not the APS that has moved far away from our ‘core mandate and values’.”

This is a particularly weak argument that strays far from the evidence and the scientific processes used to produce professional position statements. Paediatrician Dr Hilary Cass pointed out the flaws of the “everyone else is doing it” approach in her 2020-24 UK review of youth gender dysphoria treatment.

In a systematic review of treatment advice for children and adolescents from around the world, it was noted that the gender-affirming guidelines tended to reference each other in a circular fashion, producing a veneer of rigour and consensus that didn’t stand up to deeper scrutiny. When systematically examined, these guidelines were assigned exceptionally low scores on factors such as rigour and editorial independence. The Australian Standards of Care and Treatment Guidelines for Trans and Gender-Diverse Children and Adolescents, authored by Dr Michelle Telfer’s team at the Royal Children’s Hospital Melbourne, scored a mere 19 per cent and 14 per cent, respectively, in these domains.

Examination of the statements of other professional societies endorsing GAC reveals that such statements either predate the new systematic reviews or exclude those reviews, just as the APS has chosen to do.

Contrary to the APS board member’s assertion, the British Psychological Society (BPS) has also given strong consideration to reports such as the Cass review. “We agree with Dr Cass that the controversy around this issue has sometimes taken focus away from the important role of psychological interventions in gender services to support young people and their families,” the BPS said. “We agree that it’s vital to create a sound evidence base and better understanding of the long-term effects of puberty blockers and the need for more data in this area to help young people make informed decisions about their treatment and to support the clinicians providing care and treatment.”

This is not to mention the countries abroad that have issued treatment policies more cautious about medicalised GAC for children and adolescents after careful consideration of the evidence, such as Sweden, Finland, and the UK. There are also 27 US states and the state of Queensland in Australia that have restricted the hormonal and surgical treatment of minors. The difference is that these countries and states have considered all the available evidence, including the systematic reviews, not just other societies’ position statements.

Response 2: The board representative offered, “If you want to supply the specific list of peer-reviewed systematic reviews that you believe we have omitted unfairly, we can look at how they objectively meet the above criteria.” When I provided these, I received this response: “It is precisely our commitment to psychological science and ensuring our focus on robust peer-reviewed psychological evidence that guided the revision of the position paper and what references met those criteria, as well as ensuring the position statement was consistent with [the Australian Health Practitioner Regulation Agency’s] Code of Conduct and Professional Competencies that highlights the importance of respectful, evidence-based, and person-centred practice.”

Despite the repetition of this claim, there was little additional detail given, except to say that some of the studies—e.g., the systematic reviews associated with the Cass review—had received published critiques.

But this exclusion due to “critique” is inconsistently applied in the APS position statement. WPATH’s 8th standards of care (SOC-8), a key reference in the APS statement, has been harshly critiqued, not just in the research literature but also in a US court. These critiques, as revealed in the case of Boe v. Marshall, include the allegation that WPATH suppressed its own systematic reviews and abandoned minimum ages for medical interventions in SOC-8 at the request of a government department rather than as a response to clinical evidence.

Peer-reviewed critiques of SOC-8 include Zhang et al. (2026) and Taylor et al. (2024). The APS board representative failed to explain how SOC-8, a consensus-based, non-peer-reviewed document, met the inclusion criteria when articles such as Taylor et al. (2024) didn’t, simply because Taylor had a published critique. Were all the other references in the APS position statement subjected to the same criteria? Did they have no critiques? No methodological shortcomings? Answers were not provided by the APS board representative.

Regarding the APS claim that included references were expected to be “robustly peer reviewed”, a quick review of the reference list shows that many references included in the position statement are not peer-reviewed published articles at all, e.g., TransHub 2020; Victorian Government, 2021; WHO, 2023, and most notably the Australian Standards of Care and Treatment Guidelines for Trans and Gender-Diverse Children and Adolescents.

Response 3: If the systematic reviews are indeed robust and evidence-based, could it be that they have been considered “inconsistent” with the Code of Conduct of the Australian Health Practitioner Regulation Agency (AHPRA) and excluded on these grounds? The APS Board representative emphasised that the position statement needed to be robustly evidence-based as well as ensuring it “was consistent with AHPRA’s Code of Conduct and Professional Competencies that highlight the importance of respectful, evidence-based, and person-centred practice.”

This possibility is perhaps the most troubling. The nearly 20 systematic reviews submitted for inclusion in the final APS position statement were all robust, peer-reviewed and published in reputable journals. Systematic reviews sit at the top of the evidence pyramid precisely because of the transparent, rigorous processes used to produce them. These processes allow others to take the same data, perform the same analysis and produce the same outcomes.

The prospect that conventionally designed, peer-reviewed scientific literature may be deemed non-compliant with AHPRA’s Code of Conduct and Professional Competencies by virtue of being considered “not respectful” or “person-centred” enough by the APS should instil fear in every practising psychologist.

As scientist-practitioners, we are required to update our knowledge and practice based on current robust research. We turn to well-reputed scientific journals to find this. Is it now being hinted that an unknown number of journal articles may violate our Code of Conduct? How should we identify these? What happens if we share them with our colleagues? New research, or research that challenges existing thinking, is most vulnerable to these violations but also the most needed to advance knowledge. What makes a systematic review “respectful” or “person-centred”, and who decides? What if its findings are accurate but not deemed “respectful or person-centred” enough? How can regular working psychologists possibly determine this?

Response 4: Another rationale offered for the exclusion of some references was the Board representative’s statement that, “As psychologists, we are not involved with implementing medical and physical interventions, hence the title of our position statement. As medical interventions are outside of our sphere of practice, we leave these to our medical colleagues. Many omitted references of the previous draft (and your additional supplied references) are about medical interventions and thus do not meet the above criteria [for inclusion].”

The APS board representative tells only part of the truth here. Psychologists don’t prescribe medication; we don’t perform surgeries; we aren’t medical doctors. But some of us do work in gender clinics or provide gender-related care in the community. We are required to affirm all requests for transition, i.e., to support and facilitate a client’s decision to seek legal, medical and/or surgical treatments. Some of us are asked to assess a young person’s “Gillick competence” to consent to interventions, and more broadly, a person’s ability to provide informed consent. In direct contradiction to the APS representative’s correspondence, the new position statement on gender dysphoria clearly describes psychologists’ expected contributions to medicalised care including in children—

“Psychologists are well-placed to play a supporting role for transgender and gender-diverse people considering and undertaking different modes of transitioning, including for processes associated with medical transition [P8].

“Depending on the client, psychological support may also include a role in preparing for and undergoing social and/or medical transition, detransition, or retransition. In regard to medical transition, informed consent models and Gillick competence (in children) require that clients understand the range of benefits and risks associated with it. Psychologists can play an important role in exploring such benefits and risks with clients and supporting the client through any difficulties that may arise [P9].”

Gillick competence and informed consent are both specific processes, not just general terms. They require that individuals be provided with comprehensive information about a proposed intervention or treatment. This includes evidence of the intervention/treatment’s efficacy, the intended effects, predictable unintended side effects and risks, and what is currently unknown about the intervention/treatment. The individual must then be determined to be capable of understanding that information and as having the skills needed to decide whether or not to proceed. So, although psychologists don’t provide medical treatments, they play a fundamental role in ensuring a person’s understanding and in determining capacity to consent.

A recent landmark US court case provides a sobering reality check for psychologists. A detransitioner received a US$2-million payout after suing the psychologist and surgeon for medical malpractice. She underwent a double mastectomy as a minor. The case revolved around the psychologist failing to ensure informed consent and inadequate assessment and treatment, despite not being the provider of the medical treatment themselves. The psychologist was assessed as carrying 70 per cent of the liability because the surgeon relied heavily on their professional input.

Closer to home, the judge in a 2025 Australian Family Law case, re Devin, criticised an unnamed clinical psychologist at the Royal Children’s Hospital’s gender clinic, and Dr Michelle Telfer, lead author of the Australian guidelines cited in the APS position statement. Justice Andrew Strum found that Dr Telfer had given evidence as a transgender health “advocate”, rather than an objective expert witness. The judge found no record of a comprehensive “biopsychosocial” assessment of the child in the case, and he noted that the diagnoses of gender incongruence and gender dysphoria had been made only as pending trial dates approached.

The current APS position statement emphasises the role of psychologists in supporting and facilitating medicalised transitions while simultaneously excluding the highest-level references on the efficacy and limitations of those same treatments. Australian psychologists are told to affirm, advocate for and support referrals for medicalised treatment without themselves needing to have any understanding of those treatments and what they entail. This is the equivalent of expecting your GP to simply accept you have cancer based on your innermost sense, to refer you to and advocate for your right to see a cancer specialist and undergo cancer-related surgery.

Response 5: The final response category was one I am very familiar with. The APS board representative stated: “Consistency was not the driving goal of this position statement; however, AHPRA might have strong questions for any health professional working inconsistently with mainstream psychological and medical bodies and their peers in this country.”

This response concerns me greatly. The unspoken message is, “Fall into line, be quiet, your livelihood and professional reputation might be at risk if you continue.” I’m familiar with such implicit messages because I have received many over the past four years, always on psychology discussion forums, always after sharing the latest systematic review or report that challenged any aspect of GAC, and always alluding to a potential complaint against me to AHPRA.

It’s largely been a successful strategy, and more likely to be successful now that it’s been role-modelled by an APS board member. Many psychologists fear speaking up about their concerns over GAC, especially in online psychology forums. Many are willing to support me in emails and private conversations. Many thank me for speaking up and say they share similar concerns. They also describe embarrassment about not speaking up themselves, but explain they don’t due to fear of losing their job, or damaging their professional reputation or wanting to avoid being “piled on” as I have been in online professional forums.

But I am not brave. I’m fearful. I’ve seen what happens to other professionals who express concerns. However, I’m more afraid of providing non-evidence-based care and not serving my gender-diverse and transgender clients with the care they deserve.

Then there’s the issue with the editing and review that occurred between the 2024 draft statement prepared by the working group and the 2026 final statement. It took two years for an independently facilitated working group, composed of experienced multidisciplinary professionals working in the field, to produce the draft statement. The final statement acknowledges “consultation and review” from the APS Psychology of Diverse Bodies, Genders, and Sexualities Interest Group.

Was this (appropriately named) “interest group” allowed to extensively edit the draft? If so, what was their official mandate? How were they instructed to consider the evidence base? How did they manage any biases and conflicts of interest in their approach, especially when many past and present members have publicly endorsed GAC, some even arguing for the abandonment of assessments altogether? If it wasn’t this group, who did the editing?

The APS has seemingly deviated from accepted scientific practices in producing the current position statement and lacked in transparency around its processes. It has also strayed from recent legal precedents that provide psychologists with essential guidance on what is acceptable to the courts regarding standards of care. Psychologists who read the decision in Devin’s case, followed by the APS position statement, will be left genuinely confused. On one hand, the court has forbidden a child’s attendance at Australia’s leading youth gender clinic, criticising the staff from the unit and the lead author of the Australian treatment guidelines. Yet, these are the same guidelines exalted as reflecting best practice in the APS position statement.

In his decision, Justice Strum favoured a neutral, exploratory, treatment-as-usual style approach from a psychologist with experience in working with transgender, gender non-conforming and gender-diverse children. What should psychologists do? Follow the guidance from the court or that of their professional body? In practice, what most will do is simply not treat any young person presenting with these issues at all, for fear of getting it wrong, leaving these young people even more vulnerable and unsupported. They will only be able to find assistance in services that confidently offer GAC.

The confusion continues when the new APS position statement simultaneously promotes GAC while accepting no responsibility or liability for this advice or the psychology professionals who provide it. Given recent court rulings, and the actual state of the evidence base, this seems the wisest advice in the entire position statement—

“The APS, its officers, employees, and agents will accept no liability for any act or omission occurring from reliance on the information provided, or for the consequences of any such act or omission. The APS does not accept any liability for any injury, loss, or damage incurred by use of or reliance on information in this document [P2].”

I would argue that the very reason APS members pay fees is to have a reputable professional body do the heavy lifting and provide them with robust, evidence-based guidance on what they should and shouldn’t do with particular presentations. Unfortunately, that isn’t offered by the APS, and if you follow their guidance, you do so completely at your own risk. But if you don’t follow their advice, you might also be at risk of AHPRA questioning your practice. What a dilemma for psychologists just trying to do their best to support gender-diverse and transgender children and adolescents!

What is the value of the APS to its members and the public if it is unable to provide robust evidence-based guidance that it will stand behind, or transparent and impartial processes? I have faith in psychology and psychologists, and it’s my psychology training that taught me how to find, read, interpret and understand research. I have worked hard for reform from within the APS for the past 5 years, but now it’s time to fight for change in ways that actually have a chance of making a difference.

Dr Spiller is an Australian clinical psychologist. She has a track record of working with gender-diverse, gender non-conforming and transgender clients, as well as those with complex neurodivergence. GCN and Dr Spiller acknowledge that gender-affirming practitioners believe their interventions benefit vulnerable young people.

On April 13, a few days after the final APS position statement was published, GCN extended an invitation for the APS Board’s spokesman on the issue to write an opinion article arguing the case for the changes made to the 2024 draft statement. In reply, an APS spokeswoman said: “Given the statement was released only last week and will be subject to ongoing review as the evidence base in this field continues to evolve, we are not in a position to engage with specific claims at this stage.” That invitation to appear in GCN remains open.

Lost connection

Singapore’s new and restrictive guidelines for youth gender dysphoria have disappeared from government webpages.

A Ministry of Health (MOH) circular, with two separate treatment guidelines for children and adolescents attached, was uploaded last week to official, public webpages, including the Healthcare Services Act (HCSA) site.

Now the guidelines, which advise doctors against any hormonal or surgical interventions with gender dysphoric patients under 18, have been taken down.

Web searches did not turn up any public explanation by the MOH, nor any local media coverage of this unusual development.

On Singaporean LGBT social media, one poster said it was unclear whether or not the disappearance of the guidelines represented “a reversal of policy or just a cover-up”.

Last week, this person had claimed cross-sex hormones were “life-saving” and urged the local “queer community” to share the news that the government was “cracking down on trans healthcare”.

At the time of writing, the circular and both guidelines were available as archived files on the Wayback Machine.

Doctors and hospitals in the conservative Republic of Singapore would have been directly notified of the circular via the MOH Alert system.

One Australian-trained endocrinologist offering “gender-affirming hormone therapy” in Singapore has already updated her webpage to reflect the new advice from the MOH.

As recently as May 6, the day after the circular was issued, Minister for Health Ong Ye Kung was served up a question in Parliament enabling him to summarise the new guidelines.

“Psychological support should be the first line of treatment, and hormonal and surgical treatment should not be offered for children and adolescents under 18 years old,” he said.

“For adolescents aged 18 to 20 years old, hormonal therapy (excluding pubertal suppression) may only be offered in exceptional circumstances, with clear evidence of benefit, multidisciplinary team agreement, and informed consent from the adolescent and their parents.”

GCN put questions to Mr Ong and the MOH but there were no replies at the time of writing. GCN’s May 6 article on the contents of the new guidelines was based on PDF copies of the documents sent by a contact.

Although the circular that announced the guidelines was dated 5 May 2026, the guidelines themselves were dated July 2025. The reason for this delay in publishing the guidelines is unknown.

The key adolescent guidelines were drafted by a 20-strong workgroup, most members being clinicians. Although restricting the medicalisation of young people with gender dysphoria, the guidelines also use some gender-affirming language.

The incidence of gender dysphoria in Singaporean patients aged 6 to 19 years old increased from 2.17 per 10,000 population in 2017 to 5.85 per 10,000 population in 2021, according to a Q&A session hosted last year by the NUS School of Medicine.

A February 2026 letter to Annals, the journal of Singapore’s Academy of Medicine, urged the adoption of “specific education modules on gender care and sensitivity” in medical school curriculums.

The letter, signed by five members of the Department of Psychiatry at Sengkang General Hospital, cited a study identifying “significant gaps in LGBTQI+-related knowledge and preparedness among clinical-year medical students, suggesting that insufficient training may play a role in the stigma observed in healthcare”.

“Given our local cultural context, social transitioning can carry significant risks, including potential rejection, discrimination and alienation from family and community,” they wrote.

“While gender-affirming hormone therapy is comparatively accessible locally, most providers seem more comfortable with a prior psychiatric assessment, following a mental health assessment model rather than an informed consent approach. This process can often be time-consuming.”1

Red light

Singapore has issued its first set of treatment guidelines for youth gender dysphoria, advising doctors against any hormonal or surgical interventions with patients under 18.

The guidelines note the lack of high-quality evidence in the field and the concern that puberty blockers may lock in gender distress, making a transgender identity “inevitable” and preventing the re-embrace of birth sex.

“Children and adolescents below 18 years old who are diagnosed with [gender dysphoria] should not be offered hormonal and surgical treatment,” says a Ministry of Health Circular sent on May 5 to doctors and hospitals in the Southeast Asian republic of Singapore.

“Treatment for [gender dysphoria] should be sequential, starting from psychological, and moving on to hormonal and surgical treatment only for cases that are medically indicated.”

The circular, signed by Professor Kenneth Mak, Director-General of Health at the Ministry, highlights the risks associated with irreversible medical interventions given to young people “who are still developing their sense of identity”.

The circular comes with guidelines for (prepubertal) children and adolescents (from onset of puberty up to age 21) dated as finalised in July 2025.1

Citing the risk of long-term side effects and irreversible changes to the body, the adolescent guidelines recommend no cross-sex hormones before 21, the age of majority in Singapore.

However, adolescents aged 18-21 may be offered hormones “in exceptional circumstances where there is clear evidence of benefit or harm reduction (which may include medical/mental health grounds) and agreement from [a Treatment Review Panel]”, which must have one medical specialist member appointed from outside the treating team for objectivity.

It is unclear how this test of benefit and harm can be applied because, as the guidelines themselves state, “Research on adolescents with [gender dysphoria] is lacking.”

“The lack of robust research in this area leads to the uncertainty in offering advice and treatments to patients and their families.

“Many studies [in this field] have short follow-up periods. Longer-term outcome studies suffer from loss to follow-up, especially in the group where no medical treatment was offered. The outcomes of this group, often excluded from medical treatment because of greater mental health needs, are not known.”

Clinicians in Singapore are advised to make sure that any adolescents prescribed cross-sex hormones have “realistic ideas of treatment outcomes” and are “not acting under undue influence of other persons or information, whether interacting in-person or online”.2

Mix & match

The guidelines, drafted by clinician workgroups and running to 55 pages in total, use some “gender-affirming” language but also cite studies critical of that treatment approach and advocating greater caution.

The children’s guidelines say there is “no conclusive evidence” on whether social transition—where a child takes up new pronouns and an opposite-sex role, sometimes before puberty—is advisable.

“Social transitioning is associated with persistence of dysphoria from childhood to adolescence. It is not clear if it is a contributory factor to the persistence or merely an indicator of intense [gender dysphoria], which tends to persist,” the guidelines say.

The guidelines oppose any use of puberty blockers “due to the current lack of evidence surrounding safety or clinical effectiveness”, highlighting the precedent in the UK, where the National Health Service announced an end to routine puberty suppression for gender distress in 2024.

The Singaporean guidelines point out that the evidence favouring puberty blockers for gender dysphoria “is largely based on observational studies and [is] of low quality”.

Also referenced in the new guidelines is the historical finding—from before the era of early social transition and puberty blockers—that 80-95 per cent of prepubertal children outgrew their gender distress as they matured.

Singapore’s rationale for withholding puberty blocker treatment is that it “allows for the developmental trajectory of gender identity to unfold without pursuing or encouraging a specific outcome and the avoidance of potential irreversible impacts”.

“Adolescence is a developmental stage involving major changes in many aspects—biological, emotional and social—of a young person’s life. Professionals working with adolescents presenting with [gender dysphoria] should be familiar with these aspects and consider the impact of the developmental stage on the young person,” the adolescent guidelines say.

The guidelines stress the risks and potentially lifelong complications that come with cross-sex hormones, the high rates of co-morbid mental health issues in young people presenting with gender dysphoria, and the need for thorough assessment, differential diagnosis, and informed consent before any medical intervention.

“The prevalence of co-morbidity is high, particularly mood and anxiety disorders. Co-morbid diagnosis may occur independent of [gender dysphoria], may interact with the [dysphoric] symptoms and may affect its treatment,” the guidelines say.

The document lists potential co-morbidities such as autism, depression, anxiety, post-traumatic stress disorder, eating disorders, body dysmorphia, and borderline personality disorder. The guidelines say a careful assessment may take 12-18 months.

“[T]here may be a need to suspend gender-affirming medical interventions if a new diagnosis is made which significantly impacts the diagnostic and treatment process, for example, the development of psychosis with delusions can affect decision-making capacity of the individual,” the guidelines say.

Adolescents already prescribed cross-sex hormones will continue to get these drugs, subject to regular review by a Treatment Review Panel, according to the new guidelines.

In its May 5 circular, Singapore’s Ministry of Health says it “does not track medical interventions and hormone therapies specific to [gender dysphoria]” but, based on gender surgery notifications and clinical anecdote, the Ministry estimates the number of new gender patients in public healthcare as “low”.

In January 2025, the issue of puberty blockers was put on the parliamentary agenda with a question from MP and physician Dr Lim Wee Kiak, who asked about the ethics, risks and safeguards of puberty suppression for gender dysphoria.

Health Minister Ong Ye Kung replied—

“There is insufficient evidence to indicate that puberty blockers are safe for children or [that] there is significant clinical benefit to them, especially when most children do not remain gender dysphoric later in life. [The Ministry of Health] therefore does not recommend the use of puberty blockers for minors with gender dysphoria.”

Singapore’s new guidelines generally advise caution and restraint by practitioners.

“As there may be long-term, wide-ranging medical, psychological and social implications when hormonal, or hormonal and surgical, intervention is undertaken, healthcare professionals should err on the side of informed consent and harm minimisation,” the May 5 ministerial circular says.

The reference list for the adolescent guidelines includes the long-term Swedish study Dhejne et al, which drew on comprehensive health registry data, and concluded that the suicide rate for patients after medical transition was 19 times the rate for the general population.

“Longer-term outcome data [in the Dhejne study] suggests that mental health problems persist in this population and should continue to be monitored for, after medical or surgical transition,” the guidelines say.

Also cited is evidence published by the prominent psychiatrist Professor Riittakerttu Kaltiala and her Finnish colleagues that, as the Singaporean guidelines put it, “adolescent patients with pre-existing mental health and psychosocial dysfunction continue to have these problems one year after starting [cross-sex hormones]”.

“A high priority should be placed on avoidance of risks of long-term hormonal treatment because of the risks of side effects and irreversible consequences associated with medical therapy,” the guidelines say.

Among the risks specific to cross-sex hormones, the guidelines list (for males on oestrogen drugs) thromboembolic disease, breast cancer, coronary artery disease, cerebrovascular disease, among other conditions.

For females, the stated risks of testosterone drugs include dangerous thickening of the blood, severe liver dysfunction, coronary artery disease, cerebrovascular disease, hypertension, and breast or uterine cancer.

As for gender surgery, the Singaporean guidelines advise against this intervention before the age of 21, with possible exceptions for patients aged 18-21 “where there is clear evidence of benefit or harm reduction”. Again, it is not clear how this test would be applied.

“Surgeons should bear in mind that young people [sterilised by genital gender surgery] may not desire or plan for children during adolescence but may change their minds as they grow into adulthood, regardless of their identified gender, sexuality or final physical appearance,” the guidelines say.

“There are potential severe and life-long risks associated with [gender surgery]. These include complications of the urinary and gastrointestinal systems, and external/cosmetic disfigurement.”

The guidelines prioritise psychosocial interventions for young people with gender distress but acknowledge that here too the evidence is poor.

“While there is no definite psychotherapy approach that has been established as evidence-based intervention for [gender dysphoria] at this point in time, any form of psychotherapy provided to adolescents with [gender dysphoria] should be welcoming and supportive,” the guidelines say.

Paul Tyson

An obvious and unambiguous harm that arises from the capture of mental health therapeutic norms by gender theory, is the sterilisation, puberty blocker-induced sexual dysfunction, and the genital and mammary mutilation of minors. This harm is promoted by mandating that clinicians deploy “gender-affirming care”,1 heavily pressuring parents to give their consent to gender-affirming treatments and even proceeding with puberty blockers without parental consent for minors in some cases.2 All of these radical harms have been authorised by the American Psychiatric Association’s (APA) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In 2013 the DSM-5 dropped the DSM-4’s diagnostic category “gender identity disorder” and replaced it with “gender dysphoria”. This radical diagnostic recalibration was accompanied by gender theory’s deliberate confusing of biological sex with psycho-social gender. The DSM-5 had a significant and immediately realised impact in validating what are now called gender-affirming care treatment models around the world, thus facilitating a pandemic of girls and young women with autism spectrum disorder getting onto the gender-transition medicalised conveyor belt.3

The APA notes that the DSM-5 changes were made “to avoid stigma … for individuals who see and feel themselves to be a different gender to their assigned gender.” The APA goes on to explain:

“[I]t is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition …

“Gender dysphoria is manifest in a variety of ways, including strong desires to be treated as the other gender or to be rid of one’s sex characteristics …

“Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and won’t be used against them in social, occupational, or legal areas …

“[T]reatment options for this condition include counselling, cross-sex hormones, gender-reassignment surgery, and social and legal transition to the desired gender. To get insurance coverage for the medical treatments, individuals need a diagnosis … Ultimately, the changes regarding gender dysphoria in the DSM-5 respect the individuals identified by offering a diagnostic name that is more appropriate to the symptoms and behaviours they experience without jeopardising their access to effective treatment options.”4

Firstly, there is no clear terminological delineation between objective biological sex and subjective gender. Functionally, the APA seems to have accepted a co-constructed sex-gender irrealism.5 So much for psychiatry as an objective and evidence-based science. In the above APA explanation, biological sex is only directly referred to as “sex characteristics” and it is indirectly referred to as “assigned gender”. This is the ideological capture of the APA to non-scientific—indeed anti-science—gender theory.

Secondly, this is an activist justification for a profound diagnostic and treatment regimen change, rather than a clinical justification. Avoiding stigma and making sure that transgender people can get medical insurance for radical sex-presentation-altering treatments are stated reasons for launching the new diagnostic regimen.

A significant key to understanding the therapeutic impact of the shift from the diagnostic categories of the DSM-4 to those of the DSM-5 is the difference between a disorder and a condition within the DSM lexicon. If you have a psychiatric disorder, you have a mental illness. But you can suffer from a psychological condition without being mentally ill.

The DSM-4’s diagnostic category “gender identity disorder” (GID) meant that a physiological male child or youth who believed that he was really female was mentally disturbed. GID is a body morphology disturbance wherein the mentally ill mind rejects, or punishes, or hates, the sufferer’s body. Such a sufferer believes—incorrectly—that their natural body is wrongly formed. Back in the day of DSM-4, a psychotherapist did not “treat” the natural body according to the desire of the body-morphology-disturbed mind.

For GID was then seen as a mental illness, and it is the mind that is ill, not the natural and healthy body. To this day, we do not enable a sufferer from the body-dysmorphic disturbance of anorexia nervosa by helping them starve themselves to death.

Prior to 2013, the treatment for sufferers presenting with GID symptoms typically entailed long and non-judgmental listening and talking psychotherapies where the patient could safely explore their gender-identity’s misalignment with their physical body. In this process the therapist would carefully examine any psychological co-morbidities, life traumas, social pressures, and so forth, that might contribute to or even cause GID, in the hope that the patient will, with time, realign their gender identity with their naturally sexed body. Only if, after long attempts, such psychotherapy does not resolve dysphoric anguish for the patient, will reproductive disabling body-altering accommodations to the mental illness be pursued.

Prior to 2013, the large majority of GID juveniles (most of whom were boys) received such talking therapies and grew up to become comfortable with their naturally sexed bodies, with gender dysphoria simply fading away. The large majority of GID boys matured into gay men without undergoing cross-sex hormones or the amputation of their penises and testicles.6

The above mental-disturbance-treating therapeutic regimen was largely thrown away by the DSM-5. In the DSM-5 anyone who presents claiming to believe that they are a person of the opposite sex to their natural reproductive physiology is no longer deemed to have a mental health disorder. People, including children, who believe they are transgender have now been entirely de-pathologised. This, the APA believes, is in aid of de-stigmatising transgender people and respecting the validity of who queer people believe they are.

The APA now firmly asserts that there is no mental illness integral with having a transgender gender identity. But the matter does not rest there, as some transgender people experience their natural and healthy transgender identity (which is, by definition, a non-alignment of their gender identity with their natural sexual physiology) as a cause of severe psychological distress. This is the psychological condition of gender dysphoria. Let us unpack a bit further the difference between a condition and a disorder, and why the DSM-5 decided being transgender is not a “disorder”, but gender dysphoria is a treatable “condition”.

If you de-pathologise being transgender, then it might seem to follow that gender-identities should not even be mentioned by the DSM. But that would be a problem for transgender lobbyists, because they do not just want to be accepted as normal when they have a different gender to their sex, they also want hormonal and medical treatments so that they can overcome the non-alignment of their transgenderism and make their body’s sex-presentation comply with their mental gender identity.

For US health insurance purposes, to fund the treatment of gender dysphoria it must be an officially diagnosable condition (or disorder). Thus, the condition of gender dysphoria can now be diagnosed, and non-mental treatments (for it is no longer a mental health disorder) that socially and cosmetically, but not reproductively, realign one’s wrongly sexed body with one’s truly gendered identity can now be prescribed.

By discarding the DSM-4 diagnosis of GID, the APA is now sure (on what basis?) that wanting to be a person of the opposite sex is not a mental health disorder. What then causes the distress of gender dysphoria? It must be their wrongly sexed bodies. When this outlook is applied to children and youths under the age of majority, puberty can be seen as pathological, and the very possibility of a transgender-identifying child or youth growing to their natural reproductive maturity can be irrevocably removed under the banner of gender-affirming care.

But what if these children are just confused? What if their socially situated and mental gender identity is in flux? On what basis can they reasonably be expected to make irrevocable medical decisions that will radically impact their mature adult lives in ways that they cannot properly appreciate as minors?

In the diagnostic categories of the DSM-5, in practice, it is the body of the gender dysphoric sufferer that needs treatment, not their mind. To put it bluntly, it is the naturally sexed body that is the pathogen causing the psychological distress of gender dysphoria. For a transgender-identifying child, puberty itself must here be thought of as pathogenic. This is clearly implied in the treatment recommendations in the DSM-5. Significantly, no other condition in the DSM-5 is caused by having a healthy natural body or undergoing healthy natural maturation.

Some of the treatment recommendations for gender dysphoria in the DSM-5 are uniquely strange; who would have thought that chemical and actual castration can cure a boy or young man of anything?

Clearly, the APA is seeking to delicately calibrate its terminology so that transgender people can get insured hormonal and medical “care” for gender dysphoria treatments even though being a transgender person is not a psychiatric disorder. This is a serious conceptual incoherence. For if it is natural and healthy to have a gender identity that is not aligned to the biological realities of one’s actual sex, then traumatic psychological distress about the defining feature of that natural and healthy psychological profile is inexplicable in these diagnostic categories.

Further, if sex itself is no longer defined by your biological physiology, but is simply assigned, why not simply assign yourself a sex identity that does align with your gender identity, without any medical procedures at all? This entire diagnostic category is astonishingly incoherent in its own terms. Indeed, it seems that highly educated and evidence-based clinical psychiatrists are perfectly happy to accept the idea that mentally healthy transgender people must really have a fixed magical gender spirit that has been born into the wrongly sexed body. Astonishing! What parent in their right mind would trust the APA to wisely treat their gender-confused child when we know that the normal passage of adolescence, youth, and young adulthood can be very rocky and changeable as regards a developing juvenile’s sexuality and identity?

Clearly the concerted effort of queer advocates to de-pathologise anyone with a visceral loathing of their naturally sexed body has worked in ideologically capturing the therapeutic profession. And yet, the above astonishing attempt to associate clinically significant mental trauma with gender dysphoria, without making gender incongruence itself a mental health disorder is not only glaringly incoherent, it also harmfully obfuscates some very basic facts:

1. Distress about one’s sexed body is a reasonably commonplace adolescent experience, and—until very recently—almost everyone who went through it came out the other side into relatively comfortable sexual maturation without sex-mutilating surgeries.

2. Amputating primary and secondary sex organs, particularly for minors, is a drastic and irreversible “treatment” with permanent life-course consequences that minors cannot be expected to fully appreciate.

3. Until recently, those who eventually had sex-presentation reassignment surgeries and cross-sex hormones only proceeded down that pathway after years of psychological therapies seeking to help the individual come to accept their naturally sexed body.

4. The idea that if your mind rejects your healthy and naturally sexed body, then your mind is fine and it is your body that should be changed has never been considered a reasonable and essentially automatic therapy model, until very recently.

5. De-pathologising transgender ideation and replacing “disorder” with “condition” has produced an avalanche of young people who will be permanently sexually disabled for the rest of their lives, most of whom were far too young to really understand what choice they were making.

6. Natural reproductive integrity is a significant natural good. Whether any given child of normal (that is, potentially fertile) reproductive potential will mature into an adult who successfully mates and pairs with their mate to raise their children is not, of course, known when they are a minor. But to exclude that possibility from them is to rob them of the possibility of one of the most essentially human and satisfying life opportunities people get to have. It is a serious harm to rob children of that possibility when they are in a confused and distraught state about their natural nascent sexuality.

7. The integrity of the natural body is a natural good. Of course, aids for defects (like glasses) are helpful. Of course, cosmetic surgeries that make people feel better about their appearance are often benign, to a point, and satisfying when they work as intended. And technology is increasingly integral with our bodily experiences. But all of this does not discount the intrinsic good of the natural integrity of the human body. We are not post-human yet.

8. Upholding a sacred commitment to the goodness and natural integrity of the human body is integral with the Western medical tradition, as expressed in the Hippocratic Oath. One does no harm to the natural body because the integrity of the natural body is an obvious marker of good health, and good health is a natural good desired by us all.

9. Up until the capture of key therapeutic authorities (like the DSM) by gender theory, anyone who did not want good health for their natural body was considered by therapists to have a mental health problem, even if their patients were convinced that their natural-body-rejecting ideations were perfectly healthy and normal. But now, it seems, the lunatics are running the asylum. Now natural-body integrity for something as integral to human sociality as our natural sex is considered a non-issue, and radically mutilating and dysfunctioning natural human sexual organs is deemed entirely acceptable, and indeed, mandatory for minors claiming to have a transgender identity.

The supposed hormonal and medical treatment of gender dysphoria for minors is the perpetration of harm on vulnerable minors, against their best interests, against therapists who are concerned for their best interests, and against parents who must fight the state, the therapeutic authorities, and the relentless online propaganda targeting their child to essentially join a genitally mutilating and sterilisation ideology that functions like a cult. All this is of serious harm to children. This harm is ideologically perpetrated by gender theory as aided and abetted by large quantities of state and private funding, to facilitate the strategic capture of law and government.

In her forensic exposé of the gender-theory ideological capture of the Gender Identity Development Service (GIDS) for children in the UK, Hannah Barnes’ book Time to Think opens by noting this deeply worried concern by a therapist working at GIDS: “Are we hurting the children?”7 Read Barnes’ book, read the Cass Review,8 read brave outspoken therapeutic voices advocating for a “wait and see”9 psychotherapeutic approach to gender dysphoria instead of rapid and clinically unproven hormonal and surgical “therapies”.

The evidence is in: We are hurting the children because we have been duped by gender theory into making ourselves ideologically blind to obvious harms. But getting uncoupled from deep ideological capture is now no easy task, as too many people of power and prestige are invested in the correctness of the gender-affirming care model to back down just because we really are hurting the children. But gender theory is harming our children. Gender theory is wrong.

This is an extract from Paul Tyson’s new book “Gender Theory Is Wrong: A Genealogy of Sex-Irrealism, Why It Fails, and How We Can Restore a Meaningful Understanding of Natural Facts” (2026, published by Cascade Books of Eugene, Oregon). Dr Tyson is a philosophical theologian and sociologist.

‘Halt the hormones’

The fast-rising German Opposition party, Alternative for Germany (AfD), has called for an immediate moratorium on puberty blocker drugs and cross-sex hormones for minors.

“The Federal Government admits it has no idea of the risks of irreversible transitions among vulnerable young people with a high burden of co-morbidity,” said the AfD health policy spokesman Martin Sichert.

The right-wing populist party issued its call for a moratorium after a terse government response to 25 AfD questions seeking data and information on the medical transition of young people.

Those questions focused on the pre-existing mental health problems of this vulnerable group of youth; the role of ADHD, autism and trauma; the extent of psychiatric assessment and screening before hormonal treatment; detransition rates; and the influence of the UK Cass review.

In a poll published last week, electoral support for the AfD rose to 28 per cent, ahead of Chancellor Friedrich Merz’s centre-right Christian Democratic Union (CDU) on 24 per cent and the centre-left Social Democrats (SPD) with 14 per cent.

The Federal Government is run by a “black-red” or conservative-leftist coalition between the CDU/Christian Social Union of Bavaria and the SPD. These and other parties refuse to form a coalition with the AfD, claiming it represents right-wing extremism.

This so-called “firewall” or cordon sanitaire excludes any co-operation with the AfD, such as voting in support of its parliamentary motions. And yet no other major party has an evidence-based policy to restrict paediatric gender medicine.

In its answers this week, the Federal Government acknowledged an AfD-cited study of health insurance data showing an 8-fold increase in gender-identity-related diagnosis among young people aged 5 to 24 over the past decade.

In this 2024 paper by Bachmann et al, more than 70 per cent of young people had at least one psychiatric diagnosis in addition to a gender diagnosis. And after five years, only 36.4 per cent still had a gender diagnosis on their records, a result at odds with the “born-that-way” dogma of the gender-affirming treatment model.

But the Federal Government’s answers to the AfD questions pleaded the “limited” number of studies in the field of youth gender dysphoria. And while the Government said it followed the national and international debate, it stressed that the provision of these hormonal treatments was the responsibility of Germany’s largely autonomous, self-governing health system.

The Federal Government cited the recent, low-quality S2k guideline—on “Gender Incongruence and Gender Dysphoria in Childhood and Adolescence: Diagnosis and Treatment”—and said the Federal Ministry of Health had no plans to study the persistence of youth gender dysphoria nor the associated mental health problems.

Nor did the Government have any plans to prohibit irreversible gender transition of minors with pre-existing mental health problems or legislate to require a 12-month trial period of psychotherapy prior to hormone therapy; both these measures were suggested by the AfD.

In his statement on Monday, Mr Sichert said the answers revealed “massive gaps in the Government’s knowledge regarding co-morbidities before and after transitions and their long-term consequences …”

“They are resorting to excuses such as self-governance [by medical professional bodies which develop treatment guidelines] to shirk their own responsibility.

“This is grossly negligent: children are being reduced to guinea pigs for ideological experiments.

“Whilst other countries such as the UK, Sweden and Finland are restricting irreversible measures in cases of co-morbidity, and the Cass review … warns of high risks, [Germany’s Federal] Government is planning nothing: neither studies, nor legislative changes, nor educational measures regarding infertility or detransitioning.

“The AfD parliamentary group calls for an immediate ban on irreversible transitions for minors with pre-existing mental health conditions.”

Mr Sichert told GCN that “as an Opposition party, we can only push something through if there is a majority in Parliament in favour of it”.

“There are concerns within parts of the CDU regarding [gender] transitions for young people, but unfortunately these voices are also publicly following the Government’s ‘woke’ agenda and are not being heard,” he said.

The AfD questions put to the Federal Government in March cite articles posted by the lobbying group of critical parents called Transteens Sorge berechtigt (TTSB, the name being a reference to the rights and duties of parents amid the turmoil of trans). The public face of TTSB is a former Greens party member, David Allison.

Mr Allison said it was not surprising that the Government had none of the data requested, but its reliance on the S2k treatment guideline and the self-governing nature of medical professional bodies amounted to “a cop out”.

“The crux of the matter is, in my view, the political one,” he told GCN.

“The SPD is almost more ‘queer-friendly’ and obsessed than the Greens party is. The CDU has, for the time being at least, tied its fate to a coalition with the SPD.

“Although I think there may be some trans-friendly people in the CDU, the party is by and large probably critical, but silently so.

“My view is that the CDU considers the issue to be relatively marginal. It has bigger fish to fry with the SPD—economic and social policy in general.

“It is very difficult for these parties to come to common positions on big issues, including reform of the health system (currently a hot issue).

“Of course, trans interventions at public cost are a strain on the health insurance system. But they remain low relative to the much bigger issues involved in any such reform.

“Because the SPD has married itself to trans-activist positions, it probably won’t budge on them.

“The CDU is probably hoping that it can avoid a Trump reaction—“Kamala’s for they/them. President Trump is for you”.

“It’s hoping it can brush the issue under the carpet and get away with it. And they may get away with it, particularly as liberal opinion in Germany is hegemonic in the media.

“They run very little risk of attracting negative coverage from the German media if they go along with the trans agenda. It’s primarily alternative media outlets (NiUS, Apollo, etc) that are critical. And CDU grandees have already denounced these media operations as enemies of democracy.

“All this is part of a much bigger political dilemma in Germany: the cordon sanitaire against the AfD. This means that nothing the AfD introduces to parliament or public debate in general will be considered at all. There is a gigantic impasse in German politics.”

Mr Allison said the “big unknown” was whether the CDU would ever breach the cordon sanitaire isolating the AfD “and either enter a coalition with them or establish a minority government with the tacit support of the AfD.”

The next federal election is scheduled for 2029.

Popular will: Historian Katja Hoyer on German politics and the rise of the AfD

Vote denied

The AfD has a track record of raising concerns about the gender medicalisation of minors.

In October 2022, the AfD introduced a parliamentary motion urging the Federal Government to submit “a draft bill prohibiting the treatment of children who are unable to give consent with puberty blockers, cross-sex hormones and similar medications, and to prohibit associated gender-affirming surgical procedures on minors”.

The Government was also urged “to initiate a study that comprehensively examines the consequences of treating children and adolescents with puberty blockers, cross-sex hormones and comparable medications, and to investigate the psychological, physical and social consequences of ‘gender reassignment’ for those affected …

The AfD highlighted the need to research “in particular, the risk of suicide among gender-dysphoric patients or persons with trans identity, and, in doing so, specifically to determine the proportion of those individuals who, after a few years, return to living in accordance with their biological sex (detransitioners)”.

The AfD requested a substantive vote on the motion, but this was denied.

In the January 2025 debate, which resulted in an unproductive referral of the AfD motion to a parliamentary committee, the SPD member Anke Hennig said: “[T]he AfD’s repeated anti-LGBTQ+ motions and their dangerous games with the rights of the LGBTQ+ community are not merely unacceptable.”

“This is a direct attack on the values of our democracy and our society.”

Another MP, Dr Stefan Kaufmann of the CDU/CSU, who served as his parliamentary group’s “spokesperson on queer politics”, said—

“Today we are gathered here to discuss motions from a party that is, to a large extent, far-right, anti-democratic and anti-LGBTQ+, a party that seeks to roll back much of what we have achieved together in recent years, even here in the [Parliament]. That is inhumane and repugnant …”

In December 2024, the AfD introduced a draft bill to criminalise the gender reassignment of minors.

The party’s rationale stated: “For years, there has been a rise in the number of children and adolescents being treated with puberty blockers or [cross-sex] hormones because they do not identify with their biological sex.”

“The treatment of this condition—formerly known as gender identity disorder, now referred to as gender incongruence or gender dysphoria—using puberty blockers or cross-sex hormones, is seeing a sharp rise, despite studies having demonstrated the serious health and psychological side effects and irreversible long-term consequences of these drugs.

“It is also overlooked that, whilst gender-dysphoric episodes do occur in many adolescents during pubertal development and the process of sexual maturation, they normalise over the course of puberty, leading to both psychological and physical acceptance of one’s biological sex.

“This natural development is thwarted by the puberty blocker treatment of adolescents, who subsequently often even decide to take the further step of taking [cross-sex] hormones—and this, in turn, as a precursor to a later surgical sex change. This trend is being driven by political, social and medical campaigns.”

The party noted that the online Rainbow Portal—which operated from 2019-2024 with funding from the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth—“advises children who are unsure about their gender identity to use puberty blockers as an alternative to taking hormones.”

“Children in pre-puberty are directly told that the only thing that matters is feeling comfortable ‘now’ and making a decision to take puberty blockers in line with how they currently feel,” the AfD said.

“The Rainbow Portal thus glorifies drugs that have a significant impact on the development of secondary sexual characteristics and can negatively affect the normal growth of children, adolescents and young people.

“The trivialisation and downplaying of drugs that demonstrably impair pubertal maturation, driven here by the state, but also by other social lobby groups—of drugs that have been proven to impair pubertal maturation—constitutes a constitutionally highly questionable legitimisation of interference with the physical integrity of adolescents and thus stands in contradiction to Article 2(2) of the Basic Law.”

That provision guarantees a person’s “right to life and physical integrity”.

The AfD said that “the administration of puberty blockers, [cross-sex] hormones and similar medications to children who are unable to give consent constitutes a direct interference with their physical integrity and, moreover, hormonal manipulation …”

This “implies an acute risk to the child’s welfare and touches upon the criminal offence of ‘abuse of a person under one’s care’ under Section 225 of the German Criminal Code, although it is not explicitly regulated there.”

Like the 2022 motion, this AfD draft bill was never put to a substantive vote, but was sidelined by other parties in the Parliament.

GCN global briefs

Hidden agenda

United Kingdom | The UK government’s promise of a “trans-inclusive” ban on unethical conversion therapy is misleading, according to the LGB Alliance. In its latest policy bulletin aimed at MPs, the alliance says: “Any act that might be considered a conversion practice is already illegal. The sole purpose of new legislation would be to ensure that therapists, and other professionals working with children, automatically affirm every child who says they are trans. The abhorrent, historical abuses suffered by gay people are being used by trans lobbyists to convince the public that this legislation is needed”.

In The Spectator magazine, writer Lionel Shriver argues that the real conversion therapy of our times is “the industry of ‘gender transition’ itself”. She has her own candidates for prohibition. “Make it illegal to pretend to ‘transition’ minors who may be disturbed mentally but have nothing physically wrong with them. Prohibit scientifically illiterate teachers and counsellors from inculcating children with the idea that sex is anything other than permanent and that there are any more sexes than two.”

And Shriver welcomes the recent decision of the US Supreme Court striking down Colorado’s anti-conversion therapy law as an unconstitutional fetter on free speech. She writes: “Capable of affecting similar conversion therapy bans in 21 other states, the decision was 8-1, endorsed by two liberal Democratic appointees. (Baffled by the definition of the word ‘woman’, the single dissenting justice is an idiot.) The majority sensibly characterised talk therapy—speech—as speech, not merely professional ‘conduct’. They also objected to the asymmetry of a law that prohibits questioning patients’ conviction that they were supposedly born in the wrong body, but doesn’t apply to therapists who eagerly ‘affirm’ the delusion. This constitutes state discrimination based on viewpoint—aka wokey authoritarianism”.

Speaking up

Canada | A prominent Canadian gender clinician, Karine Khatchadourian, has gone public with her shift to a more cautious stance on gender medicalisation. This is big news in a country where gender ideology is strong. Dr Khatchadourian’s interview with journalist Sharon Kirkey made the front page of the National Post, with the caption: “She was one of the first doctors in Canada to provide hormones to trans-identifying youth. She now believes most children should not be medicalised”. She does not reject the gender-affirming model. However, Kirkey reports, “Khatchadourian favours aligning with Sweden and Finland’s approach, where puberty blockers and cross-sex hormones are reserved for children and teens with a history of gender dysphoria that started in early childhood and has persisted for many years”.

The dominant patient profile in today’s gender clinics is teenage females with no early childhood dysphoria; the influence of social media and peer groups is a suspected factor in the unprecedented growth of this profile since the 2010s.

Other Canadian gender clinicians have privately shared similar concerns about paediatric gender medicine without “detailed and lengthy assessments”, according to the physician and academic Dr Laura Targownik, who is trans and blogs as The Data-Driven Transsexual. Danielle Smith, the United Conservative premier of the province of Alberta, has hailed Dr Khatchadourian’s rethink as a sign that “A major shift is underway”. In February 2024, Ms Smith foreshadowed Canada’s first restrictions on access to puberty blockers, cross-sex hormones and gender surgery for minors. That Alberta policy is now in operation and potentially a model for other, more Left-leaning provinces, as Dr Targownik writes.

Meanwhile, in Quebec, a teacher who refuses to lie to parents about the covert social transition of a child at school, has launched a court challenge under Canada’s Charter of Rights and Freedoms.

“I could not live with myself if I did [lie, as required by school policy],” the teacher says. “I will not look [parents] in the eye and intentionally lie about the fact that we are enabling their child to undergo a significant psychosocial intervention without their knowledge. Transparent collaboration with parents is essential to my role as a teacher and is critical for the long-term wellbeing of children. Lying to parents about how we are treating their children, or about what is going on with their children at school, violates the principles of my vocation”. The order to lie also violates the teacher’s freedom of expression and conscience under the Charter, according to her lawyer.

François Chapleau, emeritus professor of biology at the University of Ottawa, has set out the obstacles faced by parents in the gender ideological milieu of Quebec. “[In the sex-education curriculum] children are taught, from a very young age, a pseudoscientific notion of identity detached from the reality of the body and biological sex, as if the words ‘boy’ and ‘girl’ were merely arbitrary labels ‘assigned’ at birth, unrelated to chromosomes or genitalia,” Professor Chapleau writes.

Boys on blockers

Sweden | Despite Sweden’s adoption of a more cautious treatment policy in 2022, the number of male teenagers on puberty blockers has increased. For both males and females aged 15-19, puberty blocker use peaked in 2018-2019. Since then, prescriptions of blockers for females fell sharply, albeit with a rise in 2025. The number of males on blockers showed a steady increase from 2020-2024 before levelling off in 2025. The number of puberty-suppressed males in 2025 was about 50 more than the number of females; at peak usage, females had outnumbered males by more than 100.

Paediatrician Mats Reimer, who extracted the figures from an open database, says that “some clinics in Sweden do not appear to be following the cautious treatment policy, though this applied to those under 18”; his data includes 19-year-olds. Dr Reimer told GCN he believes “the healthcare system should delay hormone treatment for gender dysphoria until after the age of 25”. He was unsure why males were now over-represented, “but I’d guess it’s because male puberty makes it harder to later ‘pass’ as the opposite sex”. It could also be that clinicians believe the evidence base is less weak for males with an early childhood history of dysphoria.

Puzzle: Males overtake females in puberty blocker usage nationally in Sweden

Two-faced

America | The American Psychological Association (APA) has been accused of straddling two contradictory positions on youth gender dysphoria. Kurt Miceli of the watchdog group Do No Harm makes this claim in an April 20 letter to the Federal Trade Commission (FTC), which has been investigating unfair or deceptive practices in paediatric gender medicine.

Dr Miceli says the commission should take a close look at the APA. In 2024, he says, the APA adopted “a strong ideological” stance in favour of gender-affirming interventions. A year later, however, the APA issued a more cautious statement stressing that a diagnosis of gender dysphoria “is not an automatic or singular pathway to medical intervention or even social transitioning”. The APA insists these two positions are consistent.

Dr Miceli says: “The APA cannot have it both ways. These conflicting messages, which will influence how psychologists and other providers counsel children and families on irreversible medication interventions, are misleading to consumers, patients, and the FTC”.

Return to common sense: Dr Miceli of Do No Harm says minors confused about gender need psychological support, not a hurried medical pathway

Attack of nerves

France | The prestigious Collège de France, an institution of higher education which trumpets its role in the free dissemination of cutting-edge research and ideas, has de-platformed a conference that features a talk on detransitioners.

The conference—Children as the target of ideologies—was booked for June 22 this year and organised by the French group The Little Mermaid directed by clinical psychologist Dr Céline Masson and child psychiatrist Dr Caroline Eliacheff. Prominent critics of paediatric gender medicine, these two health professionals were to discuss detransition with psychotherapist Stella O’Malley, Genspect’s founder, at the Collège de France. But the conference has been moved and delayed, not cancelled. It is expected to go ahead in October, with the French Senate as its venue and Senator Jacqueline Eustache-Brinio of the Republicans party as its patron.

Youth gender dysphoria is just one of several broader themes at the conference to do with well-intentioned but harmful interventions with children. The conference flyer says: “Virtuous, socially acceptable hatred [of children] is an ideologised perversion that legitimises educational, psychological or medical practices which deny the needs, psychological development and specific status of the child, a person in the making. In the name of certain values—such as tolerance, progress, inclusion and the fight against discrimination—we are manufacturing a child, a product of adult fantasies”.

The French politician and High Commissioner for Childhood, Sarah El Haïry, was to sponsor the June 22 conference at the Collège de France but withdrew, citing reservations about The Little Mermaid group, which is often smeared as “transphobic”. And then, on April 13, the Collège de France retracted its offer to host the conference, claiming the event would undermine its “principle of neutrality” and risked causing “confusion regarding responsibility for its content”.

In the media outlet Le Point, one of the conference presenters, Sylvie Tordjman, a prominent professor of child and adolescent psychiatry, wrote that in seeking to protect itself from criticism, the Collège de France had contributed “precisely to the phenomenon it claims to avoid: the absence of debate”.

His Honour’s pronouns

America | US District Court judge Mustafa T Kasubhai has ruled unlawful a 2025 declaration by Secretary of Health and Human Services (HHS) Robert F Kennedy Jr that hospitals offering “sex-rejecting procedures” to minors could lose funding under the Medicaid and Medicare programs. The 12-page Kennedy declaration notes the findings of the HHS Gender Dysphoria Report and international inquiries leading to the view that gender medicine for minors is neither effective nor safe.

In his ruling Judge Kasubhai says the peremptory nature of Mr Kennedy’s intervention “caused chaos and terror”. The judge, appointed by the Biden Democratic administration, signed his decision with (he/him) pronouns.

Gender jargon

Europe | The European Court of Justice has found Hungary breached EU law with measures presented by the member state as essential for child protection and the right of parents to raise children according to their own values. In a video summary, the court’s president, Koen Lenaerts, contends that EU law does not allow a “stigmatising” ban on the development or distribution of content portraying or promoting, as he puts it, “divergence from the personal identity corresponding to the sex assigned at birth, sex reassignment or homosexuality”. He says Hungary’s amendments infringe on the “rights of non-cisgender or non-heterosexual persons”. This, he claims, runs counter to the pluralistic foundation of the EU.

Improbable protocol

The Netherlands | A retrospective study at the Amsterdam clinic, home to the puberty blocker-driven “Dutch protocol”, reveals “a fundamental incoherence” in approach, according to an analysis by Hermes Postma published by Genspect. The study involved 1,470 patients given a first assessment between 2009 and 2019; 264 of these did not proceed to puberty blockers or cross-sex hormones. Postma notices a shift in the rationale for puberty blockers, which used to be justified as affording a child “time to think” and explore gender. Now, the Dutch researchers instead ask “whether adolescence is the right timing”, while recording the fact that many who went through natural puberty nonetheless sought treatment later.

“The same medication used without a formal diagnosis to create an exploratory space is elsewhere described as medically necessary care within the basic health-insurance package,” Postma writes. “This circular logic—natural puberty gives space, blocked puberty gives space, and blockers are also given when no diagnosis exists—reveals a fundamental incoherence at the heart of the protocol’s rationale.”

Meanwhile, in the Dutch magazine HP/De Tijd, columnist Jan Kuitenbrouwer hails the latest study from Finland—which shows a dramatic increase in the need for specialised psychiatric help after medical transition—as “another nail in the coffin of the Dutch protocol”.

Nordic imperative

Finland | The Finnish paper—“Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study”—is still generating (patchy) media coverage. In combative mode, the editorial board of The Wall Street Journal says: “Remember the ‘follow the science’ mantra? Finnish researchers have done so in a comprehensive new report on the mental-health outcomes for youth who undergo gender reassignment treatment. The results are a rebuke to those who call for irreversible interventions for children”.

The Finns made use of the country’s healthcare register to guarantee inclusion of all former patients, as well as a large group of matched controls. “This is a study with proper control, and non-selective participation, so rare, so beautiful, almost like a unicorn,” tweeted researcher Ray Yuan Zhang of the Evidence Bridge. In The Australian newspaper, columnist Claire Lehmann welcomed the unusually rigorous longitudinal study from Finland, and concludes that, “In 2026 we have enough evidence to know that rushing kids into a medicalised gender transition is unwise and unsafe”. The Swiss German-language paper, Neue Zürcher Zeitung devoted a full page to the Finnish study with the headline “A gender change does not make trans adolescents happier”.

On his Substack, journalist Benjamin Ryan put trans activist critiques of the study to one of its authors, adolescent psychiatrist Riittakerttu Kaltiala, who responds in some detail. In a webinar hosted by Australia’s National Association of Practising Psychiatrists, Professor Kaltiala addresses some of the misconceptions about the study at the 38-minute mark. She also highlights the unacceptable level of “personal defamation and threats against researchers” in the field of youth gender dysphoria (from the 55m mark). Professor Kaltiala took questions from the 57:30m mark. The recorded webinar is freely available until May 4.

Origin stories: Psychiatrist Dr Stephen Levine, a veteran in the field of gender dysphoria, teases out the links between adolescence and identity

In print

Chile | Nicolás Raveau, a Chilean detransitioner who used to be a trans activist, has published a book titled “No Longer Trans: Insights from within the LGBT activist movement and its institutional decline”. Apart from his personal odyssey, Raveau traverses the policy landscape, including Chile’s Program of Support for Gender Identity (Programa de Acompañamiento a la Identidad de Género, PAIG), which was promoted as an uncontentious psychosocial intervention. Yet, as Raveau writes, “the PAIG facilitates an accelerated and premature social transition from the age of three. What is more serious, however, is that it leads directly to hormone treatment from the age of ten and provides a ‘range’ of surgical procedures for the future”.

Ideological capture

Australia | The Australian Health Practitioner Regulation Agency (AHPRA), which has silenced a psychiatrist critical of the gender medicalisation of children, has a conflict of interest as a paid-up customer of the trans activist lobby ACON, according to The Australian newspaper. “Documents released under [Freedom of Information law] reveal howAHPRA developed an LGBTIQA+ strategy based on adherence to the gender ideology of ACON, extending to the way it regulates health practitioners,” journalist Stephen Rice reports.

“In correspondence obtained by The Australian, AHPRA boss Justin Untersteiner states that the regulator’s engagement with ACON and accreditation group Rainbow Health Australia guides ‘the way we regulate and fulfil our purpose of ensuring the preservation of public safety’. The revelations follow claims Australia’s medical complaints system has been weaponised by gender activists using a compliant regulator to intimidate psychiatrists who speak out against gender-affirming treatment such as puberty blockers, while shielding doctors who promote them.”

Blind to the evidence

America | In the northern winter just gone, “Mehmet Oz, the head of the Centers for Medicare and Medicaid Services, summoned the leaders of the country’s major medical societies to his office for what he called a ‘grand rounds’—a hospital term for a meeting where doctors discuss complex cases,” journalist Jeremy Peters reports in The New York Times.

“The topic was one of the most contentious in American medicine: Transgender medical care for teenagers. Dr Oz pressed on a question that hangs over the entire field: Why did these organizations recommend medical intervention for young patients—including hormone treatment, puberty blockers and surgery—when the research on whether it helped young patients in the long term, especially on mental health, was inconclusive?” Most of the societies defended their gender-affirming positions, but Dr Oz highlighted the independent evidence reviews in the UK, Finland, Sweden and New Zealand leading to policies restricting hormonal treatment of minors.

Tweaking the trial

United Kingdom | The UK “PATHWAYS” puberty blocker trial should incorporate safeguards based on adverse effects documented when the same hormone suppression drugs are used with gynaecological conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome, according to a recent journal article. The author, Canadian research scientist Sarah CJ Jorgensen, also argues that the PATHWAYS trial’s proposed use of a wait-listed control group could distort results via expectancy and nocebo (or negative placebo) effects.

The paper was finalised before the trial was put on hold in February, with renewed ethical concerns. One possible change in eligibility for the research is a minimum age of 14, meaning later in puberty than with the original design.

“If PATHWAYS changes the inclusion criteria to 14-16 years, then I think the risk-mitigation strategies I discuss in my commentary would apply to a larger proportion of the enrolled females, since most will have reached later stages of puberty (unless they specifically select for females with delayed puberty),” Dr Jorgensen told GCN. “My concerns about nocebo and expectancy effects would still be relevant if they use a wait-list control, though as I note in my commentary, using established forms of menstrual suppression as a blinded comparator in post-menarcheal females [those who have experienced the onset of menstruation] would largely avoid such effects.”

Tongue-tied

America | There has been claim and counterclaim since The New York Times reported in February that the American Medical Association (AMA) had agreed with the new, cautious policy on paediatric gender surgery adopted by the American Society of Plastic Surgeons (ASPS). “For the first time, two major medical groups have backed limitations on gender-related surgical treatments for minors in the US,” The Times reported, citing an AMA statement that, “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood”. In March, the AMA’s board chair disowned the statement amid claims that it contradicted existing policy. The Times stood by its report, producing the full statement given by the AMA’s chief communications officer.

“The ongoing controversy at the AMA over what exactly their position is demonstrates how divided the medical field has become over this issue,” journalist Benjamin Ryan writes in The Free Press. “According to internal video and documentation obtained by The Free Press, the organization’s own top brass can’t even align on its official public stance.” In The American Spectator, detransitioner Prisha Mosley was unimpressed: “If the nation’s largest medical association cannot clearly say that minors should not undergo irreversible, dangerous, medically unnecessary surgeries, what exactly does it stand for?”

First, do no harm

“First, do no harm” (primum non nocere) is a fundamental healthcare principle emphasising that a practitioner’s primary obligation is to avoid causing unnecessary injury or harm to a patient. It prioritises safety by requiring that potential treatment benefits outweigh risks, and urges using the most gentle, non-invasive methods first.”

The most important element in this ancient dictum is the right, indeed the obligation, for a health practitioner to question any health practice that raises issues of safety, appropriateness and/or legitimacy.

However, from the early days of the development of the “gender-affirming care” model, advocates have insisted that any young person who states they have gender dysphoria must be supported in that belief, no debate allowed.

As a result, an untold number of health professionals have been silenced, had their professional integrity attacked, and some have lost their employment for asking questions or expressing criticism about gender-affirming care. How can a practice be safe if there is a ban on exploring an aspect of it that is potentially harmful?

One egregious example of the harassment of a concerned health professional is Dr Dianna Kenny, an experienced and well-respected psychologist who has had multiple complaints against her to the Australian Health Practitioner Regulation Agency (AHPRA) for her advocacy of a more cautious approach to gender-questioning minors. Each time she has been required to go through a stressful, lengthy process to support her assessment and management of these clients, and each time it is concluded that she has no case to answer.

Two other health professionals under threat are Dr Jillian Spencer and Dr Andrew Amos, both at risk of losing their authority to practise because of their strongly expressed concerns about the gender-affirming care model. By contrast, gender clinician Dr Michelle Telfer, who was criticised by a Family Court judge in a dispute over puberty blockers for an 11-year-old boy—Devin’s case—continues in employment at her children’s hospital and a complaint against her was swiftly rejected by AHPRA.

No gatekeepers

Gender-affirming health professionals insist that a comprehensive, mandatory mental health assessment of a gender-confused person invalidates self-determination and is a barrier to “essential care”. Instead, they emphasise an “informed consent” model that prioritises immediate access to care, on the grounds that this improves poor mental health.

In Australia, prescribing puberty blockers to a child under 18 generally requires consent from both parents (or legal guardians) and the treating doctor, provided there is no dispute. If there is disagreement between parents and/or doctors about the diagnosis or treatment, a court order is needed.

Gender-affirming clinicians who insist their treatment model is the only appropriate option weaponise the verifiably false claim that the young person will self-harm if not affirmed. This alone should cast doubt on the soundness of the overall practice of the gender-affirming model.

Cause and effect

All health practitioners who see gender-questioning young people agree that these clients typically have significant mental health co-morbidities. These conditions include depression, anxiety disorders, and suicidal ideation/self-harm. High rates of neurodevelopmental disorders (specifically autism spectrum disorder), post-traumatic stress disorder, eating disorders, and substance abuse are also frequently reported.

What is strongly contested is cause and effect. Gender-affirming practitioners insist these disorders are triggered by minority stress, which is the chronic, high-level stress faced by stigmatised minority groups, including LGBTQ+ individuals, racial/ethnic minorities, and people with disabilities, due to prejudice, discrimination, and marginalisation.

By contrast, critics of the gender-affirming model consider that the increasingly high incidence of mental health problems in children and adolescents makes them vulnerable to the influence of social media. On this view, young people are induced to believe that their problems have been caused by previously unrecognised gender dysphoria. The many positive descriptions of being transgender on social media convince them that transition is the solution to their distress.

Gender-affirming clinicians believe that gender-questioning young people must be treated as a special case and have access to their own unique treatment. There is, nevertheless, abundant evidence that gender dysphoria isn’t the only problem that young people are identifying with; there is a much wider problem, as an article from Johns Hopkins Hospital explains—

“Is your child convinced they have obsessive-compulsive disorder, autism, anxiety or depression, perhaps? Increasingly, mental health professionals observe children and teens ‘self-diagnosing’ mental disorders after watching influencers discuss them on TikTok and other social media platforms. While awareness and understanding of mental health issues are important, certain exposure on these platforms can be harmful.”

Other popular diagnoses include ADHD, dissociative identity disorder, Tourette’s syndrome, bipolar disorder and the list goes on. Typically, as is the case with gender dysphoria, these young people are convinced they have the particular disorder. Should the health professional affirm this belief and provide the disorder-related treatment? If not, why not? How are these presentations any different to the minor claiming to have gender dysphoria?

Advice: US therapist Sasha Ayad on how parents can handle the risks of an “affirmative” clinic

The gay analogy

Some gender-affirming clinicians try to defend the position that gender dysphoria is a special case by comparing it to young people who question their sexuality, the argument being that a health professional wouldn’t tell a young person who claims to be gay that they aren’t gay.

One obvious difference is that supporting the young person’s belief that they are gay does not involve any medical or surgical treatment and therefore the risk of harm is minimal.

One parallel is that the right clinical response to clients questioning their sexuality—or gender—may not be straightforward.

The lesson of my work with sexuality-questioning young people particularly in the 1970s and 80s was that not all minors who presented with the belief that they were gay were in fact gay.

Some boys worried they were gay because they looked at other boys’ penises at the urinal. A boy would catch himself looking, think it was wrong, and then start obsessing about “am I gay?” This would escalate his anxiety, and he would begin “checking” to see if he was gay—that is, he’d tell himself he wouldn’t look, then find himself glancing at the next boy, and panic that it must mean he was gay, setting up an obsessive-compulsive disorder.

Other boys were being bullied, and called gay as an insult. Some felt attracted to boys and hoped they weren’t gay. Even with a boy whose sexuality seemed clearly expressed, we would talk about how to take his time with this, as sexuality can be an unfolding story, so he should not put himself under any pressure but take his time to work out what is right for him. For similar reasons, a young person’s claim to gender dysphoria should not be the end of clinical exploration.

Affirmation is not assessment

Although gender-affirming practitioners like to claim they have conducted an appropriate assessment, I have never seen a sound account of what the assessment covers, nor how the clinician reaches the view that the appropriate diagnosis is gender dysphoria. Instead, these practitioners insist that the first step in working with the young client is to ask their “preferred pronouns”, thus immediately reinforcing the child’s beliefs and shaping the rest of the assessment, such as it is.

The long-accepted assessment process is to conduct a differential diagnosis, which involves considering all options that could account for the individual’s presenting problem, and systematically ruling them out until the diagnosis that best accounts for the person’s situation is identified. This isn’t foolproof, but is recognised as best practice. Such assessment isn’t usually conducted in a rigid, linear way, especially with young people, but aims to discover the origins and meaning of their signs and symptoms.

Given that a declaration of gender dysphoria is frequently accompanied by mental health conditions, other disorders to be considered include body dysmorphia, obsessive-compulsive disorder, social anxiety, depression, anxiety, emerging paraphilia, fantasy role play, gender nonconformity, and confusion about sexuality.

How often are these diagnoses even considered? If considered, by what criteria are they ruled out? What percentage of gender-questioning clients are recommended for gender-affirming care after the first session? After the second? What is the primary diagnosis that is most often arrived at, if gender dysphoria is excluded?

Identity promotion

Being transgender is promoted on social media as the solution to a young person’s mental health problems and made more attractive by all the special services and support, the days of pride, the flags, all that goes along with it. There is the attraction of becoming part of a welcoming, supportive community, even if only online. Why wouldn’t a vulnerable young person embrace the belief that adopting a trans identity is the solution to their distress?

The evidence is that some people do well after medical and surgical reassignment. Until recent times, only adults had access to what was then called sex-reassignment surgery, and long-term follow-up of these men found that satisfaction rates varied from 68-86 per cent. These results may support medical and surgical transition for some adults but certainly not all, and yet this was a very select group that had to undergo rigorous assessment to be eligible for medical and surgical interventions. What would the poor outcome rate have been with immediate affirmation?

The evidence of the outcomes for the current, younger cohort also suggests that some do well, but accurate information about those who regret medical and/or surgical transition is difficult to accurately determine because follow-up has been poor. Trans advocates claim that because reported detransition rates are low, the gender-affirming care model is validated and should remain the only option for the assessment and management of gender-questioning minors. But there is reason to believe that much detransition goes unreported. In a 2021 survey of 100 detransitioners, only 24 had gone back to tell their clinicians they had detransitioned.

Placebo

The placebo response to any medical or psychological intervention has been extensively investigated and is recognised as a powerful effect in health interventions. Psychiatrist and researcher Dr Alison Clayton describes the gender-affirming treatment of youth gender dysphoria as a perfect-storm environment for the placebo effect—

“[W]e have a population of vulnerable youth presenting with a condition, which has no objective diagnostic tests, and that is currently undergoing an unexplained rapid increase in prevalence and marked change in patient demographics.

“The treatment response is mainly based on patient-reported outcomes … Some clinicians, who may be affiliated with prestigious institutions, enthusiastically promote gender-affirming treatment, including on the media, social media, and alongside celebrity patients.

“Some make overstated claims about the strength of evidence and the certainty of benefits of gender-affirming treatment, including an emphasis on their ‘lifesaving’ qualities, and under-acknowledge the risks. Alternative psychosocial treatment approaches are sometimes denigrated as harmful and unethical conversion practices or as ‘doing nothing’.

“This combination of features increases the likelihood that there will be a complex interplay of heightened placebo and nocebo effects in this area of medicine, with significant implications for research and clinical practice.”

However, the placebo response tends to weaken over time.

The stamp of ideology

The hallmarks of a treatment protocol based on ideology rather than evidence are hostility towards scrutiny, dismissal of any adverse claims, demonisation of those who challenge the dogma, and punishment of anyone who openly challenges the assumptions, beliefs and rules of the preferred protocol.

Good health policy requires that poor outcomes be investigated even if the rate is as low as 1 per cent. There are two aims here: to identify when a protocol is causing harm to most patients, or to identify risk factors for patients who are more likely to have a poor outcome.

Without this most basic requirement for good health care, the public are at risk of ongoing harm: the thalidomide disaster is just one of many examples that took way too long to identify.

Detransition

Regardless of the rate of detransition, these young people should have been identified, supported and investigated from the earliest days of gender-affirming care. Key areas of regret and challenges reported by detransitioners include irreversible medical effects such as mastectomies, genital surgery and permanent changes from hormone therapy. There may be a loss of fertility.

Many detransitioners report that their gender dysphoria did not improve, or turned out to be caused by unaddressed trauma, mental health struggles, or internalised homophobia. They may feel their initial transition was rushed or that medical professionals failed to explore other factors contributing to their distress. They may come to experience uncertainty of identity, a shift in understanding their own gender identity, as they realise that transitioning was not the correct path for them. Often they feel abandoned by the LGBTQ+ community and experience social isolation.

Stages for the development of regret have been identified—

Initial period: Many individuals experience high satisfaction in the first 1–3 years after transition, which may dip around 5 years post-transition.

Long-term factors: Some studies suggest that regret, when it does occur, may not set in until several years after initial procedures, especially as individuals navigate long-term changes.

Early vs late regret: While some regret is reported early, a 2023 study of surgical outcomes suggested a median of 8 years for some instances of regret.

Common drivers: A significant portion of reported detransition is caused by external pressures (lack of support, financial stress, or discrimination) rather than an internal change of heart.

Research is beginning to elaborate the factors affecting the detransition timeline—

Age and procedure: Regret is more common among those who transition earlier or with more invasive, irreversible procedures.

Definition of detransition: Studies vary on whether they measure permanent detransition, temporary detransition, or just an inner sense of regret and uncertainty as yet undeclared to others.

Support structures: The presence of strong social, familial, and professional support correlates with lower, or non-existent, levels of regret.

Restoring reason

The disturbing practice of shutting down and punishing any health professional who dares to criticise the gender-affirming model is unethical and, in my view, more like a toddler throwing a tantrum than a considered response to disagreement.

A recent example involves Finnish psychiatrist Riittakerttu Kaltiala, who is a leading clinician and researcher in the international shift away from routine gender-affirming medicalisation of minors. Last month, she was scheduled to present a webinar—titled “Medical gender-reassignment among minors: why are we cautious in Finland?”—hosted by the Royal Australian College of General Practitioners (RACGP). Her presentation was cancelled after complaints to the RACGP that the webinar would show “hostility to trans people”, imperil “patient safety”, expose the college to a backlash, and damage its reputation.1

My reaction to this is to wonder whom these complainants are protecting: gender-diverse clients or those health professionals who have nailed their professional future to the mast of a flawed health model and will suffer reputational damage when any flaws in that model are aired?

Hopefully, there is new protection for health professionals desperate to expose the flaws in the gender-affirming model. Recent legal changes in Australia have made it a criminal offence for organisations to retaliate against health whistleblowers, defined as anyone (colleagues, patients, the public) reporting serious misconduct, public safety risks, or corruption.

Practitioners who are critical of trans ideology in general—and gender-affirming care in particular—believe this treatment protocol causes harm to patients and their families. Thus, clinicians such as Dr Spencer and Dr Amos should be protected under these new national law amendments, which would make punishing or silencing them through retaliation or non-disclosure agreements a crime.

Having one model of care that is beyond review and criticism is poor health policy. It is like having anti-vaxxers in charge of immunology or anti-transfusion advocates in charge of the blood bank. Sadly, it may take several legal cases to bring about change. As for the defence that “everybody is doing it”, it won’t wash. The flaws of gender-affirming care should be obvious to any competent health professional. Can we please get the adults back in charge?

Dr Sandra Pertot retired not long ago after 50 years of practice as a clinical psychologist specialising in human sexuality, including sexual dysfunction, sexual orientation and gender diversity

Case to answer

The apparent targeting of the Australian whistleblower psychiatrist Jillian Spencer may breach international treaty rights to freedom of expression and scientific inquiry, according to United Nations independent expert Reem Alsalem.

The UN Special Rapporteur on violence against women and girls, Ms Alsalem has just published the 8-page letter on Dr Spencer’s case which she had sent to the Australian government confidentially through diplomatic channels on February 19.

In her letter Ms Alsalem said she understood that Dr Spencer, a child and adolescent psychiatrist, had faced disciplinary action and dismissal from her hospital in the Australian state of Queensland after going public about the risks of the gender-affirming treatment model for minors.

Without prejudging the facts, Ms Alsalem expressed “serious concern” about the case, citing the International Covenant on Civil and Political Rights and its guarantee of “the right to freedom of expression, including in relation to public-interest speech by professionals and whistleblowers”.

She also invoked “the freedom indispensable for scientific research” under the International Covenant on Economic, Social and Cultural Rights.

Ms Alsalem highlighted reports that Dr Spencer had spoken out in “her capacity as a medical professional raising concerns about matters she considers to be of public interest, including the rights and well-being of children”.

Ms Alsalem said this treatment of a psychiatrist engaged in open debate risked “creating a chilling effect on other health professionals’ willingness to raise concerns about clinical practices concerning children experiencing gender distress…”

And this could potentially undermine “the best interests of the child and adversely [affect] the realisation of children’s rights under the Convention on the Rights of the Child, including the rights to health and protection from harm”.

Dr Spencer told GCN she was “pleased that [Ms Alsalem] cares enough to intervene and to highlight to the government that the Queensland Children’s Hospital may be breaching international human rights law in their attempts to fire me”.

In March, a complaint against Dr Spencer was referred to the Australian Health Practitioner Regulation Agency (Ahpra) after she shared on the social media platform X an article from The Australian newspaper. The article reported that Ahpra and the Medical Board of Australia had ordered another psychiatrist, Dr Andrew Amos, to cease his social media critiques of the gender-affirming model.

The complainant reportedly cited “fear for their safety” as a result of Dr Spencer’s post and her suggestion that her social media followers petition against “gender-affirming care”.

Against this background, Australia’s National Association of Practising Psychiatrists (NAPP), under the leadership of its president Professor Philip Morris, has intervened to advocate “strongly for the right of our medical colleagues to speak without fear or favour on topics of medical importance”.

“We stand up for colleagues who in good faith offer comment and debate about controversial practices, especially when there is a risk of harm to patients,” the NAPP statement said.

“We remind the Medical Board of Australia that respectful professional discourse by doctors should be encouraged on matters of significant clinical and ethical importance.

“Any regulatory action such as censure, restriction, or cancellation of the registration of doctors in these circumstances may give rise to concern that the Board is limiting the capacity of doctors to exercise their freedom of speech and express their views.”

On April 14 the NAPP hosted a webinar by Finnish psychiatrist Professor Riittakerttu Kaltiala, who is a leading clinician and researcher in the international shift away from routine gender-affirming medicalisation of minors.

Her talk—“Medical gender reassignment in minors: Why are we cautious in Finland?”—had been advertised for March 10 by the Royal Australian College of General Practitioners, but was cancelled after activists complained.

In suspense: For Jillian Spencer, the gender-affirming model crosses a red line

Silent treatment

In her February 19 letter Ms Alsalem put questions and requests for comment to Australia’s government, including any measures taken to ensure “that disciplinary or employment-related measures do not create a chilling effect on health professionals’ and especially whistleblowers’ engagement in public debate concerning the best interests of children experiencing gender distress”.

On X, Ms Alsalem said she had received no reply from Australia. The usual practice is to publish such letters, together with any response, 60 days after they are sent.1

The Special Rapporteur has already put on the public record her concern for the welfare of minors subjected to “experimental, irreversible medical interventions related to gender reassignment”.

In a report last year, Ms Alsalem listed the harms of social and medical transition including “persistence or intensification of psychological distress; persistence of body dissatisfaction; infertility, early onset of the menopause and an increase in the risk of osteoporosis; sexual dysfunction; and loss of the ability to breastfeed in cases of breast mastectomy (to mention a few)”.

She noted the co-occurrence of gender dysphoria and autism, and pointed out the particular vulnerability of girls “to the socially contagious stereotyped roles [of gender] as a coping strategy, placing them at risk of erroneously adopting stereotypes as their core identity while experiencing dissociation from their sexed bodies”.

In February’s letter to the Australian government, she raised the Convention on the Elimination of All Forms of Discrimination against Women, and stressed the importance of “informed consent in decision-making concerning the sexual and reproductive health of women and girls”.

This required access to “evidence-based and unbiased information” about the risks of gender medical interventions.

Ms Alsalem said the Convention on the Rights of the Child recognised “an intrinsic right to life and to full development”. She quoted the Committee on the Rights of the Child on the entitlement of children to “physical and psychological integrity”.

We’re psychologists, not script-writing medicos, and so we don’t need to know that the evidence for puberty blockers and cross-sex hormones is so weak that there is no firm basis for claiming these interventions improve the mental health of minors.

My paraphrase, but that, in effect, appears to be the official line from the Australian Psychological Society (APS).

In a 2024 draft position statement on transgender mental health support, an APS taskforce had included the UK Cass report and gold-standard systematic reviews of the evidence base, which had led to more cautious guidelines on the medicalisation of minors in England, Finland and Sweden.

In the 2026 final statement, signed off by the APS board, all those up-to-date international studies disappeared.

One mother, whose child has complex problems as well as gender distress, contacted the APS to ask why psychologists were not being told about the poor state of the evidence and this new caution in the field of gender dysphoria treatment.

On April 10, the day after the public release of the position statement—“Supporting the mental health and wellbeing of transgender and gender-diverse people”—she got a reply from psychologist Andrew Chua, who said he was speaking for the APS board.

“It is critical to understand that as psychologists, we are not involved with implementing medical and physical interventions, hence the title of our position statement,” Mr Chua said.

“As medical interventions are outside of our sphere of practice, the international studies you quoted are not referenced in our position statement. If you have concerns about current medical interventions, please contact the Australian Medical Association or the Royal Australasian College of Physicians…

“We are very confident, up to the date of the publication, that we have considered the relevant robust psychological evidence…”

Assume, for the moment, that psychologists play no role whatsoever in a minor ending up on blockers or hormones. Now can we make sense of the disappearing references?

Among the studies not adopted from the 2024 draft was a systematic review of the evidence on psychosocial support for gender dysphoric youth. Surely this is relevant psychological evidence. Robust, too, because systematic reviews sit at the top of the evidence pyramid. But this one was commissioned by the Cass review, which activists smear as “anti-trans”.

Social transition—new pronouns and a new name for a child adopting a cross-sex role—also falls within the non-medical domain of psychology. The 2024 draft advised caution here—“[S]ome practitioners suggest that the use of a new name or pronouns in children who are yet to be assessed may be considered a form of active intervention”. Why was this caution abandoned in the final APS position statement?

Clinical psychologist Ken Zucker, an international authority on youth gender dysphoria, is one of those practitioners who believes that parents should be made aware of the long-term implications of early social transition. In a 2019 article for the journal Child and Adolescent Mental Health, Dr Zucker says—

“A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).

“Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterised as iatrogenic.”1

The 2024 APS draft included a recent, Cass-commissioned systematic review of the scientific literature on social transition; another piece of relevant and robust psychological evidence missing from the 2026 final statement. Instead, psychologists will read that asking for a client’s pronouns is part of “inclusive practice”. If this position statement is taken to heart, parents won’t be advised by a psychologist that early social transition of their child is likely to lead to lifelong medicalisation.

Gay, not trans: US detransitioner Jonni Skinner tells his harrowing story of gender medicalisation

Pushing a medical model

It should be obvious that psychologists do not have to do the prescribing or perform the surgery to promote and enable medical transition of minors.

The 2024 draft stated that, “Medical gender affirmation is not the only way to support transition”. The final version says: “Psychologists are well placed to play a supporting role for transgender and gender-diverse people considering and undertaking different modes of transitioning, including for processes associated with medical transition”. Here, the APS cites the Australian guideline used to justify blockers, hormones and mastectomies for minors.

This treatment guideline—first issued in 2018 by the Royal Children’s Hospital (RCH) Melbourne—scored 19/100 for the rigour of its development, according to peer-reviewed research commissioned by the distinguished paediatrician Dr Hilary Cass, who led the 2020-24 review in the UK. But all the research associated with Cass, including several systematic reviews, was removed in the final APS statement, while the low-quality guideline from RCH Melbourne remained.

How does Mr Chua justify retention of this document, which has medical and surgical—not psychological—interventions at its core? In 2019, paediatrician Dr Michelle Telfer, first author of the RCH guideline and director of its gender clinic, appeared before a royal commission into mental health.

She said: “… it’s not just the mental health clinicians within our [RCH gender clinic] team that are there to support mental health, because for trans and gender-diverse children it’s actually the medical interventions as well as some surgical interventions that help their mental health”. There is no good evidence to support her claims, according to the systematic reviews cited in the 2024 APS draft.

Citing such reviews, the worried mother who exchanged emails last week with Mr Chua said she believed the 2026 APS statement was “notably out of step”.

“Not because it lacks compassion, compassion is essential, but because it does not fully engage with the level of clinical uncertainty now recognised internationally, nor does it clearly support psychologists to navigate that uncertainty through careful, exploratory practice,” she said.

“Psychologists occupy a critical safeguarding role, particularly for children and adolescents. Where guidance does not explicitly protect the space for thorough assessment and formulation, there is a real risk that complex presentations are prematurely simplified.”

When the APS taskforce began its review in 2022, there was an explicit policy mandating the gender-affirming approach, despite the weak evidence base. The 2024 draft statement did better by acknowledging that the field is contested: “Scientific literature and professional guidelines vary considerably in recommendations regarding the best way to provide care for gender-diverse and transgender people”. As for the 2026 final statement, it is muddled but can be read as a return to an affirmation-only stance.

The document does offer some reassurance to practitioners who would avoid the gender-affirming model as incompatible with mainstream psychological norms and methods. The new 2026 statement says—

“The APS recommends an individualised approach to psychological care which is fundamentally person-centred. The approach to treatment should be formulated on a ‘case-by-case’ basis in close collaboration with the client. In all cases, care should be respectful and evidence-informed with particular attention to being culturally sensitive and considerate of the intersectionality of multiple minority identities.”

And the statement also says—

“As with all clients, a thorough psychological assessment and case formulation is recommended to gain a comprehensive understanding of acuteness of distress, socio-cultural background, as well as risk and protective factors and differential diagnoses. Treatment approaches to address psychological distress should be discussed clearly and openly with the client.”

But this is undercut, elsewhere in the document, by the requirement for “inclusive practice” including the practice of “asking for and [making] the correct use of a person’s name, pronouns and terms for their gender and body, as they prefer”. This sounds like immediate affirmation, not a comprehensive assessment with differential diagnosis. Is it “inclusive” for a psychologist not to consider whether awkward same-sex attraction or mental health problems better explain the distress that a teenager presents as gender dysphoria?

The 2024 draft statement would have alerted psychologists to the fact that, far from being the gold standard, the gender-affirming model and its claim to “lifesaving” outcomes have been seriously challenged—

“The best way to provide psychological care for people with gender dysphoria is debated in the scientific literature, professional guidelines, and in broader social discourse. Emerging research including multiple international, independently conducted systematic reviews and evaluations from national health services [in the UK, for example, Sweden and Finland] have investigated elements of the dominant medical gender-affirmation model.”

And elsewhere in the draft—“More systematic and longitudinal research is needed to determine the long-term impacts of social, medical, and surgical transition, detransition, and retransition particularly of children and adolescents, as well as the specific needs of neurodivergent children, adolescents, and adults with gender-related distress.”

That sobering reality is gone from the final APS statement, which makes an unreferenced and circular claim that—“Scientific literature, professional guidelines, and professional bodies including the APS, support the use of affirming practices that enable transgender and gender-diverse people to thrive.” Nothing is said about the low quality of these sources.2 This kind of exuberant, evidence-lite claim is typical of the affirmation-only mindset.

The 2024 draft APS statement also contained better protection for perfectly ethical exploratory psychotherapy—

“One role of any psychologist may be to discuss an individual’s understanding and meaning of gender in the context of client self-discovery. It is important that this gender-reflection (exploration) work is taken with care, client-led, and outcomes consider the needs and wishes of the client.

“It is important to note that such processes are not considered conversion therapy unless a particular gender or gender expression is promoted as ‘correct’ or ‘proper’ by the practitioner… [P]articular care should be taken when undertaking gender related work with child and adolescent clients.”

In some jurisdictions, conversion therapy is not only unethical but illegal. The 2026 APS statement adopts a distinctly less reassuring tone for practitioners who work in the mainstream tradition of exploratory psychotherapy—

“One role of psychologists may be to discuss an individual’s understanding and meaning of gender in the context of client self-discovery. If this work is to be conducted, it is integral to ensure that this is client initiated and led, due care and consideration is taken, and outcomes are driven by the needs and wishes of the client and not others (e.g., the psychologist, a parent or partner).

“Psychologists must ensure that these processes do not constitute conversion therapy practices (i.e., efforts to alter, suppress, or change a person’s gender), such as by not promoting a particular gender or gender expression as ‘correct’ or ‘proper’.”

The 2024 APS draft statement cited an important paper by Australian psychoanalyst Dr Roberto D’Angelo and colleagues with the self-explanatory title “One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria”. It’s banished from the 2026 position statement. What remains in the final statement is a paper by Canadian legal academic and bioethicist Florence Ashley, who argues that “gender exploratory therapy” may be nothing more than a mask for opposition to the affirmative model.

In this 2022 paper Dr Ashley poses a series of questions for clinicians, including this—

“Given concerns that premature affirmation may foreclose gender identity and exploration and considering that puberty blockers arguably have far less of a foreclosing impact on gender than endogenous puberty, do you think that clinicians should offer and encourage puberty blockers for all questioning and even perhaps all cisgender kids? Would your answer change if you were absolutely certain that puberty blockers had no negative long-term side effects?”

In another paper, Dr Ashley has argued that blockers, hormones and “more rarely” surgery for trans adolescents must be judged effective to the extent that they serve an individual’s “embodiment goals”.

“Offering transition-related medical care to adolescents is ethically justified regardless of proven mental health benefits, that is, regardless of whether it is proven that adolescent medical transition causes an improvement in mental health such as by reducing distress.” Dr Ashley is trans.

Presumably, this radical approach would be outside the psychologists’ “sphere of practice” invoked by Mr Chua.

But the APS has endorsed the RCH treatment guideline, and it is worth keeping in mind the views of Dr Telfer as first author of that document. At the 2019 royal commission, she said—

“[I]t’s really interesting when we think about mental health clinicians within the context of trans and gender-diverse children, because you don’t really need someone to diagnose a person with gender dysphoria, because a trans identity is something that’s so innately personal that really only that young person or adult, depending on what time of their life they’re coming in, only they know how they feel about their gender and whether that’s a problem or not for them.”

In April 2025, Dr Telfer was criticised by an Australian Family Court judge for giving testimony as a trans health “advocate”, not as an objective expert witness. In this case, with the mother’s approval but the father’s opposition, the RCH gender clinic was proposing puberty blockers for a 12-year-old boy, Devin, who was gender non-conforming.

Devin’s treating clinician was a psychologist identified only as Dr N. The boy had been attending the clinic for more than three years, but a (legally necessary) diagnosis of gender dysphoria was only made as the trial date approached. The judge, Andrew Strum, was troubled to find no evidence of “a comprehensive biopsychosocial assessment” of Devin in Dr N’s notes. Justice Strum made orders protecting the boy from the puberty blocker intervention.

The judge found that the RCH clinic “has a single approach; gender dysphoria, if diagnosed there, is treated with puberty blockers and attendances upon Dr N or one of her colleagues. No alternative treatment options are offered by the [clinic] for gender dysphoria diagnosed there, other than prescription of puberty blockers by a paediatrician…”

“[I]n response to a question by me, [the treating psychologist] Dr N could not identify a single case of a child who had been referred by her, or one of her colleagues, to a paediatrician at the [clinic] who had not been prescribed puberty blockers.”

Unsuccessfully, the mother sought to strengthen the case for puberty blockers by invoking the affirmation-only position expressed in a September 2019 media statement issued by the APS with the heading “APS Refutes ‘Social Contagion’ Arguments”. Justice Strum was not persuaded—

“[That media statement] was over five years ago; much proverbial water has passed under the bridge since then, including the Cass report in 2024 and, as [expert witness] Dr R said in cross-examination (which evidence is uncontroverted), this statement is under review. Accordingly, I place little weight upon the official, but possibly, if not probably, outdated position of the Australian Psychological Society.”

Now, in 2026, the APS is pretty much back to where it started five years ago. The board cannot say it was unaware of the risks posed by the gender-affirming model.

As recently as February this year, a group of APS members sent a 12-page letter to the new president, Dr Kelly Gough, and the board.

The letter cited parent reports of troubling practices by some psychologists, including—

“A clinical psychologist initially described herself as ‘gender exploratory’, but after six sessions declared the adolescent ‘definitely trans’ and endorsed the adolescent’s assertion of no future regret—without disclosing recent suicidality to the parent.

“A second clinical psychologist, after a one-hour meeting with the parent (having never met the autistic adolescent), stated affirmation was necessary to prevent suicide risk.

“Psychologist tells a 15-year-old boy to cut off contact with his mother, with whom he lived, because she did not support gender transition.

“Psychologist refers 14-year-old girl in one session to RCH Gender Service.

“Psychologist at a state gender service considered that ALL minors referred to the service were good candidates for transition, because the waiting list was so long that any who were not serious would have dropped out.

“Psychologist refuses to engage with a young person with gender distress after the mother voices concern about affirmation.

“Psychologist takes parents aside to tell them that unless they affirm their child’s transgender identity, proceeding with therapy would be pointless and that they have one last chance to have a relationship with their child.

“Psychologist provides incorrect advice to a minor that consent from both parents is not required, when parents are questioning hormonal treatment.

“Psychologist sends a letter home with a gender-distressed young adult to deliver to his parents, admonishing them for not affirming their son’s gender identity then refuses to engage any further with them.”

The group letter also warned the APS of litigation risk. “If APS members are led to believe gender affirmation is evidence-based, they risk contributing to patient harm and exposure to litigation,” the letter said.

“The APS is therefore responsible for providing accurate, evidence-based recommendations given the serious long-term health effects of medical transition and the limited quality evidence for mental health benefit.

“Litigation is increasing, including cases brought against professional associations. An up-to-date list of more than 35 international cases is available upon request.

“Last month [January 2026], in the first of its kind, a New York jury awarded US$2 million to a detransitioner in a malpractice case concerning a double mastectomy at age 16.3

“Seventy percent of fault was attributed to the psychologist, based on inadequate psychological evaluation, insufficient risk disclosure, and inadequate safeguards prior to irreversible surgery.

“Several malpractice suits against Monash gender clinic [in the Australian state of Victoria] were settled out of court in the early 2000s, and we understand several such cases are ongoing in Australia.

“Financial liability may end up driving policy change where evidence review has not.”

Certainly, there is little foundation for the APS claim that the non-medical nature of psychology explains the decision to impose on practitioners a position statement stripped of high-quality (but inconvenient) studies.

GCN invited Mr Chua to write an opinion article arguing the case for the changes made to the 2024 APS draft statement. In response, an APS spokeswoman said: “Given the statement was released only last week and will be subject to ongoing review as the evidence base in this field continues to evolve, we are not in a position to engage with specific claims at this stage”. GCN does not dispute that gender-affirming clinicians believe their interventions help vulnerable youth.

In 2021, a complaint against me was lodged with the Australian Psychological Society (APS).

The complaint alleged that I was, in essence, an ignorant transphobe for daring to suggest in a podcast for the College of Clinical Psychologists that it was essential to conduct a comprehensive assessment of gender-questioning young people in order to arrive at the safest diagnosis for each individual. I also expressed the view that some young people with mental health problems such as anxiety and depression, and particularly those who are socially isolated, were influenced by social media to believe that identifying as trans was the solution to this distress.

This was in conflict with the APS policy mandating the gender-affirming model for the assessment and management of gender-questioning clients. That policy instructed psychologists to—

affirm the person’s gender;

challenge negative attitudes towards gender diversity;

discuss referral options for gender-affirming treatments if desired; and

advocate for the support needs of transgender people.

In response to the complaint, I was able to make a case for my approach in a long and well-researched document, and ultimately the APS decided that I was entitled to my professional opinion.

In September 2021, I wrote to the APS expressing my concern that its support for the gender-affirming model of care exposed the Society to risk.

Legal cases by people who regretted their transition and were seeking compensation from their gender-affirming clinicians were beginning to emerge. In my view, it was unwise to affirm a young person in the absence of a comprehensive mental health assessment to determine which was the safest option for that client.

I was aware of other psychologists who held the same concerns about the APS’s adoption of gender ideology without adequate consultation with the membership base. Some were prepared to express their doubts about the safety of the gender-affirming model but many were too intimidated by the abuse they saw others receive from trans ideology advocates. “Transphobe” and “bigot” have become favoured words to shut down opposition, and if that doesn’t work, there may be a potentially career-ending complaint to the employer, the APS or the Australian Health Practitioner Regulation Agency.

Finally, in July 2022, the APS formed a panel/taskforce to develop a position statement on gender-diverse clients. The stated aims were to ensure that clinical practice remains evidence-based, ethical, and safe, while navigating rapidly evolving research and diverse perspectives within the profession. Panel membership included people with “lived experience”, psychologists with research and practice experience, an independent chair, a general practitioner, and a psychiatrist.

The taskforce ran for two years but it wasn’t until February 2025 that the first draft from the taskforce was made available to APS members for comment. This draft clearly didn’t please everyone; it was always going to be difficult to integrate the diversity of views into a coherent whole. It is unknown how many members made comments on the draft. Time passed, with many queries to the APS about its progress and when it would be released. The final document was made public on April 9 this year.

It seems the APS leadership team had decided, for reasons never disclosed, to hand over the first draft to the APS Psychology of Diverse Bodies, Genders, and Sexualities Interest Group for their “consultation and review”. It’s my guess that the revisions of the taskforce’s document came solely from the input of this group.

It is fair to say that this final document is an insult to the taskforce members who spent their time and energy working towards a genuine consensus document. Instead, it appears that revisions by the genders and sexualities interest group have taken the APS back to the position where the taskforce started. The exercise has been a total waste of time and is a betrayal of APS members who are aware of the flaws in the gender-affirming model.

Back to affirmation: tweaks and deletions from the draft statement to its final form

Doublethink

The ability of members of the genders and sexualities interest group to tolerate cognitive dissonance is stunning. On the one hand, for example, they insist on immediate affirmation, on the other hand the position statement says—

“As with all clients, a thorough psychological assessment and case formulation is recommended to gain a comprehensive understanding of acuteness of distress, socio-cultural background, as well as risk and protective factors and differential diagnoses.

“Treatment approaches to address psychological distress should be discussed clearly and openly with the client.”

It is worth noting that 55 per cent of detransitioners in a 2021 survey said clinicians didn’t give adequate medical evaluation before gender transition.

Despite the seriousness of this issue, I couldn’t help being amused by the “Disclaimer and copyright” section that appears on page two of the new APS document. It is quite common for a disclaimer to be included in position statements. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) followed common practice:

“Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient.

“The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.”

The APS has taken the concept of a disclaimer to a whole new level. Their text denying future liability says—

“This publication was produced by The Australian Psychological Society Ltd (APS). The information provided is general in nature and does not replace individual professional clinical assessment, judgement and decision making. Although every reasonable effort has been made to ensure the accuracy of the information, no guarantee can be given that the information is free from error or omission.

“The APS, its officers, employees, and agents will accept no liability for any act or omission occurring from reliance on the information provided, or for the consequences of any such act or omission. The APS does not accept any liability for any injury, loss, or damage incurred by use of or reliance on information in this document. Such damages include, without limitation, damages that might be regarded as direct, indirect, special, incidental, or consequential.

“Any reproduction of this material must acknowledge the APS as the source of selected passage(s), extract(s), or other information or material reproduced. For reproduction or publication beyond that permitted by the Copyright Act 1968 (Cth), permission should be sought in writing.”

One of the triggers for setting up the taskforce was to provide clear, evidence-based guidelines for APS members who worked with gender-questioning young people, so they would have a solid defence in the event of a complaint against them. This was the whole point of my letter to the APS in September 2021.

A common grievance of dissatisfied clients is that the clinician did not spend time on an assessment but simply affirmed their belief they were transgender in the first session. With this in mind, I naively assumed that an in-depth assessment would be mandatory in the new APS document. Instead, proper assessment comes across as just a possible option, outweighed by the dogma that if a client says they are trans, they are trans, and must be affirmed immediately, for example, by asking them their pronouns.

For me, the whole point of the taskforce was to stress the importance of making every effort to identify the safest outcome for each individual client. This position statement falls far short of that goal. And the disclaimer sends a clear message to psychologists—the APS does not have your back.

Dr Sandra Pertot retired not long ago after 50 years of practice as a clinical psychologist specialising in human sexuality, including sexual dysfunction, sexual orientation and gender diversity

Comment

In its new statement on gender dysphoria, the Australian Psychological Society promises it will “inform members of relevant advancements in the field”.

But this is a document doctored to exclude the most significant development of recent times—the 2024 UK Cass report and a brace of gold-standard systematic reviews since 2018, all exposing the lack of good evidence for the “gender-affirming care” of minors.

And yet the society has the cheek to insist that members must keep “up to date with the latest knowledge and guidelines”.

A psychologist reading the new position statement—“Supporting the mental health and wellbeing of transgender and gender-diverse people”—will find little reason to hesitate before referring a child to a puberty blocker-driven gender clinic.

This statement has a backstory. In 2021, clinical psychologist Dr Sandra Pertot was confronted with a complaint, her first in 45 years’ practice. In a podcast, she had talked about gender dysphoria from a mainstream clinical perspective. She did not sound “affirming” enough, according to some trans listeners. The complaint was resolved with the society acknowledging the “multiple perspectives and views” on the topic.

But now the society was on notice. It had an uncritical affirmation-only policy and activists stood ready to enforce it. Back then, the policy stated: “As a professional organisation committed to evidence-based practice, the Australian Psychological Society (APS) therefore opposes any forms of mental health practice that are not affirming of transgender people—including children. Any psychologist involved in such practices is likely to be in breach of the APS Code of Ethics.”

But the APS also had some members well-informed about the risks and flaws of the gender-affirming model. So, in 2022, the APS commissioned a panel to review its affirmation-only policy. Two years later, it issued a new draft policy for consultation. Last year, members began to wonder why it had not been finalised and published.

The 2024 draft was a compromise. It was far from free of gender ideology, but it would have alerted psychologists to the sobering results of systematic evidence reviews in the UK, Sweden and Finland, and the more cautious approach in those countries to the gender medicalisation of minors.

The tension in the draft document showed in the “further reading list” for members. It included the Cass report, but it also recommended gender-affirming treatment guidelines from the Royal Children’s Hospital Melbourne and the World Professional Association for Transgender Health (WPATH).

Psychologists diligently working through the reading list could end up very confused. Those treatment guidelines were found to be of low-quality and not fit for use, according to a peer-reviewed study commissioned by paediatrician Dr Hilary Cass, the author of the 2024 report. Dr Cass was critical of a practice of circular referencing among low-quality guidelines which created a false impression of consensus favouring the gender-affirming model. Where should psychologists place their trust—in the Cass report or those guidelines?

Today we discovered how the APS has resolved the dilemma.

No mention of the Cass report in the 2026 position statement. No mention of the systematic reviews, undertaken independently in several countries, which showed no good evidence for the puberty blockers and cross-sex hormones given to gender-distressed minors. But the low-quality gender-affirming guidelines remain in the new statement. Gone is the draft’s warning that these guidelines “differ in terms of ideological standpoint and scientific rigour and the outcomes have been widely debated”.

This story has played out internationally. Small groups of activists capture the policymaking machinery of medical or mental health associations and resist attempts to restore balance. It’s easy to see now why such factional politics are necessary. Gender-affirming care for minors has such a weak evidence base that its clinical dominance must depend on authority—so-called eminence-based medicine—and the silencing of dissent.

The new APS statement makes no reference to the unprecedented spike in gender clinic caseloads since the 2010s, nor does it note the puzzling flip in patient profile from boys with early-onset gender dysphoria to teenage girls often with a range of psychiatric problems but no prior history of dysphoria.

The 2024 draft did not dodge this reality: “In recent years, there has been a marked increase in the number of young people being referred to specialist or medical gender clinics, the reasons for which are debated”.

The draft cited the work of the American researcher Dr Lisa Littman who coined the term “rapid-onset gender dysphoria” to suggest that social media and peer groups might be influencing the trans identities adopted by young people. This possibility is unacceptable to gender ideologues. And so, the Littman references are banished from the 2026 statement.

Even the WPATH guideline, much cited by the new APS statement, concedes that, “For a select subgroup of young people, susceptibility to social influence impacting gender may be an important differential to consider.”

Speaking of subgroups, the APS has an entity known as the Psychology of Diverse Bodies, Genders, and Sexualities Interest Group. They get a shout-out on the Acknowledgements page of the new position statement.

False advertising

The mental health of young people appears to get worse after they undergo the hormonal and surgical interventions promoted by gender clinics as “lifesaving”, according to an unusually comprehensive study.

“Among adolescents who underwent medical gender reassignment, psychiatric morbidity increased markedly during follow-up—rising from 9.8 per cent to 60.7 per cent in feminising gender reassignment and from 21.6 per cent to 54.5 per cent in masculinising gender reassignment,” the new paper from Finland says.

This long-term retrospective study by Sami-Matti Ruuska and co-authors involves 2,083 gender-distressed patients aged under 23 when referred to specialist clinics; 38.2 per cent went on to have medical interventions.

Thanks to Finland’s comprehensive healthcare register, the study does not suffer from the uncertainty of patients lost to follow-up. And it benefits from comparison with 16,643 matched controls in the general population. (Gender dysphoria as a field has been plagued by poorly designed studies with problems such as small or unrepresentative samples, short-term follow-up, missing patient data, and lack of a control or comparison group.)

Dr Ruuska and his colleagues checked the psychiatric treatment history of the gender dysphoric patients at the time of their first appointment at Finland’s gender clinics and two-plus years afterwards; the median follow-up was almost 5 years and the maximum 25 years.1

Patients were divided into two cohorts: 1996-2010 and 2011-2019, the latter period coinciding with the unprecedented international spike in gender clinic caseloads.

“Severe psychiatric morbidity is common among gender-referred adolescents and appears to be more prevalent in those referred after the recent surge in referrals,” the paper says. “Psychiatric needs do not subside after medical gender reassignment.”

Fear not

The four Finnish authors, among them the prominent adolescent psychiatrist Professor Riittakerttu Kaltiala, were responsible for a complementary 2024 paper that challenged the “transition or suicide” narrative of gender-affirming clinicians and activists.

Drawing on healthcare register data for this earlier study, the Finnish researchers concluded that suicide was rare among dysphoric youth; medical transition did not appear to reduce suicide risk; and the elevated suicide risk among gender clinic patients was explained by their psychiatric conditions, not by gender dysphoria itself.

Clinical psychologist Ken Zucker, a leading international authority on youth gender dysphoria, welcomed this research as “very important”.

“It is now time to bury the ‘trans kid or dead kid’ trope,” Dr Zucker told GCN.

“Although we know that adolescents and adults with gender dysphoria report suicidal ideation and suicide attempts at a rate higher than non-clinical populations, the rates are, by and large, similar to what one sees in many mental health conditions.”

Chicken and egg conundrum

The Finns’ new paper, just published in Acta Paediatrica, urges clinicians to give priority to these gender patients’ psychiatric conditions, such as depression or anxiety, and the researchers suggest such conditions may not be secondary to gender dysphoria.

“[I]n light of the present findings, severe psychiatric disorders do not appear primarily attributable to [gender dysphoria]. Psychiatric disorders require their due treatment regardless of a young person’s gender identity,” the researchers say.

“It should be noted that in some individuals, medical [gender transition] appears to be linked to deterioration in mental health,” their new paper says, noting the potential for oestrogen to cause depression in males seeking to feminise their bodies.

In the 1996-2010 period, 66 per cent of gender patients had needed specialist psychiatric care two or more years after the first appointment; this compared to 18 per cent of matched controls receiving such specialist care.

In 2011-2019, gender patients were markedly more reliant on psychiatric care than were controls from the general population, both at the first appointment (48 per cent v 15.3 per cent for controls) and at follow-up (61.3 per cent v 14.2 per cent).

The share of gender patients with a history of specialist psychiatric treatment prior to their gender clinic referral doubled in the transition from the 1996-2010 period to 2011-2019.

“No such change was observed among the controls. This suggests that increasingly, adolescents with severe psychiatric morbidity are referred to [gender clinics]. The change is hardly attributable to improved recognition of mental disorders, as no similar rise was observed in the control group.”

The increased psychiatric need of the 2011-2019 cohort is at odds with the minority stress theory, which attributes mental health disorders in trans-identifying patients to a hostile and prejudiced society, the researchers say.

“With the opening up of society with regard to sexual and gender minorities, a decrease in psychiatric morbidity might have been expected in the later [gender dysphoric] cohorts, although reduced stigma may also increase treatment seeking,” they say.

“The notable increase in those contacting [gender clinics] and the increased psychiatric morbidity among them since the 2010s may suggest that, for some, mental health challenges may manifest as concerns related to gender identity.”

UPDATE | The researchers acknowledged the limitation that their study could not analyse in detail why these patients needed psychiatric services.

Asked about this issue, Professor Kaltiala told GCN that healthcare register data used for the study included diagnoses and in-patient periods but not treatment nor information about a patient’s problems related to family life, romantic relationships or work.

One transgender journalist’s critique of the new study suggests that psychiatric appointments are part and parcel of the gender-transition process in Finland and therefore may not point to serious psychiatric morbidity.2

However, Professor Kaltiala said the young people seen by specialised psychiatric services in her country would have “severe disorders”. These services were focused on “those really in need”, consistent with national criteria for health equity.

“In Finland, you do not get admitted to specialist-level services if you don’t have mental disorders at all or [have only] mild disorders and problems,” she said. “Primary-level services are available for needs related to milder disorders and psychosocial difficulties.”

She said the gender-referred youth in the new study were much more likely than matched controls to have a history of severe mental disorders, often dating back some years before they reached the gender clinic.

“Thus, many developed feelings of gender dysphoria in the context of severe disorders,” she said.

“Severe mental disorders during adolescence generally have potential to complicate identity development. It rather seems that feelings of gender dysphoria are sometimes secondary to severe mental disorders.”

If it were the other way around, and the mental disorders were secondary to the dysphoria, those disorders would be “expected to subside with medical gender reassignment”, according to the Dutch treatment protocol adopted internationally, she said.

But this did not happen in the new Finnish study.

Instead, the need for specialist psychiatric services—and therefore the scale of serious mental disorders—increased after medical transition, as the study by Professor Kaltiala and her colleagues reported.

What children are owed

Children have a right to “full development” and the protection of their future life choices, according to a Portuguese draft law that would ban puberty blockers and cross-sex hormones for gender-distressed minors.

The bill put up by the centre-right Christian democratic CDS-PP party secured enough support to pass its first reading in parliament on March 20, being approved in general and referred to the Committee on Constitutional Affairs, Rights, Freedoms and Guarantees for detailed debate and possible changes before a final vote.

CDS-PP is a member of the centre-right minority coalition government, the Democratic Alliance.

Portugal’s centre-left president, António Seguro, has the power to veto bills or promulgate them as law.1 Gender-affirming clinicians have launched a campaign against the proposed restriction of hormonal treatment for minors, claiming puberty blockers are “reversible” and resorting to the “transition or suicide” narrative.

Children as young as 11 are being referred for blockers at their first appointment in Portugal, and even primed on future surgery options during the same consultation, according to Youth in Transition, a Portuguese group of parents and young people opposed to gender medicalisation. Young adults are reportedly given cross-sex hormones with little caution or delay.

The CDS-PP draft law prohibiting paediatric hormonal treatment was one of three anti-gender ideology bills given first-reading approval by parliament last Friday with strong support across the political right.

Each bill seeks the repeal of Portugal’s 2018 trans-activist policy, which enabled legal sex change for adults without any medical oversight, and gave the same self-ID right to teenagers aged between 16 and 18 with parental approval and a health professional’s report.

The 2018 measure was “one of the most damaging gender self-identification laws in the European Union” and ended screening for co-morbidities such as autism, mental health issues, trauma and internalised homophobia, said Marisa Antunes, a Portuguese journalist who follows the gender issue.

“This law was passed in 2018 with virtually no public debate, with all left-wing parties voting in favour,” she said.

Its repeal, approved in principle by parliament on March 20, would reinstate a 2011 law requiring a medical certificate before an official change of name and sex.

Antunes said that key institutions in health—including the Portuguese Society of Clinical Sexology, the Order of Psychologists, and the College of Sexology of the Medical Order—were “ideologically captured”.

“They have joined forces to maintain the current [2018 trans] law and have presented to the parliament ‘scientific’ documents contesting the reliability of the Cass report, endorsing the World Professional Association for Transgender Health guidelines, and fiercely defending hormone blockers ... with no questioning at all by the media,” Antunes told GCN.

Since last Friday’s vote, she said, mainstream media coverage has kept recycling the story of “transgender people who struggle to be accepted” but made no reference to the plight of young people caught up in rapid-onset gender dysphoria.

However, on the eve of the historic vote, a prominent psychiatrist and suicide prevention researcher, Dr Ricardo Gusmão from the University of Porto, joined the debate to challenge the claims of the gender-affirming side.

On his LinkedIn page he published a summary of his devastating analysis of three scientific documents sent to the parliament by the Society of Clinical Sexology (SPSC), the Order of Psychologists (OPP), and a group of 210 health professionals—documents opposing reform of the 2018 trans policy and advocating for gender medicalisation.

Using the international GRADE system to rate the quality of research data, Dr Gusmão found that 80-92 per cent of the references cited in these three documents involved low-quality evidence or very low-quality evidence.

In his analysis, which he sent to parliament, he warned that the three documents in question ignored or underplayed—

the exponential international growth in demand for youth gender medicine and the possible role of social contagion;

the potential for puberty blockers to “interfere with brain and cognitive maturation during critical developmental windows”;

the doubtful capacity of minors to make irreversible medical decisions;

recent studies indicating a 10-30 per cent long-term detransition rate;

and “the medicalisation of homosexuality—concern that affirmative care may function as reverse conversion therapy for young people who would otherwise grow up to be LGB adults.”

“The opinions of the SPSC, the group of professionals and the OPP present themselves as technical-scientific but rely predominantly on evidence of very low or low quality,” Dr Gusmão said.

“By ignoring the most robust systematic [evidence] reviews of the last decade and the clinical paradigm shifts that have occurred in several European countries, they fail in their mission to guide political decision-makers on the basis of the highest standards of evidence.”

Dr Gusmão recommended that Portugal follow the more cautious trajectory of countries such as the UK, Finland and Sweden; classify hormonal treatments of minors as experimental and restrict them to research; and adopt psychotherapy and psychosocial support as the first-line treatment for youth gender distress.

The CDS-PP bill also notes the striking rise of restrictive policies on the treatment of minors with puberty blockers and cross-sex hormones in several countries as “the scientific evidence has increasingly been called into question”.

Ideology, not science

Paulo Núncio, who leads the CDS-PP in Portugal’s parliament, said “there is no scientific basis for administering puberty blockers [for gender dysphoria],” Euronews reported.

He said “ideology has replaced truth and science, and 12-year-old children have been turned into guinea pigs for ideological obsessions”. “It was the greatest delusion of wokeism against children in Portugal. These therapies must end, and now.”

The bill invokes the right of parents “in carrying out their irreplaceable role in relation to their children”, the right of a child to “full development”, and the need for “protection against situations that may compromise such development”.

It also cites the principle that “decisions taken during childhood must not disproportionately limit the individual’s future life choices before they reach sufficient maturity to fully exercise their autonomy”.

“Among the frequently cited concerns [about the use of puberty blockers to interrupt normal growth] are impacts on bone mineral density, neurocognitive development, psychosocial maturation, the exacerbation of psychiatric conditions—notably suicidal tendencies—and future fertility,” the bill says.

It references the European Academy of Paediatrics’ 2024 statement on youth gender dysphoria which acknowledges a qualified “compassionate grounds” argument for puberty blockers while conceding serious concerns about this “off-license” drug use.

“Although widely licensed to treat precocious puberty, [this drug] use in [gender dysphoria] is controversial, not least whether [this] use is experimental or innovative. Some countries now restrict [blockers] to research, or to an exceptional/case-by-case basis,” the academy’s statement says.

“[Puberty blockers] may irrevocably lead to the use of trans-sex hormones and surgical transition, so it may arguably compromise rather than facilitate freedom of choice.”

The Portuguese draft bill says: “In the case of interventions intended to interrupt or alter the natural course of puberty, decisions made during childhood have profound repercussions on physical, reproductive and psychological health throughout adulthood.

“The issue of minors’ legal capacity to consent to complex medical procedures with long-lasting consequences is therefore of particular importance, especially where such profound changes are involved as those considered in cases of gender incongruence or gender dysphoria.

“The greater the complexity, irreversibility or existential impact of a medical intervention, the greater the requirement for maturity and capacity to give valid and fully informed consent.”

The bill seeks to “protect the integrity of children” and would regulate both public and private healthcare.

It stipulates that—

“The prescription, dispensing or administration to minors under the age of 18 of medicines, hormone therapies, pharmacological treatments, or treatments of any other nature, intended for the hormonal blocking of puberty or the induction of characteristics corresponding to a sex different from the minor’s biological sex, in the context of gender incongruence or dysphoria, is prohibited.”

If enacted, the bill would make an exception allowing hormonal treatment of “minors with proven sexual ambiguity or endocrinological or genetic disorders, who are duly monitored by a medical and multidisciplinary team”.

Of the other two draft laws referred to the committee on March 20, the bill from the social democratic PSD party would tighten up the rules for legal sex change, while the bill from the populist-right Chega party would banish gender ideology from the school curriculum as well as prohibiting paediatric medical transition.

The trans-activist lobby Opus Diversidades deplored the bills as “a setback in terms of human rights in Portugal”. The well-funded LGBTI+ lobby, ILGA Portugal, has been prominent in the campaign to entrench gender ideology in state policy and to defend it from parliamentary reform.

GCN global briefs

Detrans clinic

America | A non-profit medical clinic for US detransitioners is in planning, a historic meeting of 70-plus detransitioners hosted by Genspect in Washington DC has heard. Katy Hurd, a Seattle-based family physician with her own history of gender dysphoria, told the March 12 Life Beyond Transition conference that the needs of detransitioners—including their complications from hormonal treatment and transgender surgery—represented an “abominable” gap in healthcare. She said the proposed Seattle area clinic might open a year after a start is made with a telehealth service in six months or so; some US$500,000 in funds would have to be raised.

Apart from detransitioners, the clinic would cater to people who are gender-questioning or those “who are mostly content with their transition but just want a second opinion”. Dr Hurd said she hoped the clinic could serve as a model for others.

But such clinics would not be able to charge for services until the ICD diagnostic system is updated with billing codes for detransition. Kurt Miceli of the medical watchdog group Do No Harm told the conference that a proposal for ICD codes covering desistance and detransition in its various forms would be put to the Centers for Disease Control and Prevention on March 17. Not only would new codes lead to better healthcare and insurance cover for detransitioners, they would also generate hard data disproving activist claims that transition regret is negligible.

On litigation, a conference panel of lawyers addressed the popular misconception that lawsuits should have swiftly and easily shut down the abuses of paediatric gender medicine. The obstacles and delays facing detransitioner claims included short statutes of limitations barring actions in many states, low caps on damages awards, the hefty cost of expert reports for plaintiffs, and the time chewed up by appeal points.

Even so, the recent $2 million award to detransitioner Fox Varian showed the potential for claims by vulnerable young people to succeed if they can be brought before a jury. Such awards, settlements and even unsuccessful claims could influence legislators to extend statutes of limitations and cause hospital risk managers to back away from paediatric gender medicine. The panel agreed that crunch time would come when medical indemnity insurers withdrew coverage for puberty blockers, cross-sex hormones and gender surgery, exposing doctors to personal liability.

“Because if there’s a $20 million verdict against a surgeon, instead of it being capped and the insurance company paying for it, that surgeon is losing his house,” litigator Kevin Keller said. “He’s uncovered, personally exposed ... that’s what will make them stop doing this.”

Detrans chat

International | Web developer Peter James Steven has created an AI chatbot to disseminate the stories of detransitioners. He came to the topic knowing people who had seen transition as the only answer to their plight. Then he discovered other answers in detransition narratives. “Ethical healthcare would prioritise helping people work through their problems and learn to love themselves,” he says.

“Gender-affirming care is a band-aid solution that’s deployed with an ideological rigidity that shuts down alternatives. Detrans AI exists to make those alternatives visible: people who worked through their distress, who found other paths, who want their stories counted in a conversation that currently excludes them.” His Q&A chatbot, which mines the Reddit r/detrans community and YouTube, is available in 33 languages.

Not so cautious

Sweden | Some gender clinics are ignoring Sweden’s strict national guidelines and pushing ahead with puberty blockers and cross-sex hormones for minors, the Göteborgs-Posten newspaper has reported. In 2022, the country’s National Board of Health and Welfare issued new guidelines, acknowledging the weak evidence base and advising these hormonal treatments only be given in “exceptional” cases outside clinical trials. But new countrywide figures for 2024 show small increases in the total number of minors on blockers (70, up by 2) and hormones (171, up 6) compared with the year before the board’s 2022 guidelines.

“Several clinics have continued with hormone treatment even though [the board] advises against it in most cases,” Göteborgs-Posten said in its article headlined “Transition of children continues: did we really pull the emergency brake?”.

Marking their own homework

The Netherlands | Dutch Health Minister Sophie Hermans has defended the credibility of an inquiry into the medico-legal compliance of paediatric gender medicine in the country that created the “Dutch protocol”. In December last year, legal scholar Professor Lodewijk Smeehuijzen published a critique of the inquiry by the independent Health Council. He raised concerns about its committee makeup, bias and conflicts of interest likely to favour the Dutch protocol. “According to Smeehuijzen, the Health Council’s advisory committee is poorly equipped to meet that mandate,” Hermes Postma wrote for Genspect’s Substack, Inspecting Gender.

“Of its twelve members, six are directly or indirectly involved in prescribing puberty blockers or cross-sex hormones, and several are affiliated with the institutions that developed, implemented, and publicly defended the Dutch protocol. Those same institutions would face significant reputational, professional, and potentially legal consequences if the practice were deemed unlawful or scientifically unsound.”

In her March 9 response to parliamentary questions about the Smeehuijzen critique, Minister Hermans said it was the responsibility of the Health Council to guarantee the independence of its advice. On the crossover between committee members and practitioners of the Dutch protocol, Hermans said the council had given consideration to “whether the [appointed] experts came from different university medical centres, universities and research institutions”.

“The committee also consulted various clinical experts from England, France, Germany and Sweden, with varying perspectives on transgender care for young people.” Professor Smeehuijzen had been invited by the council to “share his knowledge and objections”. Hermans said the Dutch Cabinet would send its policy response to the parliament once the council’s advice was published, which is now expected to be in the second quarter of this year.

A retrospective chart study at the Amsterdam gender clinic most associated with the Dutch protocol has found that not meeting the criteria for a gender dysphoria diagnosis and serious mental health problems were the two main reasons for under-18 patients not going down the path to hormonal treatment. Even so, roughly a quarter of those not medicalised had received a dysphoria diagnosis. Of 1,470 patients given a first assessment between 2009 and 2019, 264 did not proceed to puberty blockers or cross-sex hormones; 76 of those patients were re-referred to the clinic as adults.

“These findings underline the importance of comprehensive diagnostic exploratory trajectories with a holistic and developmental approach, also focusing on whether adolescence is the right timing for [hormonal treatment], before considering any medical interventions in gender incongruent youth,” the researchers said. Their paper concedes that social media and peer networks are one possible reason for the international surge in youth gender clinic caseloads.

Dr Oz weighs in

America | A senior health official in the Trump Administration, Mehmet Oz, who is Administrator for the Centers for Medicare & Medicaid Services, has intervened in the dispute over the shutdown of the paediatric gender clinic at NYU Langone Medical Center. New York state Attorney General Letitia James has threatened legal action if the clinic is not reopened. In a letter to James, Dr Oz defended the shutdown, saying “Our children are not guinea pigs,” The New York Post reported.

“Given that emerging medical evidence continues to demonstrate the harm these procedures inflict on children, it is both irresponsible and false to declare the other side of this ongoing scientific debate definitively ‘medically necessary.’” Dr Oz continued, “It is worse still to compel doctors to perform procedures that remain the subject of substantial dispute. It is also unethical. Your claim that discontinuing these interventions constitutes unlawful discrimination is irresponsible.”

Missing data

Australia | “Six of Australia’s eight states and territories have refused to release any data on the number of children prescribed puberty blockers to treat gender dysphoria, maintaining a veil of secrecy that prevents proper oversight of the highly controversial treatment,” The Australian has reported. The newspaper quoted experts saying this lack of information would not be considered acceptable for any other medical condition. An analysis of incomplete data obtained under Freedom of Information law suggested at least 2,387 children were put on hormone suppression for gender dysphoria between 2014 and 2025.

The state of Queensland has paused new prescriptions of blockers and hormones for minors with gender dysphoria on safety grounds. As a senior staffer at the Queensland Children’s Hospital, home to a paediatric gender clinic, psychiatrist Jillian Spencer was an early voice for caution but was accused of misconduct for speaking out publicly. A termination letter sent her last year by hospital management may have been an unlawful reprisal action, according to the state Crime and Corruption Commission, The Courier-Mail has reported. However, the commission said it would not intervene while Dr Spencer was fighting for her job in separate court proceedings.

Misguided

International | A quality assessment of the World Professional Association for Transgender Health’s current standards of care, known as SOC-8, has found “important flaws in their development, notably a lack of scientific rigor and opaque conflict of interest management, which could undermine the trust in these recommendations”. The project, involving eight assessors with “diverse views”, advised against uncritical adoption by clinicians of the WPATH treatment standards. “The methodology limitations of the guidelines could hinder the delivery of optimal healthcare to vulnerable youth,” the peer-reviewed evaluation paper warns.

WPATH’s document, crafted with a view to securing insurance coverage and fending off litigation, suffers from debilitating internal contradictions, according to an article in The Dispatch. Joseph Figliolia writes that “while less attuned observers tend to assume that ostensible safety guardrails and nods to psychological assessment in WPATH’s guidelines make patient regret and harm unlikely, the guidelines’ emphasis on affirmation is at odds with the clinical concept of ‘differential diagnosis’.”

“WPATH’s guidelines implicitly deprioritize differential diagnosis—drawing clinically meaningful distinctions between disorders that have overlapping symptoms or expressions—by maintaining that other complex mental health challenges are really just secondary to the experience of dysphoria, and not possible drivers of distress.

“[And] despite often deploying the language of ‘medical necessity,’ WPATH’s SOC-8 pulls a bait and switch by embracing the ‘gender incongruence’ classification—as opposed to ‘gender dysphoria’—which removes distress as key diagnostic feature and conceptualizes ‘gender diversity’ as a normal, entirely non-pathological way of being in the world. It’s unclear, however, how this understanding of ‘gender incongruence’ necessitates the need for invasive medical interventions.”

More proof of no proof

United Kingdom | The National Health Service has released ten new systematic reviews of the evidence on puberty blockers and cross-sex hormones for minors, following its decision to pause hormone use with 16 and 17-year-olds for lack of good evidence. “The new reviews add to a list of now over 20 systematic reviews, all of which come to the conclusion: evidence is insufficient to support the practice of pediatric medical gender transition,” the Society for Evidence-based Gender Medicine said. The NHS documents also note that the service is reviewing the evidence for cross-sex hormones use by adults.

More US manoeuvres

America | Texas congressman Dan Crenshaw has introduced to the House of Representatives a federal bill to frustrate the practice of Democratic states setting themselves up as “trans sanctuaries” for minors fleeing restrictions on medical transition in Republican states. “Children should not be transported across state lines to undergo irreversible medical procedures that are abusive and harmful just to circumvent home state laws or keep parents and guardians in the dark,” said Crenshaw, a Republican.

The US Department of Health and Human Services is investigating a series of “federally qualified health centers”—among them Whitman-Walker Health in Washington, DC—over what it describes as “sex-rejecting procedures”. And Republican Senator Bill Cassidy, a physician, has asked the Department of Health and Human Services (HHS) to release emails and communications written by the agency’s Biden-era assistant secretary Rachel Levine, a paediatrician and trans-identified male who aggressively promoted medical transition for minors, The Daily Wire has reported. The communications sought include interactions about the trans agenda between Dr Levine, the White House and medical organisations.

Gender colonialism

International | Genspect has published an essay illuminating for anyone curious about the claim that indigenous traditions lend credence to gender ideology. “Rather than ‘indigenous ways of knowing’ teaching us more expansive definitions of gender, indigenous peoples [in Southeast Asia] have been sexually exploited by a prostitution and transition industry built on the customer’s gender stereotypes, constantly in search of the novel and the exotic-erotic in order to develop and grow new markets,” the essay says. The customers were often served up by European colonialism.

Consumer shield

America | The US Federal Trade Commission has launched a consumer protection investigation into the American Academy of Pediatrics (AAP) and the World Professional Association for Transgender Health (WPATH), Bloomberg has reported. The commission sent legal demands for documents and testimony to both entities on January 15 relevant to whether they have made false or unsubstantiated claims when marketing treatment for paediatric gender dysphoria.

Those demands include all WPATH’s communications with medical organisations over its current treatment standards, known as SOC-8, as well as all communications related to the systematic evidence reviews requested from Johns Hopkins University. AAP is being asked for information on the development of its contentious 2018 “affirmation-only” policy statement, including all participating individuals and entities and any funding source. Both AAP and WPATH challenge the commission’s authority to take this action. In July 2025, the commission held a workshop on “The Dangers of ‘Gender-Affirming Care’ for Minors”.

Not popular

America | A new poll of Democratic supporters reveals more mainstream, cautious attitudes than suggested by party policy. The Manhattan Institute poll involved 2,593 people who were either registered Democrats and/or voted for Kamala Harris in 2024. Only 21 per cent of respondents agreed with transgender medical interventions under 18. Only 32 per cent of radical respondents, described as “woke fringe”, endorsed these interventions for minors.

As time goes by, public opposition to paediatric medical transition is becoming more pronounced in the US. In a recent survey by The Argument of 3,003 registered voters, 56 per cent were against puberty blockers and cross-sex hormones for minors, even with “doctoral and parental consent”. A substantial minority of voters (31 per cent) for Kamala Harris also vetoed these medical interventions. On gender surgery for minors, 62 per cent were in opposition, including 45 per cent of parents who voted for Harris. The Argument, a Left-leaning Substack, said “it’s worth noting that Americans used to be more progressive on these issues. Even as late as 2024, Gallup found a majority of voters more aligned with the progressive viewpoint on this. The backsliding on this is sharp and recent.”

The Manhattan Institute’s Leor Sapir noted that those polled did not appear very reassured by the fact that doctors were advising these medical treatments. “The poll’s results thus imply that Americans don’t trust doctors—in particular, it would seem, doctors with ‘gender’ expertise—to make the right decision when it comes to helping children and adolescents who experience discomfort with their sex,” Sapir said.

It’s what lawyers do

New Zealand | A finding of unsatisfactory conduct against a lawyer who warned gender clinicians about their exposure to legal liability has been overturned. Acting for clients, Stephen Franks of Franks Ogilvie sent letters last year to 20 health practitioners warning them of the potential legal risks in prescribing gender medicine such as puberty blockers. After complaints, a New Zealand Law Society committee found Franks had used the law “for an improper purpose, including for the purpose of causing unnecessary distress to another person’s reputation or occupation”.

That finding “cannot stand”, according to a recent decision by Legal Complaints Review Officer Fraser Goldsmith. “The very purpose of a lawyer or firm sending a letter on behalf of a client is, in many if not most instances, to endeavour to lend weight to whatever concern, position or purpose the client seeks to express or advance. That is what lawyers do. This is why a client comes to its lawyer and says, ‘we need a lawyer’s letter about this’. This cannot conceivably be improper in principle.” Goldsmith also noted that none of the six people who complained had received the letter. Since Franks sent the warning, the NZ government has announced a policy banning new prescription of puberty blockers. A judicial review challenging that policy is to be heard in May.

Big spend

America | More than US$ 135 million was spent on paediatric gender medicine over five years from 2019, according to an analysis of US congressional budget data published in the journal JAMA Pediatrics. That amount was paid under the government Medicaid fund and the Children’s Health Insurance Program. The lion’s share was accounted for by off-label puberty blocker drugs, the rest spent on surgery and cross-sex hormones.

“This sum [of $135m] likely marks the end, at least for now, of substantial public spending on these medical interventions, given the intense and widespread opposition among Republican elected officials to paediatric gender medicine,” journalist Benjamin Ryan reported.

GCN global briefs

Teen hormones on hold

United Kingdom | The National Health Service (NHS) has announced it will pause new prescriptions of cross-sex hormones for minors, the BBC has reported. A small number of teenagers would be affected, according to the NHS. Activist group TransLucent said it would consider litigation against the decision.

After the 2024 Cass review highlighted the very weak evidence base, the NHS was told to take “extreme caution” before giving 16 and 17-year-olds hormones; under-16 prescribing was not allowed. On March 9, the BBC reported, a 90-day consultation would begin, ahead of longer-term NHS policy on cross-sex hormone treatment for teenagers.

If 16- and 17-year-olds can no longer access NHS hormones, it would mark the end of the “Dutch protocol” for gender reassignment of minors within the public system, where routine supply of puberty blockers has already stopped. It would also undermine the rationale for the puberty blocker trial, since most patients are expected to progress to hormones. (Teens already on NHS hormones can continue, subject to clinical review.)

Professor James Palmer, national medical director for specialised services at NHS England, said that following the Cass review, there had been “an in-depth review of all available clinical evidence for using oestrogen or testosterone either alone or with other medications to treat gender incongruence and dysphoria. This review has established that the available evidence does not support the continued use of masculinising or feminising hormones to treat gender incongruence or dysphoria for young people under 18.”

The Sunday Mail newspaper cited an internal NHS document “which acknowledges that injecting oestrogen and testosterone [as cross-sex hormones] can cause blood clots, breast cancer, heart disease, stroke and ‘impaired sexual function’.” Hormones are still available through UK private health and unregulated online suppliers.

Meanwhile, doctors have called for urgent investigation of trans activist groups advising young people how to use hormones obtained on the black market, The Times said. “To have organisations that facilitate self-medicalisation with no clinical oversight is dangerous,” one Scottish GP told the paper. “The greatest harm is in the prescribing of cross-sex hormones. These are used off-licence and there is mounting evidence of the increased risk of irreversible harms, which include stroke, ischaemic heart disease and early mortality.”

No more secrecy

America | State policies requiring teachers to keep parents in the dark about their child’s gender transition at school are likely to be unconstitutional. In the Mirabelli case, a majority of judges on the US Supreme Court have held that the plaintiff parents may well succeed in their constitutional challenge to California’s “gender secrecy” policy. The rights cited by parents included the free exercise of religion under the First Amendment and the due process clause of the Fourteenth Amendment. The court reinstated an injunction stopping enforcement of the California State policy pending a lower court appeal.

One set of parents in the case only discovered their daughter had transitioned at school after a suicide attempt. “The State [of California] argues that its policies advance a compelling interest in student safety and privacy,” the March 2 per curiam decision of the Supreme Court said. “But those policies cut out the primary protectors of children’s best interests: their parents.”

“Everyone agrees that children’s safety is the overriding equity. And the injunction here promotes child safety by guaranteeing fit parents a role in some of the most consequential decisions in their children’s lives. The injunction also permits the State to shield children from unfit parents by enforcing child-abuse laws and removing children from parental custody in appropriate cases,” the court said.

Law firm Thomas More Society—representing plaintiffs including Elizabeth Mirabelli and another teacher, Lori West, who did not wish to lie to parents—said the 6-3 ruling was “the most significant parental rights ruling in a generation”. The firm’s special counsel Paula M Jonna said: “The Supreme Court has told California and every State in the nation in no uncertain terms: you cannot secretly transition a child behind a parent’s back”. For more commentary, see National Review, US government officials responsible for health and families, City Journal and Fox News.

Silenced

Australia | A petition has been launched in protest against the silencing of a psychiatrist, Andrew Amos, who has been a prominent critic of the gender-affirming medicalisation of children. The Australian Health Practitioner Regulation Agency (Ahpra) has ordered him to cease social media commentary “in relation to gender medicine, gender identity and/or expression, and transgender persons”. Trans activists had complained about Dr Amos.

A petition calling on Ahpra to “uncensor” him has been started by West Australian politician Maryka Groenewald of the Australian Christians party. “As a medical professional, Dr Amos has every right to speak out on the critical risks of puberty blockers and so‑called ‘gender-affirming care’ for children,” the petition says.

The Australian newspaper reported that Ahpra’s Medical Board used its “immediate action” power to move against Dr Amos; that power requires the board to have “a reasonable belief there may be a serious risk to people and it is necessary to take action … to protect the public”. The Board placed restrictions on him seeing patients, despite his focus being academic.

The Medical Board code of conduct for doctors prescribes a vague “cultural safety” and “respect” for “gender identities”. Its material defines “gender fluid” people as those who “can be one gender, multiple genders or no gender”. Ahpra as an institution shows the influence of gender ideology.

Category error: Psychiatrist Andrew Amos discusses his view that gender-affirming care is at its core a political strategy rather than a medical model

About that consensus

America | Marking an important shift, The New York Times has published an opinion article concluding that the science is not “so settled” in favour of paediatric gender medicine after all. The article by journalist Jesse Singal cites the shift to caution on gender surgery for minors by the American Society of Plastic Surgeons (ASPS) and the American Medical Association (AMA). No longer could the weakness of the evidence base be countered with the seemingly reassuring line that every major medical association in the US endorsed gender-affirming care. Singal also suggested that the apparent medical consensus, while it lasted, relied on activist capture of policymaking and low-quality treatment guidelines engaging in deceptive, circular referencing.

In The Atlantic, writer Helen Lewis had a similar message. “As the shaky evidence base for youth gender medicine has become better known, activists have retreated to an argument from authority,” she wrote. Lobby groups such as the American Civil Liberties Union and GLAAD, as well as the Democratic Party, have cried “medical consensus” when confronted with proof after proof that puberty blockers and cross-sex hormones rest on very poor scientific evidence. The Lewis article was headlined “The Tide Goes Out on Youth Gender Medicine”. The Free Press hosted a panel discussion, with Singal included, on the vibe shift.

In a letter to the AMA, 20 state attorneys-general, led by Alabama Republican Steve Marshall, pointed up the tension between the association’s new concession of the weak evidence for under-age gender surgery and its continued advocacy for hormonal treatment. “Our concern is that the evidence base is similarly lacking when it comes to the provision of puberty blockers and cross-sex hormones to treat gender dysphoria in minors,” the letter says.

In a video interview with journalist Lisa Selin Davis, surgeon Scott Glasberg, a past president of the ASPS, explained the background to the new cautious position of the society; a key driver was the fact that the evidence for paediatric gender surgery was of low quality and low certainty.

Dr Glasberg recalled claims that “these were lifesaving procedures” improving mental health. “The data hasn’t panned that out yet,” he said, citing a number of systematic evidence reviews. These included the McMaster University review of surgery for patients under age 26—commissioned by the Society for Evidence-based Gender Medicine—as well as the Cass review of the hormonal treatments that may lead to surgery. Gender surgeons have pressured the ASPS to abandon its new cautious policy. The society is standing by its position, according to Brian Christine, assistant secretary with the US Department of Health and Human Services.

Cancel corner

United Kingdom | A doctor who played a key role in the decision to pause the UK clinical trial of children on puberty blockers has been recused by the Medicines and Healthcare products Regulatory Agency (MHRA) from further oversight of the research. This followed a media report on past social media posts by Professor Jacob George expressing views that are gender critical and biologically realist. None of the posts concerned the clinical trial. Professor George took up his role as chief medical and scientific officer at the MHRA in January, one month before the MHRA’s letter raising concerns about the trial.

However, reporting by journalist Hannah Barnes reveals that the MHRA had serious concerns about the trial before last November when it gave approval for it to go ahead. “Most significantly, the MHRA argued that the study’s follow-up period for the children taking part was ‘inadequate to assess the long-term benefits and risks’ of suppressing puberty in this group of children and young people,” Barnes wrote. The MHRA accepted reassurances from the research team running the trial at King’s College London.

The Barnes article for The New Statesman also identifies shortcomings in the process leading up to the trial’s approval from the Research Ethics Committee. All this predated the controversy over Professor George’s social media history. The MHRA said there was “no evidence to suggest that decisions taken [by Professor Barnes on the trial] were not impartial”, but he was being recused “as a precaution”.

Journalist Sonia Sodha criticised Professor George’s removal for mainstream beliefs based on science and evidence—for example, that men should not be able to self-identify into women’s sport—with “no direct connection” to his responsibilities at the MHRA. “Citizen detectives on X have already uncovered social media posts from others involved in signing off clinical trials expressing sentiments aligned with a belief in gender ideology—will they be recused from anything to do with puberty blocker trials too? Where does this stop?” Sadha wrote.

The group Sex Matters, which advocates for biological reality, said Professor George should be reinstated. In a letter to the MHRA, the group said he was the victim “of a media witch-hunt against him for expressing [legally protected] ‘gender-critical’ beliefs”. One of Professor George’s posts, predating his MHRA appointment, bemoaned the “well-meaning idiocy” of those in the NHS denying the “basic biological fact” that sex is fixed at birth.

The Committee for Academic Freedom said public officials were “not required to be opinion-free” and noted there was no finding of wrongdoing against Professor George. “Academic careers—particularly in medicine and the life sciences—are built not only on publications, but on participation in regulatory panels, advisory committees and clinical trial leadership,” the committee said. “If lawful views expressed on live public controversies can later trigger removal from such roles absent any proven partiality, researchers will draw rational conclusions about the career risks of speaking plainly.”

Australia | A gender service in the regional city of Cairns has been the subject of a damning inquiry. “Children as young as 12 were prescribed puberty blockers without adequate assessment, documentation or monitoring [at the Cairns service]; staff feared ­reprisal when speaking up about patient safety concerns; and parents who objected to the treatment were alienated,” The Australian newspaper reported.

The inquiry’s findings were covered with unusual accuracy by Australia’s public broadcaster, the ABC, which for years has uncritically promoted paediatric gender medicine. The taxpayer-funded ABC has disseminated gender identity ideology in its search for success in the “workplace equality” competition run by ACON, a former gay rights body turned trans lobby.

“Newly released documents show how the ABC won platinum status last year with trans lobby group ACON after pledging to use its unique position to push the advocacy group’s agenda in its on-air journalism and programming,” The Australian reported on March 9.

“But the ABC has refused to reveal key documents submitted to ACON in its chase for gold and platinum over the last two years, despite a promise by managing director Hugh Marks to review links with the lobby group after The Australian exposed repeated breaches of the broadcaster’s editorial standards.”

Lawsuits

America | The landmark $2m damages award to US detransitioner Fox Varian continues to generate commentary. The Economist said doctors should take seriously the threat of “a flood of medical-malpractice claims”. To support its view the magazine cited Varian’s victory in court, as well as the new policy of the American Society of Plastic Surgeons (ASPS) opposing gender surgery for anyone under age 19. On its editorial page The Wall Street Journal welcomed the surgeons’ cautious policy as “Good Sense on Transgender Children”.

However, retired lawyer Peter Sim, who follows the gender medicine debate, said the New York jury’s verdict for Varian might not herald a wave of successful detransition lawsuits. The obstacles noted by Sim include short statutes of limitations blocking claims, capped damages awards in many US states, and the new more defendant-friendly standards of care, SOC-8, issued by the World Professional Association for Transgender Health (WPATH).

The Fox Varian litigation was fought on SOC-7, a standard of care that the defendants did not meet. WPATH president-elect Loren Schechter testified in the case that that in his opinion the WPATH recommendations did not represent the standard of care in the legal sense, meaning the benchmark for judging in litigation what a reasonable doctor ought to do with a given patient.

The Fox Varian verdict, and the ASPS-AMA shift away from paediatric gender surgery, were picked up in France by the newspaper Le Figaro. The Australian Society of Plastic Surgeons, asked for its reaction by The Australian, refused to state a position on gender surgery for minors; it is seeking universal public funding for these procedures for anyone 18 or above who has “gender incongruence”, a depathologised condition involving no need for any psychological distress. The Canadian Society of Plastic Surgeons did not respond to a request for public comment on the issue of under-18 gender surgery.

Approved, until it wasn’t

A talk to familiarise Australian family doctors with a safer treatment approach to youth gender dysphoria will not go ahead as planned after a medical college buckled to activist pressure.

The well-subscribed March 10 webinar presentation by Finnish psychiatrist Riittakerttu Kaltiala—a leading clinician and researcher in the international shift away from routine “gender-affirming” medicalisation of minors—had been approved and advertised since the New Year by the Royal Australian College of General Practitioners (RACGP).1

(UPDATE | Professor Kaltiala said the conduct of the RACGP was not “appropriate and polite,” The Australian newspaper reported on March 7. “It is obvious that there are parties who want to control what Australian GPs hear.”)

GP Louise Kirby, who was among the more than 200 subscribers who signed up for the RACGP event, told GCN—

“We’ve reached a point where presenting outcome data is called harmful, and where speaking out to protect children from irreversible, damaging interventions is incorrectly framed as an attack on children. That inversion should alarm every clinician”.

Professor Kaltiala set up paediatric gender services in Finland 15 years ago on the strength of promising results reported by the famous Amsterdam gender clinic, which pioneered the puberty blocker-driven “Dutch protocol” of gender reassignment for minors.

But Professor Kaltiala and her colleagues were confronted by quite a different group of often psychiatrically troubled adolescent patients—chiefly female adolescents with no early childhood history of gender dysphoria—who did not do well after medical transition.

This poorly understood shift in patient profile would become dominant internationally, including in Australia.

In 2020, following a systematic review of the evidence, Finland became the first country to adopt a more cautious treatment policy, declaring medical reassignment for minors “experimental” and prioritising mainstream mental health interventions.

Professor Kaltiala’s webinar for the RACGP was approved, and doctors attending could count this learning activity towards their “continuous professional development” (CPD).

On March 3, subscribers to the webinar—titled “Medical gender reassignment among minors: why are we cautious in Finland”—received an automated reminder about the event.

But members of the activist group GPDU for Gender-Affirming Healthcare, which has transgender activist Teddy Cook among its administrators, had already been orchestrating complaints about the Kaltiala webinar and sharing the email address of RACGP president Michael Wright.2

One GPDU member posted: “This is one of those situations where volume of concern (i.e., multiple individual complaints) would be considered helpful … If you struggle to write letters, I am happy to email you what I wrote”.

The network of the gender medicine lobby, the Australian Professional Association for Trans Health (AusPATH), was also mobilised against the webinar. The email of the RACGP’s chief executive, Georgina van de Water, was circulated.

Complaints to the RACGP claimed the webinar showed “hostility to trans people”, would imperil “patient safety”, expose the college to a backlash and damage its reputation.

The title of Professor Kaltiala’s presentation mirrors that of a peer-reviewed article in which she explains Finland’s shift to caution. She has also written about this for The Free Press.

The RACGP webpage for her March 10 talk had included a trigger warning—

“This webinar will discuss sensitive topics related to gender identity in young people, including differing clinical perspectives and international treatment approaches in order to assist GPs to make their own evidence-based decision.

“Some content may be challenging for attendees. Please engage in ways that feel comfortable for you”.

Disappearing act: The RACGP webpage promoting the Kaltiala talk

Change of heart

On March 4, an email from the RACGP announced a “postponement and format change”, insisting the webinar had not been cancelled.

Citing “constructive feedback” and “many strong views held from across the RACGP membership”, the college said it had decided—

“… this topic would be best redesigned as a panel discussion, which will allow us to holistically engage with the sensitivities and nuance associated with transgender and gender-diverse healthcare”.

No details on timing or panel membership were given. There was no undertaking that Professor Kaltiala would be included.

On the RACGP webpage advertising the Kaltiala talk, her name and the outline of her presentation have been removed. The title of her session remains.

A March 4 update note from Associate Professor Jeremy Hudson, who chairs the specific interests council for the college, says: “This topic should not be cancelled. It is complex, evolving and important. A panel discussion will allow a broader range of expertise, a stronger evidence base, and a safer environment for professional dialogue.”

“Redesigning this session means identifying appropriate panel members and refining the format. This will require a delay and we will share a new date once confirmed.”

Gender-affirming clinicians and trans activists have a track record of refusing to debate their critics, smearing them as “anti-trans” and saying they would feel “unsafe” to share a panel with them.

On March 6, subscribers to the Kaltiala webinar were sent an automated message that it had been “cancelled”.

Double standard

The RACGP has promoted the gender-affirming model without alerting doctors to critiques or less invasive treatment approaches.

In June 2025, a learning activity worth five hours of CPD was offered on “Gender and gender diversity”.

“The purpose of this activity is to demonstrate how general practitioners can positively influence the lives of gender diverse individuals through gender-affirming healthcare,” the CPD webpage says.

The college’s Australian Journal of General Practice has published articles uncritically advocating for gender medicine. AusPATH’s fast-track “informed consent” guideline for hormones is recognised as an “accepted clinical resource” by the college.

The gender-affirming treatment model has been shielded from critical inquiry and scepticism internationally by activist capture of small policy-making committees in medical associations, one-sided media coverage, low-quality treatment guidelines exaggerating the scientific evidence for the model, and the silencing of dissenters as purveyors of “hate”, “bigotry” and “transphobia”.

This creates a deceptive appearance of medical consensus in favour of puberty blockers, cross-sex hormones and surgery for young people.

Suppression: Oxford University sociologist Michael Biggs on the emergence of the very novel idea that puberty is a disease, even “torture”

Expertise withheld

Dr Kirby, who was among the doctors hoping the Kaltiala webinar would go ahead, characterised her own position as opposing “medical and surgical interventions on children and adolescents confused or distressed about the natural process of puberty”.

She said she and her GP colleagues had been denied the benefit of learning from the experience of Professor Kaltiala as “a world-class clinician”.

“Replacing a world-class, evidence-based speaker with a ‘panel discussion’ isn’t balance. It is effectively a veto,” Dr Kirby told GCN.

“The RACGP has signalled that activist pressure outweighs clinical evidence.

“Finland reviewed its own evidence and changed course. Australian doctors registered in large numbers to hear why. The RACGP’s response was to shut that conversation down. What exactly are they afraid GPs will conclude?

“Primum non nocere—First, do no harm—cannot be practised by doctors who are forbidden from examining evidence of harm. Silencing Dr Kaltiala under the pretence of a postponement and panel creation doesn’t protect patients. It protects a treatment model from scrutiny.”

The gender medicine lobby sees the family practices of GPs as vital to expanding and mainstreaming cross-sex hormones for teenagers, given the long waiting lists for children’s hospital gender clinics.

In Queensland, where the government has stopped new hormonal treatment in the public health sector, GPs are being recruited to prescribe puberty blocker drugs for children.

Not all members of the gender-affirming GPDU group were opposed to hearing from Professor Kaltiala. One member posted: “I feel clear about what my position is and feel like I could effectively articulate why I disagree with the approach [advocated by Professor Kaltiala]”.

Professor Kaltiala is chief psychiatrist at Finland’s Tampere University Hospital and professor of adolescent psychiatry at Tampere University. She is a prolific researcher in the field of youth gender dysphoria.

GCN sought comment from her and put questions to the RACGP.