‘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.

Queering reality

For all the cries of “Protect trans kids”, transgender health policy did not evolve from concern about the well-being of gender-confused children but from a clearly stated political aim to break down social norms of gender and sexuality. The intention of the early trans activists was to legitimise all forms of sexual expression, most of which are male sexual behaviours and some currently illegal (e.g., exhibitionism, voyeurism), without regard for the rights and well-being of affected children and females.

While current supporters may genuinely believe they have the best interests of “trans kids” at heart, the reckless nature of the “gender-affirming” treatment model poses a risk to youth welfare.

Indoctrination

Child indoctrination is the process of teaching children to uncritically accept a set of beliefs, values or ideologies.

When schools teach children only one version of “gender identity”—such as the claim that feeling uncomfortable in their body or anxiety about puberty means they could be in the wrong body—this is indoctrination, not education.

When the contents of the program are kept secret from parents, it suggests conscious indoctrination. Otherwise, the designers of these programs would welcome parent input and the opportunity to discuss any concerns. No doubt there are presenters who believe the gender ideology they teach. Others just go along with it because they know any criticism will be punished.

When these programs allow the child to uncritically embrace the new ideals and associated behaviours—such as social transition at school without parental knowledge or consent—it is clear the presenters are seeking converts to their cause.

These programs are presenting an ideology with the aim of significant social change, regardless of the welfare of the child or the distress of the parents. Children are taught that a person’s gender identity is independent of their biological sex or anatomy and that they can define their own gender, including non-binary identities that are neither “boy” nor “girl”. They are encouraged to find their “preferred pronouns” and given support to transition at school, which is kept secret from parents, allowing this new belief to be acted out and reinforced in real life.

Trans activists have perfected the art of using all media platforms and public events to justify their intrusion into school curricula by establishing a brand slogan, “Protect trans kids”, that portrays any child who questions their gender as a member of the most marginalised, vulnerable group in society. But are gender-questioning young people really that special?

Vulnerable children in care are just one example of a deserving group that could benefit from even a small portion of the funding and attention given to trans health services. The plight of those in our child protection and youth justice systems is described in a 2024 report by the Australian Human Rights Commission into systemic barriers to supporting vulnerable children in care. It covers a 12-year period and identifies inadequate levels of investment; inadequate levels of information sharing and collaboration; limited workforce capacity and support; a lack of mechanisms for oversight, monitoring and transparency; and limited opportunities for children to participate and be heard.

“Children in contact with the child protection and youth justice systems have complex needs such as poverty, marginalisation, systemic racism, disabilities, learning problems, and poor mental and physical health. And we know the systems that are meant to help them are not fit-for-purpose,” Commissioner Anne Hollonds said.

Compare this to the extent of dedicated healthcare programs for gender-questioning children and young people, the training of education and health staff, the focus on the perceived needs of this group in health and education services, and the ongoing effort to keep trans issues at the forefront of community and health concerns.

Social influence

The impact of social media on the mental health of young people is well established, such that Australia’s government has banned under-16 access to some platforms. It takes high levels of denial to claim that the dramatic increase in gender-questioning young people had nothing to do with their exposure to gender ideology on social media.

Trans advocates are inventive in the way they keep trans issues front and centre on the social agenda. Here are some of the events promoting trans ideology scheduled for March 2026 in Australia—

• Trans Day of Visibility (TDOV) March 31, 2026:

  • Dr Yves Rees in Conversation: Reservoir Library, Victoria, celebrating the annual day of awareness

  • Trans Day of Visibility Pride in Diversity: Various national events focused on inclusion, including in-person and online initiatives

  • “You Can’t Ask That” TDOV Panel (Online): A candid, conversational-style panel about gender diversity, visibility and real inclusion

  • Trans Joy Swim and Gym (State of NSW): Held at Cook + Phillip Park Pool, Sydney, on March 29

• Trans Day of Vengeance 2026: A fundraiser supporting the Incarcerated Trans and Gender-Diverse Community Fund and RISE Refugees.

• Midsumma Pride March 2026: A major, visible demonstration of support and community in Melbourne

• MEDUSA Trans Visibility Party (March 29, 2026, NSW)

• Pride in Protest TDOV Rally (March 30, 2026, NSW)

Only a naïve health professional would rule out social influence as a major factor in the high rate of trans identification in young people.

Adolescent challenges

It is disturbing to think about what it will take to reduce the influence of gender ideology on the healthcare of a group of confused young people. They aren’t confused about their gender so much as confused about the pathway through adolescence and puberty, at a time when being average is considered to be social failure.

More than ever, young people are under pressure to be individuals, yet fit in with the group. They are told they can be anything they want, reach any goals, if they try hard enough. The reality is, of course, that most people are under the bell curve as average, ordinary individuals who will meet daily challenges in an average way.

Queer activists play on the tension between wanting to be special, yet wanting to fit in. It is difficult to break through all the noise created by trans activists signalling that transition is the cure for this distress.

What is needed now is for concerned health professionals, educators, parents, journalists—anyone who sees the damage this indoctrination of children is causing—to take a step back from the trans issue and start providing information on how to help young people in general to negotiate the pathway through adolescence.

Obscured by gender

Many schools have personal development programs that begin in the kindergarten years and progress through to the middle of high school. These programs are a valuable resource for students to learn about emotional resilience, interpersonal relationships, how to cope with bullying, drug awareness and so on.

Adolescence is recognised as a time of increased emotional distress. The 2023 State of the Nation Report highlights a mental health crisis, with 35.9 per cent of secondary students reporting high anxiety, depression, or both, alongside widespread learning disengagement.

Around one-third (34 per cent) of Australian young people report experiencing suicidal thoughts or behaviours by age 18-19, with higher rates among females (38 per cent) than males (31 per cent). Suicide is the leading cause of death for those aged 15-24, accounting for roughly 30-32 per cent of all deaths in this group. Suicidality peaks around age 16-17. Untreated or under-treated mental health conditions—particularly depression, anxiety disorders, bipolar disorder, and conduct disorders—are the strongest predictors, present in up to 90 per cent of adolescent suicide cases.

When issues of gender are discussed in a school program, it needs to be in the context of a general discussion on sexuality, gender identity, social expectations, body image, self-esteem, mental health, and so on.

The overall message of these programs should be that it takes time for a young person to work out who they are, their goals in life, including their sexual orientation and gender identity. They may change their mind many times about their values, wants and needs, their expectations for their future.

If they feel different to others of the same sex and sometimes wish they were the other sex, it is helpful to begin with acknowledging they are gender non-conforming to allow for ongoing discovery about what is best for them. It is essential to make clear that while it is possible to adopt the gender role of the other sex, it is impossible to change sex—that is, it is impossible to be the other sex.

If a student indicates the desire to adopt the gender identity of the other sex, social transition at school must include, without exception, a discussion with parents because they will find out eventually, and their belated discovery will greatly increase any emotional response.

Failure of duty

Those practising gender-affirming care have dictated health policies about the assessment and management of gender-questioning young people for the best part of a decade, and any open challenge to this policy has been at times ruthlessly suppressed. This is quite contrary to good health practice, so it is not surprising that lawsuits against individual health professionals and professional societies are beginning.

One of the major points of difference between gender-affirming care and the work of a traditional health professional is the former’s abandonment of a comprehensive assessment of a young person, who typically presents with significant co-morbid mental health problems. Instead, affirmation begins immediately when the child is asked their preferred pronouns.

The failure to explore all possible options that might account for the young person’s often very recent decision they are trans, is likely to become the major health scandal of our times. The duty of care of all health professionals is to make every effort to ensure they have arrived at the safest diagnosis and to develop the most appropriate treatment plan for that individual.

Health professionals who take the view that the gender-affirming model of care fails to do this, now need to shift from pointing out the flaws in that model to presenting a detailed model of the care they advocate. One way to do this is to give thought to the structure and content of a module on gender identity in the curriculum of the undergraduate program for their particular profession, and to develop workshops on gender for those already in the workforce.

The most difficult task in providing such training is to get past the power and control of gender activists such as members of the World Professional Association for Transgender Health and its regional affiliates, but change is slowly coming and the demand for a detailed alternative assessment and management position for gender distress may come quicker than now seems possible.

Adults in the room

Although gender ideologues have had a stranglehold on the media, cracks are showing, so it is time to develop a comprehensive suite of topics which offer information and advice to help children and families navigate through policies of transgender indoctrination.

A major hurdle for the health professions is that the power of the trans movement comes mainly from the adults who insist a man can become a woman. It is a myth that self-ID laws allowing legal sex change are a modest measure for the protection of males who want to live quietly as a woman. The much broader agenda of self-ID is revealed in the fine print of the process. In the Australian states of NSW and Victoria, for example, there is no limit on the number of times a person can change the sex on their birth certificates. Why would a person who genuinely believes they are the other sex need to change their identity more than once?

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

UPDATE | UK Health Secretary Wes Streeting has taken action to enliven a stalled follow-up study of young people seen by the Tavistock gender clinic.

On February 26, Mr Streeting put before parliament an order enabling the “data-linkage” research recommended by the Cass review, which noted the lack of long-term data on children given puberty blockers and cross-sex hormones. Adult gender clinics run by the National Health Service had refused to co-operate with this project.

Mr Streeting said “small but important improvements” had been made to the data-linkage study—with NHS England now assuming responsibility for the research—and he said it was his “clear expectation that all relevant organisations will now provide the data required to complete this study.”

A group of 23 consultant psychiatrists has urged the UK government to pursue a follow-up study of the 9,000 minors seen at the London-based Tavistock gender clinic rather than persisting with the contentious clinical trial of puberty blockers.

“There will be a lot we can learn from this cohort [of ex-Tavistock patients] and this should now be the priority,” the psychiatrists wrote in a letter to The Times newspaper on Monday.

“It was alarming to learn that National Health Service adult clinics refused to co-operate with the research team who were tasked with this follow-up study, and we would hope that a reinvigorated effort would now be undertaken.”

On Friday, it was announced that the PATHWAYS clinical trial of puberty blockers, which was to start recruitment of up to 250 participants as young as age 10, had been put on hold after the Medicines and Healthcare products Regulatory Agency (MHRA) raised safety and ethical concerns.

Those concerns included the risk of “long-term biological harms” including sterilisation, permanent bone damage, and cognitive ill effects. In talks begun this week with the trial researchers, the MHRA is seeking a series of changes and restrictions, most notably a minimum age of 14 for participants.

Detransitioner Keira Bell, who is involved in potential High Court litigation to stop the clinical trial, said evidence of the harm done by blockers to former Tavistock patients such as herself was available.

“They can find all of my medical notes & tests, which I also have in my possession, to add to the list of children already put on [blockers] who suffered negative effects,” she tweeted on Sunday.

She recalled feeling her body “shut down” on puberty suppression, with night sweats, difficulty sleeping and studying at school.

The “data linkage” follow-up study to discover the adult clinic outcomes of ex-Tavistock patients had ethical clearance and, like the clinical trial, was recommended by paediatrician Hilary Cass following her four-year review of youth gender dysphoria treatment. It’s thought that some 2,000 of the 9,000 minors seen at the Tavistock between 2009 and 2020 were prescribed puberty blockers.

On hold: Helen Joyce of the group Sex Matters discusses the pause to the trial

Nothing new here

The Department of Health and Social Care described the MHRA’s concerns as “new” and said the trial would be paused pending “scientific dialogue” with the researchers in charge at King’s College London.

In a statement to parliament, Labour Health Secretary Wes Streeting said the trial “will not start to recruit until the issues the MHRA raised have been resolved. It will only be allowed to go ahead if the expert scientific and clinical evidence and advice conclude it is safe to do so.”

Several commentators have pointed out there is in fact nothing new about the reasons given for halting the trial, prompting the question how the research secured regulatory and ethical approval last November.

Journalist Hannah Barnes, known for her investigative work on the scandal at the Tavistock clinic, noted that the MHRA had belatedly acknowledged the implications of the reality that the vast majority of children begun on blockers would proceed to cross-sex hormones.

Early puberty suppression followed by cross-sex hormones is expected to cause sterilisation. The trial was to recruit children from Tanner Stage 2, the onset of puberty occurring around age 10. But delaying blockers until age 14 means participants, especially females, may be well advanced in puberty.

“Blocking early puberty, the MHRA says, risks sterilising children and is unethical,” Barnes wrote in The Times.

“But what remains [with a minimum age of 14] is a trial purporting to analyse the effectiveness of blocking puberty to treat gender-related distress which only studies participants who have already gone through puberty (at least for girls).

“It is highly questionable whether such a study could tell us anything useful—and therefore might also be unethical. It would be loathed by those who support the medical transitioning of children, too.”

The original protocol for the trial also faced the objection that its poor design meant it could not fill the gaps in evidence lamented by Dr Cass.

Under the protocol, the two-year trial is to recruit minors with a diagnosis of gender incongruence—a depathologised variant of gender dysphoria without any necessary distress. The randomisation of the trial involves merely a difference in timing of the same treatment, with one group starting on blockers straight away and the other beginning after a year’s delay. The outcome measure is a self-reported quality-of-life survey.

One key change proposed by the MHRA is a “much more detailed physiological safety assessment”, given that “the physiological and adverse pharmacological impacts may long outlast and outweigh any detected differences [in subjective quality of life].”

The MHRA also urges greater vigilance for the possibility that suppression of natural sex hormones interferes with development of the adolescent brain.

“We recommend that advice from independent clinical experts in neurocognition and brain imaging should be sought to advise what degree of adverse fMRI signal change between [brain] scans would necessitate withdrawal from the study. We would like to discuss this as a key safety assessment measure at 12 months.”

Puberty blockers are prescribed “off label” by gender clinics, meaning they do not have regulatory approval for use with gender dysphoria or incongruence. Blockers, known as gonadotropin-releasing hormone analogues (GnRHa), overstimulate the pituitary gland until production of the male and female sex hormones required for normal development is suppressed.

GnRHa drugs have been tested and licensed for conditions including prostate cancer, where testosterone can feed tumour growth, and central precocious puberty, when premature sexual development begins in very young children and the hormone suppression drugs are administered until they are old enough to enter puberty in sync with their peers.

Explainer: how do GnRH drugs work?

See you in court

The litigation brought by detransitioner Bell, together with parents’ organisation Bayswater Support Group and psychotherapist James Esses, seeks judicial review of the decisions last November to approval the trial by the MHRA and a research ethics committee (REC). The defendants are listed as the co-ordinating Health Research Authority and Health Secretary Streeting.

“Both decisions were flawed on the basis of irrationally approving a clinical trial on a group that is vulnerable not only because of their age, as children below the age of 16 who may potentially be as young as 10 … but also their vulnerability from a high incidence of other conditions such as autism and ADHD, and social difficulties,” says the statement of facts and grounds for the judicial review application.

“The trial design is inherently flawed; it lacks a rational scientific purpose; and it is incapable of yielding clinically meaningful data.”

The judicial review application, which is yet to go to a hearing, relies in part on expert evidence from neuropsychologist Sallie Baxendale of University College London, the author of a 2024 review paper warning that blockers may interfere with critical windows in development of the adolescent brain.

“Professor Baxendale explains that the trial involves exposing children to an intervention that deliberately interferes with normal development, in the absence of a clear scientific rationale, a testable hypothesis, reliable outcome measures, or any evidence-based method of identifying who is likely to benefit and who is likely to be harmed. Decisions about enrolment [in the trial] are therefore necessarily based on belief rather than evidence,” the statement says.

The judicial review claim also cites the work of Glasgow University’s Professor of Integrative Physiology, Neil Evans, who with Norwegian researchers has demonstrated enduring cognitive impairment in sheep given GnRHa puberty blocker drugs. The implication is that as fellow mammals, humans might suffer similar deficits in thinking and memory.

“There was obviously relevant information [that Professor Evans] could have provided to the MHRA or REC had he been asked, which would have been highly relevant to their decision-making,” the statement says. “Yet no questions appear to have been asked about this issue…”

The statement says the REC appeared to have been misled by the claim of the King’s College researchers proposing the trial that “there was no data at present on the cognitive impacts of puberty blockers”.

Children in the trial were to be promised up to £500 in Love2Shop vouchers for completing psychometric tests which could be redeemed at shops including Currys, Uber Eats and Xbox, according to The Daily Telegraph.

Dr Cass contends that the question of the safety and effectiveness of puberty blockers for gender-questioning minors is one that must be answered.

“These children who are on this trial will be about the most closely monitored you could imagine,” she told the BBC before the MHRA’s February 20 intervention.

“People will be very carefully looking at all aspects—their cognitive development, their psychological development, their bone development—and any hint that there are any significant long-term risks, they would come off the trial.

“So, it’s a very careful trial, but what’s much more worrying is the children outside the trial who are getting these drugs from unregulated and dangerous sources [online, for example] with no monitoring, and possibly for the wrong reasons.

“If we never answer this question [of the evidence for puberty blockers], we’re going to have ongoing charlatans just handing out inappropriate drugs.”

On Sunday, Dr Cass criticised the MHRA-imposed pause in the trial.

“There are no new research findings and the MHRA hasn’t presented any new evidence,” she told The Observer. “It feels to me like they are responding to political pressure rather than to science.”

Conservative Opposition Leader Kemi Badenoch welcomed news that the puberty blocker trial had been paused.

“We know that these drugs are actually a form of conversion therapy on gay kids told they were born the wrong sex,” she tweeted.

“Let’s focus on giving children and young people a positive body image instead of drugging them into oblivion and leading them down the path of irreversible biological changes.

“No child can consent to such treatments. So, it is right that this unethical trial is paused. It should be stopped completely.”

The UK’s Prime Minister Keir Starmer has come under cross-party pressure, including from within his own Labour Party, over the trial as an unacceptable experiment on vulnerable children.

Students at King’s College London have launched a petition and open letter opposing the trial, the premise of which they describe as “ideologically based”.

“[The trial] treats claims associated with gender identity ideology, such as the notion that a child’s asserted gender identity should be affirmed through medical intervention, as established fact, rather than as hypotheses that remain subject to serious debate within medicine, psychology, and the social sciences,” the open letter says.

“When a trial embeds a particular ideological framework as its starting point, it risks shaping research questions, outcome measures, and interpretation of results in a way that favours a predetermined conclusion. Such bias is especially concerning in a field where the evidence base is weak, the population is vulnerable, and alternative explanatory and therapeutic models exist.”

Dianna Kenny

There has been recent speculation within Australia and internationally that the numbers of young people identifying as trans or non-binary and who present to gender clinics and hospitals for gender transition interventions are declining.

In October 2025, the Society for Evidence-based Gender Medicine (SEGM) analysed recent surveys from the US claiming that trans identification and non-binary identification were in “free fall.” SEGM begs to differ, arguing that the analyses reporting decreases in identification are the result of poorly worded survey questions and inappropriate statistical weightings being applied to the data. Their own analysis of the US college students’ survey (NCHA) comprising 2.5 million students (average age=20; female=70%) attending 1,000 higher-education institutions over the last 25 years showed the opposite result i.e., that trans/non-binary identification was at its highest yet—from 4.7% to 6.7%—compared with 0.1% in 2015, with 8% females and 5% males not identifying with their biological sex.

Data are sensitive to small variations such as change in wording of survey questions over time. In 2015, in the NCHA survey, the question wording changed from “What is your gender?” to “Do you identify as transgender?” after which there was a sharp rise (three times greater) from 0.5% to 1.6% in the number of participants identifying as transgender. Last month SEGM updated its sceptical analysis of US college data and debunked an article in the Swiss media which had declared “the gender revolution is over.”

Another question of interest is whether the numbers of young people enrolling in gender clinics and receiving treatment have changed over time. To assess trends in gender transition interventions, all data for total patients, new patients, continuing patients (i.e., total n minus new n), numbers commencing puberty blockade (PB), and numbers commencing cross-sex hormones (CSH) were obtained under freedom of information law from the Royal Children’s Hospital (RCH) in Melbourne, Australia, for the period 2017-2025. Table 1 shows the annual numbers by category and year.

Table 1: RCH patient data 2017-2025

For total patients there has been a strong increase over time, from 410 in 2017 to 1,226 in 2025. New patient referrals peaked in 2021–22 and have declined for three consecutive years since 2021–22. This reduced incidence is not yet statistically significant because there are insufficient data points past the peak referral year. If we formed conclusions from the intake numbers alone, it would be difficult to argue that numbers are not declining. However, there is a difference between observed change and statistically significant trends. Currently, there is no statistically confirmed long-term downward trend in new patients. Table 2 shows the trend.

Table 2: Trend in RCH patient data

To date, there have been three consecutive years of contraction, with an overall reduction of ~65% from peak. (However, as I explain below, there has been a diversion of patients from RCH to the Orygen/headspace Trans and Gender-Diverse Health Service, which takes young people from age 12.)

The picture at RCH itself becomes more complex when other available data are analysed. These indicate that the overall activity of the RCH gender service has not declined. Numbers of patients who are continuing care have shown a statistically significant increase. This reflects longer treatment pathways and cohort accumulation.

Further, there is no downward trend in the number of children taking puberty blockers. The trend currently suggests long-term increase with expected year-to-year variability.

Similarly, there is no decline in the number of young people on cross-sex hormones. In fact, there have been recent increases despite fewer new referrals. Table 3 shows the trend analysis for each category of patient since 2017.

Table 3: Trend in patient categories at RCH

From these data we conclude that there is no evidence of reduced medical intervention, and no evidence of reduced service demand overall (see Figure 1).

Figure 1: Hormonal interventions at RCH

It is important to note that new referral numbers and treatment numbers are not interchangeable indicators. Current short-term declines in referrals do not yet indicate reduced clinical services/intervention. Even though new referrals have declined since 2021–22, ongoing “care” and interventions (PB and CSH) continue at sustained or increasing levels. The upward trend in the prescription of CSH at RCH is disturbing given that RCH only accepts young people up to the age of 16 years. This means that this service is providing CSH to 14-15-year-olds!

Conclusion

Across the 2017–18 to 2024–25 period, total and continuing patient numbers increased significantly, while new patient referrals peaked sharply in 2021–22 and declined substantially over the subsequent three years. Although this post-2021 decline in new patients is large in magnitude, averaging −172 patients per year, it does not yet meet statistical criteria for a sustained downward trend due to the short post-peak observation window.

On the contrary, numbers commencing puberty blockade and CSH show no evidence of decline; puberty blockade commencements increased significantly over the full period, and CSH commencements display a rising tendency in recent years. The data therefore support a distinction between declining new referrals and continuing or increasing treatment initiation among existing patients.

If current post-2021 trends persist, new referrals could drop to around 50 in the year 2026-2027. However, ongoing treatment of continuing patients, growing at around 150 per year, would bring the total number treated to around 1,350 by 2026-2027. We must therefore conclude that declining new referrals do not equate to reduced service volume or reduced medical intervention.

How can we understand the sharp decline in new patient referrals to RCH?

In Victoria, Australia, in addition to the RCH gender service, several other services also offer gender interventions to young people. These include the Monash Gender Clinic, which accepts referrals from young people aged 16+ and the Orygen/headspace Trans and Gender-Diverse Health Service, which accepts young people aged 12-25 years and provides CSH. This service is available across the five Orygen-led headspace centres, as well as via telehealth. One of their stated key responsibilities is to recruit GPs into their Trans and Gender-Diverse (TGD) Health team. These GPs will then “support” other GPs and registrars to provide gender services, much in the same way as pyramid-selling schemes operate in commercial markets. In addition to Orygen/headspace, at least another seven community-based gender services operate throughout the state.

With so many service providers for TGD young people, one explanation for the decrease in RCH new referrals is that the common pool is being divided amongst more providers, with regional young people using the now-available regional services.

In 2022, Michelle Telfer, former director of the gender service at RCH, spoke of the collaboration with Orygen as a Gender Service Expansion Project, and described it as “a collaboration funded by the Victorian Government in 2021, which brings together Orygen and their five associated headspace centres in northwest metropolitan Melbourne, RCH, Monash Health, Transgender Victoria, and Transcend Australia.” Orygen has shifted its priorities from those originally stated at its inception, which were to provide services for early onset psychosis.

The role of COVID-19 in referral patterns is not clear. One would have expected a decrease, not a peak, in 2021 at the height of the pandemic, but several clinics reported peak referral numbers.1 One explanation is that COVID was highly disruptive to the development of children and young people and there was an increase in emotional and behavioural disorders. Excess social and digital media use during which transgenderism was aggressively marketed, together with social isolation, may have resulted in some young people expressing their psychological distress as a gender identity crisis.

Since then, there appears to have been a decrease in referrals to gender clinics across Australia, but this is probably an artefact of the greatly expanded gender services on offer and the incursion of private practitioners into this field, from whom numbers are very difficult to obtain.

In summary, the most likely candidate explanations for the drop in new referrals to RCH since 2021 include the Orygen/headspace project and other expansion strategies, and a reduction in the upper age limit for referrals to RCH to <16 years. The Queensland Children’s Gender Service also revised their upper age limit to <17 years, which was accompanied by a similar reduction in new referrals.

Limitations

Data on clinical referrals and treatment for trans youth in Australia are incomplete and possibly unreliable because health services do not uniformly publish comprehensive annual figures, they make it difficult to obtain figures from gender services (e.g., Orygen has refused to provide data), require lengthy freedom of information applications, and private practice activity is rarely captured.

Professor Kenny, a child and adolescent psychologist, is author of the book InTRANSigence

Put down the knife

The American Society of Plastic Surgeons (ASPS) has become the first major US medical association to adopt a cautious stance on paediatric gender medicine, citing the weak evidence base and potential long-term harm to young people.

In its new position statement, the ASPS recommends “that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”

At least 5,200 American teenage girls had breasts surgically removed as part of a gender transition from 2017 to 2023, according to a Manhattan Institute analysis of insurance claims.

Last month, a young woman named Fox Varian was awarded $2 million in damages for the trans double mastectomy performed on her at age 16. Hers was the first claim by an American detransitioner to reach a jury verdict. There are 27 other known lawsuits filed by US detransitioners, according to journalist Benjamin Ryan.

It’s not just the surgery

The ASPS statement, issued on February 3 but officially approved on January 23, goes beyond surgery, stating that puberty blockers and cross-sex hormones also lack “a favourable risk-benefit ratio”, and highlighting the inability to predict which minors will see their gender dysphoria resolve naturally as they mature.

“[W]hen the likelihood of spontaneous resolution [of gender dysphoria] is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-maleficence (i.e., promoting health and well-being while avoiding harm) requires a precautionary approach,” the ASPS statement says.

It also stresses the risks arising from the role of surgeons in the multidisciplinary treatment pathway beginning with social transition, blockers and hormones.

“Because the evidence base for this care pathway is [of low or very low] certainty and increasingly suggestive of potential harm and long-term complications, downstream surgical decision-making carries heightened ethical, clinical, and legal risk,” the statement says.

“Plastic surgeons should maintain a working understanding of the current limits of evidence regarding social transition, puberty suppression, and cross-sex hormones…”

In the absence of high-quality scientific evidence, gender clinicians and trans activists have made much of the appearance of consensus among major US medical associations in favour of the gender-affirming treatment approach. That consensus represents the activist capture of small policymaking committees, according to critics of gender ideology.

On February 3, however, the American Medical Association (AMA), a prominent promoter of “gender-affirming care”, reportedly shifted position on trans surgery.

In a statement to National Review, the AMA said “the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement … the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

Unreliable guides

The gender-affirming approach is codified in guidelines from the World Professional Association for Transgender Health and the Endocrine Society, as well as a position statement from the American Academy of Pediatrics.

Unlike other medical associations, the ASPS had not endorsed those gender-affirming documents.

In its new statement, the ASPS notes these documents “did not meet accepted criteria for high-quality, trustworthy clinical practice guidelines” following a peer-reviewed evaluation of international guidelines commissioned by the UK Cass review.

The ASPS statement also acknowledges the influence of systematic reviews of the (low certainty) evidence for hormonal and surgical treatment of gender distress in minors, as well as the emergence of more cautious therapeutic policies in Finland and Sweden, plus the 2025 gender dysphoria report of the US Department of Health and Human Services (HHS).

In the domain of ethics, the ASPS statement challenges the activist claim that “patient values and preferences” and “emerging adolescent autonomy” can justify these medical interventions when the evidence base is poor.

“The patient education and informed consent process, which incorporates patient values and preferences and acknowledges emerging autonomy, operates within—not independently of—this evidentiary threshold,” the statement says.

“[Patient autonomy] does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile, particularly in adolescent populations where decision-making capabilities are still developing.

“In pediatric contexts, the threshold for intervention must be higher and safeguards more stringent.”

The ASPS statement also takes issue with the marketing of gender surgery as “lifesaving”.

“Because the best available evidence indicates suicide deaths are fortunately rare and the incremental impact of surgery on suicide prevention is unknown, ethical decision-making should not be driven by crisis claims. Instead, the ethically appropriate posture for plastic surgeons is greater caution,” the statement says.

A watershed

The Society for Evidence-based Gender Medicine (SEGM), a critic of the poorly evidenced gender-affirming model, welcomed the ASPS statement as “a watershed moment in US medicine”.

“ASPS is the first major American medical association to recommend against gender-related surgical interventions for patients under 19, including chest, genital, and facial procedures,” said SEGM co-founder Dr William Malone.

“This position recognizes serious gaps in foundational knowledge in the field, including the absence of reliable long-term evidence, as well as increasing indications of potential harm and lasting complications for minors from the entire ‘connected clinical pathway’ of gender-affirming care, including social transition, puberty blockers, and cross-sex hormones—and culminating with surgery.

“SEGM welcomes this call for heightened scrutiny, precaution, and medical self-correction, reflecting the growing recognition that irreversible interventions in adolescents demand far stronger evidence, clearer safeguards, and truly evidence-based clinical guidance.”

The Manhattan Institute’s Leor Sapir, a co-author of the HHS gender dysphoria report, said a key question in the months ahead would be whether new concern about trans surgery would also extend to blockers and hormones.

“If other medical groups or individual doctors who have endorsed pediatric medical transition agree with the ASPS on surgeries, on what grounds can they continue advocating for puberty blockers and cross-sex hormones, given that these interventions also have an unfavorable risk-benefit profile and are given to minors whose sense of self is still developing?” Sapir said.

He pointed out that prominent gender clinicians are among the membership of the ASPS, including plastic surgeon Loren Schechter, the incoming president of WPATH.

In Fox Varian’s medical negligence trial, Dr Schechter testified that “Surgery in and of itself is not a treatment or a mechanism to prevent suicide,” reported journalist Benjamin Ryan.

However, in a previous Florida case involving a minor seeking trans surgery, Dr Schechter gave evidence in 2022 that such surgery was “medically necessary” and that “the denial of necessary medical care is likely to perpetuate gender dysphoria and create or exacerbate other medical issues, such as depression and anxiety, leading to an increased possibility of self-harm, negative health outcomes, and even suicide.”1

News of the Fox Varian damages award is reaching large audiences, with coverage in The New York Times, New York Post, The Free Press, The Epoch Times and Daily Mail. The new ASPS policy has been covered by The Washington Post, The New York Times, Reuters and The Hill.

Gary Geelhoed

It must be confusing for mainstream people trying to make sense of the increasing coverage and complexity of the transgender issue in Australian society. They are well aware of past inequalities for women, the gay community and various racial groups both in the legal sense and in terms of their treatment in wider society. Given that these groups now have full recognition under the law and more generally in society, many people are now also sympathetic to an apparently new minority, trans people, facing what could be perceived to be similar challenges.

The LGBTQ+ alphabet groups, while often lumped together, in reality have little in common and increasingly the trans group is at odds with the lesbian group over the definition of the term “woman”. Also, it is becoming increasingly clear that many young, confused people who are same-sex attracted are being encouraged into the trans group.

Most people believe adults should be allowed to identify as they like, dress as they like and love who they like, as long as no one else is harmed. The issues around the emergence of transgender folk, however, are more complex when it comes to children and adolescents.

The characteristics of previously discriminated-against groups—women, ethnic minorities and the same-sex attracted—remained fixed as society changed to a more sympathetic view. But a core belief of trans individuals is that their gender is what each individual identifies it to be, not what society might deem it to be. Those other once-marginalised groups asked to be accepted as they are. Trans individuals ask that society recognise them as the sex or gender opposite to that with which they were born.

This may go beyond superficial aspects such as dress, hair and makeup to permanent medical treatments and procedures such as puberty blockers and cross-sex hormones, as well as surgery to remove breasts or to create approximations of a vagina or penis. Many people are sympathetic to adults who feel driven to go down this path and to make such serious decisions.

Historically, there has always been a very small percentage of the population, mainly boys, who at a very early age identify as the opposite sex. The majority of these children in time would go on to re-identify as their original sex with many growing up as same-sex attracted. Another well-recognised group were middle-aged men who chose to live as women but generally did not regard themselves as actual women.

What has changed, largely across the Anglosphere, is that the number of children and adolescents who now wish to transition to the opposite sex has grown exponentially, with the majority now being female at birth. Often, they have shown no inkling prior to “coming out” that they were transgender, hence the term ROGD (Rapid-Onset Gender Dysphoria). A significant number are same-sex attracted and many are on the autistic spectrum.

Chart: Referrals at the London-based Tavistock clinic dramatically illustrate the international shift in patient profile from a small number of male children to very many female adolescents

Child safeguarding

While many people support or at least try to understand adults who wish to transition, they are troubled that increasingly younger individuals are being guided down this path. To be very clear, the current discussion on the best approach to children and young adolescents who identify as trans should not be clouded by reference to social inequalities in the past for the LGB community or the decision of an adult to transition to the opposite sex. The concern is for the increasing numbers of children and adolescents taking this largely one-way, lifelong path of medicalisation.

While not allowed to drive, vote or even have tattoos, young people are allowed in increasing numbers to decide they are in the “wrong body”. In many jurisdictions, responsible adults, including parents and health professionals, are expected to “affirm” this choice. Resistance or even a more nuanced “wait and see” approach—while addressing other possible mental health issues—is being labelled “transphobic”. In some jurisdictions, the “wait and see” approach is in effect prohibited under law.

It seems clear that confused and troubled young people are attracted to the idea that changing gender will improve their lives and, in many cases, the positive affirmation they receive—and in some cases, testosterone treatment—may achieve this in the short term. The good intentions of gender clinic staff are not in question.

Usually, this sudden realisation in young adolescents that they are in the “wrong body” is the first inkling that parents have. More worrying is the small number of parents who appear to be driving the process from a child’s young age, a practice that once would have been labelled as Munchausen by Proxy.

Affirmation for parents may mean agreeing with their teenage daughter’s decision to block her pubertal development, take lifelong medications and surgery rendering her infertile and with impaired sexual function.

What is increasingly clear is that this great increase in numbers over the last ten years coincides with the advent of social media. Repeatedly, young people attest to both discovering the concept of transgenderism online and being directly influenced to explore further, often in social clusters.

Video: Physician and researcher Dr Lisa Littman, who coined the term ROGD, outlines early results from a significant new study of today’s markedly different caseload of gender-distressed youth. This was a key presentation at Genspect’s 2025 conference in Albuquerque, New Mexico.

Spotlight on medicos

Troubled young people struggling with the transition to adulthood are being encouraged and celebrated for identifying as the opposite sex. Once this might have been a time of confusion from which the majority would emerge as intact young women coming to terms with their sexuality and perhaps autism and depression. Increasingly, however, these young people enter adulthood on lifelong medication, some with radically surgically altered bodies and sterility. All this with very little evidence to attest to the long-term positive outcomes promised and increasing evidence of the problems associated with long-term medications and surgery.

Because of this, a very bright spotlight should be trained on the medical profession which controls and permits the administration of puberty blockers, cross-sex hormones and surgeries. The history of medicine is littered with many dark dead-ends which at the time were trumpeted as great advances. Among these were removal of children’s tonsils unnecessarily, extraction of all healthy teeth to prevent caries, removal of healthy large bowels (colons) assumed to be toxic, and the equivalent of waving a knitting needle in frontal lobes, lobectomy, to treat various mental disorders.

Modern medicine strives to be evidence-based but evidence for the diagnosis and treatment of ROGD is lacking. For instance, the oft-quoted “better to have a live son than a dead daughter” deployed to influence parents is not supported by any meaningful study. While there may be adults who have transitioned in the past after careful and long consideration who now lead happy lives, there are no long-term studies showing that on balance this is the usual experience. The evidence for this new cohort of ROGD adolescents is virtually non-existent, given their short history.

We do, however, know that the physiological and anatomical changes of drugs and surgery are lifelong. The standard in the past was to only go down the trans path, recognising its rarity, after other approaches and explanations had been worked through. The more recent phenomenon of young girls being affirmed and placed on the trans treadmill after only a short period, with other factors and explanations largely ignored, is very different.

The experience at the London-based Tavistock Gender Identity Development Service (GIDS), which operated for decades in the UK, is instructional.

An independent report by consultant paediatrician Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, concluded that GIDS was “not safe” and suggested a need for a “fundamentally different” service. As such, GIDS closed in 2024 and was replaced by regional hubs with a more holistic approach allowing for all issues in young peoples’ lives to be examined when presenting with confused identities.

The risks of medical harm and regret are exemplified by the story of the Tavistock GIDS detransitioner Keira Bell, a troubled teenager who at the age of 16 was prescribed puberty blockers followed by testosterone a year later; at 20, she had a double mastectomy. “But the further my transition went, the more I realised that I wasn’t a man, and never would be,” she recalls. “We are told these days that when someone presents with gender dysphoria, this reflects a person’s ‘real’ or ‘true’ self, that the desire to change genders is set. But this was not the case for me. As I matured, I recognised that gender dysphoria was a symptom of my overall misery, not its cause.”

In the UK, following the Cass review, bipartisan policy has ended the routine use of puberty blockers for gender-distressed minors outside a clinical trial scheduled to start this month. Other European nations, New Zealand, half of America’s states and Queensland have paused, banned or restricted the gender medicalisation of minors. It is time that Australia as a whole follows suit. In my own state of Western Australia, the release of the model of care for the gender clinic at the Perth Children’s Hospital gives rise to the same kinds of concerns occasioned by the ideological “gender-affirming” treatment model elsewhere in the world.

The tide of opinion is turning as more people become aware of this very specific problem of young adolescents being affirmed and subjected to lifelong medical and surgical consequences. They realise this is very different to the now largely dissipated wider discrimination against the LGB community.

I am now at the end of a long career in medicine. I trained as a general paediatrician, ran a tertiary paediatric emergency department for 22 years, was a federal councillor of the Australian Medical Association and an AMA WA President. I was Chief Medical Officer and Assistant Director General for the WA Department of Health for five years.

In my opinion, the current treatment of gender-confused minors is the biggest medical scandal of my time in medicine. While I respect the rights of adults to identify and live how they wish, I call on the profession to objectively look at the evidence—or rather, the lack of it—in this complex area of paediatrics. And I urge the profession to advocate for the banning of puberty blockers, cross-sex hormones and surgery for these vulnerable minors.

Professor Gary Geelhoed is a retired paediatrician and researcher who served as Chief Medical Officer of WA and directed the emergency department of the Princess Margaret Hospital for Children, which was succeeded by the Perth Children’s Hospital, home to a gender clinic. His comments on that clinic’s model of care, and the gender-affirming treatment approach generally, are reported in The Weekend Australian newspaper today.

The Gist

The prospect of gender clinicians having a legal defence against medical negligence actions will be influenced by Australia-wide treatment guidelines now being drafted, according to a report to the state government of Queensland.

The independent review’s report, published on December 19, confirms that the evidence for the use of puberty blockers and cross-sex hormones with gender-distressed minors is of low quality.

Queensland’s centre-right Liberal National Party government, which commissioned the review earlier this year, has extended a pause on new hormonal treatment in the public sector until there are results from the controversial UK clinical trial of puberty blockers.

“We believe that it’s in the safety and interests of children that these drugs not be made available through the public system until such time as there is better evidence available,” Queensland Health Minister Tim Nicholls said.

New Zealand’s ban on new under-18 treatment with blockers and hormones, itself paused pending court review, is also to be revisited after the UK clinical trial, which is scheduled to start in January with results not expected before mid-2032.1

The remote, sparsely populated Northern Territory is to join Queensland as the second Australian jurisdiction to ban these hormonal treatments in public health, The Sunday Territorian newspaper reported on December 21.

Steve Edgington, health minister for the centre-right Country Liberal Party administration in the territory, said minors had to be protected from the “dangerous ideologically driven practices” of paediatric gender medicine.

He said the government’s ban was “consistent with approaches taken in other jurisdictions including Queensland, New Zealand and several European countries”.

In a statement, he said only “a handful of young teenagers” had been getting these hormonal drugs through NT public health. Earlier this year, in response to a request that Edgington release basic treatment data, it was claimed that the NT Department of Health “does not maintain data collection or a register for patients experiencing gender dysphoria”.

Meanwhile, in the US, the Trump administration has announced measures seeking to enact an effective national ban on hospitals offering puberty blockers, cross-sex hormones or transgender surgery, such as double mastectomy, to gender-distressed minors.

US Health Secretary Robert F Kennedy Jr has foreshadowed rules that would deny federal payments under Medicaid, Medicare and the Children’s Health Insurance Program to any hospitals offering “sex-rejecting procedures”, as he termed them. Hospitals are heavily reliant on these federal insurance schemes.

At a Washington, DC, event on December 18, Kennedy said the key inspiration for the new restrictions was the recently reissued scientific report on youth gender dysphoria commissioned by his Department of Health and Human Services.

“I don’t think anybody can read that science without saying we made a huge mistake here [by allowing paediatric medical transition],” Kennedy said. “It’s a disgrace to the medical establishment that they let this go on for so long, based upon so little positive data.”

The detail

High-risk meds

The report of the Queensland review panel led by psychiatrist Professor Ruth Vine noted the concern of some health practitioners that hormonal treatment of gender-distressed minors was “experimental” and carried the risk of medical negligence actions. As well, the panel said, government health services would be “vicariously liable” for negligence by staff gender clinicians.

However, under the law, clinicians would have a defence if they were following a practice widely accepted by peer professional opinion, and it did not matter if some practitioners disagreed with this opinion.

The panel said it had “heard from a significant range of medical practitioners who supported the provision of [puberty blockers] and [cross-sex hormones] in line with existing standards and guidelines”, and therefore the panel did not think this practice “would be deemed negligent”.

But what was judged a reasonable standard of care by the courts would probably be influenced by the new Australian treatment guidelines being drafted by the National Health and Medical Research Council, the panel said. Interim advice on puberty blockers is expected in mid-2026, with the full guideline to be issued in 2028.

The NHMRC-endorsed guideline will supplant the low-quality “Australian standards of care” gender dysphoria guideline issued in 2018 by the Royal Children’s Hospital (RCH) Melbourne and used across the country, including in Queensland.

The new NHMRC guideline is charged with evaluating the quality of evidence using the international GRADE system, whereas the RCH authors failed to rate the quality of the evidence for their treatment recommendations.

Multiple systematic reviews—undertaken independently in countries including Finland, Sweden, the UK, Canada and Germany—have concluded that the evidence base for paediatric medical transition is very weak and uncertain.

Given the freeze on new hormonal treatment in Queensland’s public sector, the Vine panel’s legal warnings take on more immediate relevance for gender clinicians in private health who pick up unmet demand for blockers and hormones.

Despite its reassuring take on the negligence issue in general, the panel stressed that the success of any legal claim would turn on the facts of the given case, with key vulnerabilities being any departure from guidelines, failure to undertake a proper assessment in diagnosing gender dysphoria, or not documenting properly the clinical decisions in the patient record.

“The provision of medications which are accompanied by a range of reversible and/or irreversible physical and psychological outcomes, where clinical evidence ranges from unknown to weak or moderate, to a cohort of children and adolescents whose capacity to consent is variable, can reasonably be described as a high-risk area of medicine,” the panel said.

In this wider ethical context, the Vine panel also said that “medicating otherwise physiologically healthy children and adolescents to help in managing their internal distress in the face of wider societal misunderstandings of gender diversity may create a disproportionate and indefensible burden on them”.

“This consideration may become particularly problematic where the long-term physical and mental health and social impacts of prescribing [blockers] and [hormones] are not settled.”

Into the unknown

Another legal risk raised during the review panel’s talks with health practitioners related to any failure by gender clinicians to disclose “material risks” before minors undergo hormonal treatment.

The concern was “that there are either unknown risks and consequences of the use of [blockers] and [hormones] in young people, or uncertainty surrounding some risks, some of which may potentially carry very serious consequences,” the panel said.

“Where there are unknown and uncertain risks, there is an obligation to disclose that fact. It is important the patient and/or their decision-maker are made aware of the fact that there are unknown risks and long-term consequences associated with treatment, and/or there is a lack of evidence or understanding about some risks/consequences.”

On the adequacy of the informed consent process at the Queensland Children’s Gender Service (QCGS), a government facility based in Brisbane, the panel heard conflicting accounts, with some “young people and their families [stating] there was not a full appreciation of the risks, consequences and uncertainties” of blockers or hormones.

“To discharge the duty to disclose material information, it is imperative that full, detailed and genuine discussions surrounding the risks, consequences and long-term impacts of the treatment occur and are appropriately documented in the patient record,” the panel said.

“There should also be adequate documentation of the disclosure and discussion of the fact that there are potentially unknown risks and consequences of the treatment, and that this is understood by the patient/decision-maker before proceeding with treatment.

“In relation to the disclosure of material information, the risks, side effects, long-term consequences and the fact that there are likely unknown risks or consequences, are all types of ‘material information’ that must be disclosed to and understood by patients and their decision-makers.

“Reasonable alternatives to [blockers or hormones] should also be discussed and explained. Thorough documentation of discussions around the informed consent process is required, demonstrating the extent of the discussions about these issues, in addition to signed consent from the patient.”

The panel also flagged the shift in gender dysphoria law as laid down by Australia’s federal Family Court, citing the landmark ruling in re Devin’s case, where Justice Andrew Strum ordered that a 12-year-old gender non-conforming boy be protected from puberty blockers, which interfere with normal sexual development.

“Some judicial decisions have questioned whether minors will ever reach a threshold of understanding to validly consent to [blockers or hormones] based on unknown risks and long-term consequences and based on the potential for such treatment to impact the minor’s future reproductive capacity and sexual functioning,” the Vine panel said.

“Relevant issues include that the young person is still developing, and their views on deeply personal areas such as parenthood, sexuality, sexual function and identity, may be in flux.”

Referring to the tension between Justice Strum’s ruling and other more permissive court decisions, the panel listed a series of legal risks for gender clinicians, including the provision of blockers or hormones under the “depathologised” diagnosis of “gender incongruence”, which unlike gender dysphoria requires no distress and would undermine the legal claim that these interventions are “therapeutic”.

The panel said it “understood” that at the QCGS, a diagnosis of gender dysphoria, not mere gender incongruence, would “always” be made before consideration of blockers or hormones.

However, the panel was told, variously, during its consultation process that “a diagnosis may be changed to justify access to “blockers or hormones; that “a diagnosis is pathologising and a source of oppression”; and that “diagnosis does not help to predict which adolescents will desist or detransition and [that] the stability of diagnosis from adolescence to adulthood is unclear”.

Video: At Genspect’s Albuquerque conference Dr Patrick Lappert details the “fraud and misrepresentations” of gender surgery

Data vacuum

Queensland’s Vine panel noted defects in data collection, analysis and reporting by the Queensland Children’s Gender Service (QCGS), which was still operating without a “finalised written model of care”, relying on a 2023 draft.

It also used an out-of-date “gender-affirming” work instruction which did not reflect the QCGS adoption of the latest, eighth standard of care from the World Professional Association for Transgender Health, which abruptly abandoned minimum ages for medical interventions following pressure from the US Biden Administration.

The QCGS work instruction states that “chest reconstructive surgery”—double mastectomy for girls who identify as male or non-binary—is “an integral part of the transition process” for many.

Staff at the QCGS are instructed that girls as young as 15 may be competent to consent to the removal of their healthy breasts.

The document claims this surgery, which the Queensland Children’s Hospital itself does not perform, “may be in the best interest of an older adolescent under 18 years” in unexplained “exceptional circumstances”.

Presumably this can continue, because the government treatment pause is limited to blockers and hormones, and does not prohibit the QCGS referring its female patients to private surgeons.

Asked by GCN if he would review or stop such referrals, the office of Queensland Health Minister Tim Nicholls said the government was “not looking at areas outside of the scope” of the job entrusted to Professor Vine.

The Vine panel advised that if blockers and hormones were to resume in the public sector, a “finalised QCGS model of care should outline the routine collection of outcome measures,” implying that this has not been happening.

“While we were able to consider some data from QCGS, this was limited in extent and analysis,” the panel said.

“We note the absence of QCGS annual reporting on service activity, outcomes and safety and quality data. The impact of this absence is that the service does not know at any given time what its patient cohort looks like in detail.

“The limited capacity of QCGS to record, search and collate information and the absence of a finalised written model of care also adds to the difficulty of understanding what occurs and has occurred in practice.”

The QCGS, the panel said, lacked “the capacity to capture in an accessible/searchable way (other than individual entry into each patient’s clinical notes)” information such as—

the diagnoses of gender dysphoria;

the medication or dosage prescribed or administered;

observed or reported side effects and/or effectiveness of medications;

the number of patients who undergo fertility preservation procedures;

the reason for discharge;

and presence or absence of co-occurring conditions.

Nine-year-olds on blockers

The panel did manage to get some basic treatment data from QCGS, which showed that, measured by median age, younger children were being given puberty blockers as time went by.

In 2019, 117 patients were started on blockers, with the youngest aged nine and a median age of 15. In 2022, 81 patients began on blockers (minimum age nine and median age of 13). And last year, there were 24 patients initiated on blockers (minimum age 10 and median age of 12).

In 2019, 88 patients began cross-sex hormones, meant to be taken lifelong, with a minimum age of 14 and a median age of 16. In 2022, 103 patients began hormones. In 2024, there were 85 new patients on hormones. For each of these three years, the median age for starting hormones was 16, with the youngest aged 14.

“In each year for which the panel was provided data, some patients who commenced [hormones] had previously received [blockers] and others had not,” the panel said. No clarifying percentages are given.

“Without more detailed data, we are unable to comment further on the proportion of those who are referred that do meet criteria for a diagnosis of gender dysphoria or the extent or detail of assessment and information provision,” the panel said, suggesting that the QCGS claim of always requiring such a diagnosis could not be verified.

The Vine panel’s report does not mention international data suggesting that the vast majority of children begun on puberty blockers will proceed to cross-sex hormones, a combination with potential harms such as sterilisation, sexual dysfunction, cardiovascular disorders and as yet unknown long-term disorders during a lifetime of medicalisation.

Notwithstanding this omission, the panel says “it appears from the available research that the effects of [puberty blockers] are reversible”. Elsewhere, the panel says blockers are “largely reversible if used for a limited time”, without explaining in what way they might not be fully reversible.

On the possible cognitive harm of puberty blockers interfering with critical windows in development of the adolescent brain, the panel said no conclusions can be drawn because of the limited evidence.

Yet the limited evidence did not prevent the panel talking up the “potential psychosocial benefit” of puberty blockers, while hedging that cause and effect in these low-quality studies are unclear and “long-term outcomes are uncertain”.

The report also talks up a recent gender-affirming treatment guideline from Germany, without making clear that this project had abandoned a necessary but inconvenient systematic review of the (weak) scientific literature, and was downgraded from its intended “evidence-based” status to a mere consensus-based document.2

Update, December 30: The Vine panel’s riding orders were advisory, it was not charged with making policy recommendations. Its report offered the state government three options: no blockers or hormones for gender-disressed minors in the public sector (this being the option chosen by Cabinet); back to gender medicine as usual for the QCGS; or a QCGS-led system with stricter oversight and reporting. It’s fair to say that much of the report appears consistent with the third option. (Note: I’ve added this paragraph as it seemed necessary in hindsight—BL.)

The panel did suggest some caution before medicalisation.

“Our view is that a person/child-centred approach warrants the full assessment and early management of any co-occurring conditions before initiation of [blockers or hormones],” the panel said.

“This in no way diminishes the importance of respect, acceptance and engagement. Young people and their families expressed appreciation for a gender-affirming approach, but for some parents, this was also viewed as a barrier to having co-occurring problems, conditions or issues that may be contributing to their child’s distress addressed.”

Scarce psychological support

The panel said that in 2022-23, the QCGS responded to its growing waitlist of patients by cutting back mental health support.

This was characterised as “refocusing QCGS clinicians on delivering mental health support through assessment only and redirecting consumers to external practitioners for ongoing mental health treatment and monitoring”.

And the panel was told that “children currently on the QCGS waitlist do not receive psychological support from QCGS and struggle to receive support from private or other clinicians due to them being on the waitlist”.

Also, the panel heard of “the challenges experienced by individuals that were referred from QCGS for mental health support in the context where general local [child and youth mental health services] are already operating at full capacity and private providers, particularly relevant specialists, are scarce and costly”.

The panel highlighted the lack of co-ordinated data on—and oversight of—paediatric gender treatment not just in Queensland, but nationally.

“While services in all Australian jurisdictions are generally making [an] effort to collect and analyse data on who is accessing the service, what treatment is provided and with what outcome, overall, we noted a lack of integration across services, and between the public, primary and private sectors,” the panel said.

“We noted limited information on numbers of young people prescribed [blockers or hormones] for gender dysphoria, how such treatment is monitored and assessed and how long-term outcomes are tracked.

“There is currently no statewide line of sight of the provision of [blockers] and [hormones] for children and adolescents with gender dysphoria in Queensland.

“We were informed of various avenues of obtaining [blockers and hormones], including through QCGS and certain local [public hospital and health services], in the private sector, through moving interstate, obtaining access internationally and through illegal means. We were also informed of significant variation in practice including safety and quality processes and clinical oversight and accountability.

“The panel is not aware of any requirement of private providers in specialist or primary care to provide data on the numbers or outcomes of young people to whom they prescribe or administer [blockers or hormones].”

Hormone misinformation

As if to reassure, the panel declared that the use of synthetic testosterone drugs to masculinise a female minor’s body “is quite tightly regulated”.

“Testosterone deficiency is a requirement for [publicly funded] prescription of testosterone therapy,” the panel said. “We were advised by QCGS that such prescriptions are written on the basis that the individual concerned is considered testosterone deficient.”

In fact, trans-identifying girls have no hormonal disorder until they are given testosterone drugs in male-level doses.

Under the taxpayer-funded Pharmaceutical Benefits Scheme (PBS), testosterone is available to treat the male disorder of androgen deficiency/testicular disorder. To secure access to PBS-subsidised testosterone, gender clinicians purport to apply this diagnosis to females who identify as male or non-binary.

In a 2019 Medical Journal of Australia podcast, gender clinician and endocrinologist Dr Ada Cheung explained the prescribing rationale for biological females who identify as transgender men on the basis that they lack testicles. (Endocrinologists specialise in hormones.)

Dr Cheung acknowledged there was no PBS listing for testosterone to treat gender dysphoria, but said females who identify as “transgender men are males, and they have a low testosterone level, so they have androgen deficiency, and they don’t have testicles.”

“So, we’ve been able to use the [PBS] indication ‘androgen deficiency due to an established testicular disorder.’ And when I’ve checked this with the PBS, they … have said that this is okay.”

Earlier this month, the British father of a 15-year-old autistic girl who was prescribed a potentially fatal dose of testosterone by the online clinic GenderGP spoke publicly for the first time about the resulting case heard by England’s High Court last year.

“I was foolishly under the belief that being under 16, she couldn’t access this stuff. There’d be due process,” the father, identified as “John”, told The Times.

“He describes how—in his view—his ex-wife weaponised gender medicine to cut him out of his daughter’s life, how his daughter went from being sectioned for anorexia to being affirmed in her trans identity by all the adults in her life except him, how she was given a prescription for testosterone after one online session with a counsellor, and how this was injected by her local NHS GP with no blood tests or clinical evaluation,” The Times reported.

The High Court heard expert evidence from an Australian paediatric endocrinologist that the double “loading” dose of adult-level testosterone prescribed for the girl put her at risk of sudden death.

A comparable “loading” dose of testosterone is suggested as a starting dose for female adolescents in RCH Melbourne’s “Australian standards of care” used by clinics across Australia, including the QCGS.

Children’s Health Queensland, the government entity responsible for the QCGS, did not reply when GCN asked last year if it used this dangerous dose of testosterone.

There is no accurate public data on how many girls nationwide have been exposed to synthetic testosterone at male-level doses far in excess of the naturally low levels of this powerful hormone in a female body.

In passing, the Vine report remarked that the RCH guideline “may be interpreted as lessening the requirement for psychiatric sign off in every case compared with other guidance that requires or strongly recommends psychiatric involvement for all patients”.

GCN does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable minors.

GCN global briefs

Rush to diagnosis

Colombia | A young woman whose history of sexual abuse, depression, anxiety, self-harm and an eating disorder was allegedly ignored by gender clinicians has launched a test case against one of Latin America’s most famous private hospitals. Known as Laura, she was given testosterone at 15, followed by puberty blockers and a double mastectomy; she has since detransitioned.

She had reportedly been sexually abused from the age of five to seven by the family’s domestic help, and kept silent about it for almost ten years. She feared growing up as a woman, then encountered transgender material online and felt she wanted to become a man. “If you are uncomfortable with your period, if you prefer wearing jeans to skirts, if you don’t wear make-up—they said [on YouTube] that all of these were reasons to become a trans man,” Laura told the Colombian news magazine Semana. “In my fear of being a woman, which I had had since childhood, and my teenage confusion, all of this made sense. I started to think I was a boy.”

In 2017, her worried parents took her to the Valle de Lili hospital in Cali, Colombia, which bills itself as the best in the country. At that time, its gender clinic was just being established and Laura’s case was to be the “success story to launch” the new unit, according to the pro-family New Democracy Foundation, which filed her multi-million-peso medical malpractice action on November 7 in the civil circuit court of Cali.

The case argues that her gender dysphoria diagnosis was rushed, her trauma and co-morbidities were ignored, she was given testosterone younger than allowed by treatment standards, the use of puberty blockers to suppress her menstruation was irregular, and she lacked the emotional and cognitive maturity to consent to irreversible treatment.

“The clinic confused a symptom (bodily dissatisfaction typical of trauma) with a diagnosis of dysphoria,” New Democracy said. “Supramaximal doses of testosterone and ‘masculinisation of the chest’ caused real physical pathologies where none existed before. The treatment Laura underwent caused permanent risks to her fertility, breastfeeding, reproductive health, and mental health.” Her case relies on expert reports from a Chilean psychologist, a Swedish paediatric endocrinologist and two American physicians, one a psychiatrist and the other a specialist in women’s reproductive health.

It is said to be Colombia’s first detransitioner lawsuit and a potential precedent for Latin America. Laura “hopes that her story will prevent further harm to other minors,” New Democracy said. The hospital said it could not comment on individual patients, but insisted that “all interventions and procedures performed at the institution are based on scientific evidence and have the respective informed consent,” Semana reported.

Blocker repulsion

United Kingdom | The UK clinical trial of puberty blockers, recommended by the Cass review and scheduled to begin in January, is coming under intense legal, political and clinical pressure. A solicitor’s letter to the regulatory agencies that signed off on the PATHWAYS trial has threatened court action if the experiment is not stopped. The potential litigants are parents’ association the Bayswater Support Group, psychotherapist James Esses of Thoughtful Therapists and Tavistock clinic detransitioner Keira Bell.

Their lawyer’s letter, seeking a response by December 19, argues that the trial—which is to recruit more than 200 children younger than 16—is unethical and unlawful. The letter notes the unusual nature of the condition under treatment; gender incongruence being “neither a physical disease or illness, nor a mental health disorder”. “The trial therefore proposes to provide a pharmacological intervention which prevents a physiologically normal process in order to treat a presentation which involves neither physical nor mental ill-health. This is not medicine as it is usually understood.”

The letter contends that the flawed design of the trial will not deliver clear results, saying “the trial outcomes will be affected by, among others: (i) bias engendered by the lack of a blind control group such that any placebo effect will be attributed to the administration of the treatment; (ii) the confounding factor of psychosocial intervention being provided alongside the hormone treatment, as well as the impact of other factors such as social transition, particularly where the primary outcome expected relates to self-reports by children on emotional wellbeing; and (iii) the likelihood that the administration of treatment itself may change the trajectory of gender identity development in children”.

In defence of the trial, the centre-left Labour government has invoked cross-party support for the Cass review, and the Department of Health insists the trial proposal passed “extremely rigorous safety checks”, and includes “multiple safeguards in place to protect young people’s wellbeing, including clinical and parental approval”.

In parliament, the prominent Conservative MP Claire Coutinho put a pointed question to Labour Education Secretary Bridget Phillipson, asking if she believed “that an eight-year-old child with autism can consent to a medical pathway that will leave them infertile and without sexual function for the rest of their life? If not, will she tell the Health Secretary [Wes Streeting] herself to stop this puberty blocker experiment, which will biologically castrate children?”.

In an interview, Streeting confessed he was “deeply uncomfortable” with the idea of “medication that delays, or indeed stops, a natural part of our human development, which is puberty”. However, he said he was “trying really hard as a politician not to interfere or block clinical advice [favouring the trial] by people who are, frankly, far more qualified than me”.

Streeting has been sent a letter of opposition to the trial from 20 named clinical psychologists, echoing his discomfort with the idea of suppressing a child’s natural puberty. “Leaving behind the heated ideology which to date has interfered with debate, the reality is that [a] previously suppressed profound lack of consensus remains within the clinical community and that the trial should therefore not proceed,” the psychologists’ letter said.

The group Genspect had ten questions for Streeting, including: “Childhood gender non-conformity is strongly associated with same-sex attraction in adulthood. How will the trial avoid unnecessarily medicalising children who would otherwise grow up to be healthy, same-sex attracted adults?”

Challenges to the puberty blocker trial have been given prominent coverage across British media. At last count, more than 70 MPs and 35 peers had put their names to a cross-party letter organised by independent politician Rosie Duffield asking Streeting to abandon the trial. Her December 5 letter claims the trial is “a dangerous mistake that could devastate the physical, psychological, sexual and reproductive health of over 200 vulnerable children, leaving them medically dependent for life”.

The Sun newspaper reported that Labour Prime Minister Sir Keir Starmer was facing “a growing revolt” within his own party over the trial. All five UK MPs of Nigel Farage’s populist-right Reform party have signed a letter to Sir Keir calling for an immediate halt to the trial, which they said would “place children at foreseeable risk while offering no credible justification that any potential benefit outweighs the harm”.

In an editorial, The Times opposed the trial as “indefensible” and difficult to reconcile with Dr Cass’s own warning that puberty blockers were “powerful drugs with unproven benefits and significant risks”. The newspaper argued that the ethical alternative to the trial was a proper follow-up of the thousands of former Tavistock patients such as Bell.

A perilous pivot

South Africa | HIV clinicians and their institutions have unwisely pivoted in South Africa to promote the poorly evidenced medical treatments of “gender-affirming care”, according to an article in The Daily Friend newspaper by Dr Janet Giddy, a physician whose experience includes HIV, tuberculosis and rural medicine.

“With no oversight, HIV clinicians uncritically stepped into a role they were never trained for, and unfettered by the rigours of scientific method, boldly promulgate ‘Gender-Affirming Healthcare for South Africa’,” she wrote. Dr Giddy, a member of the group First Do No Harm SA, argued that this embrace of ideological gender medicalisation might create a pretext for politicians to defund evidence-based HIV programs, and result in people dying.

Gender racketeering

America | Florida’s Attorney-General James Uthmeier has filed a court action accusing the organisations behind gender-affirming care of deceptive trade practices and racketeering. The complaint alleges that the World Professional Association for Transgender Health (WPATH), the American Academy of Pediatrics and the Endocrine Society knew there was no credible evidence for the medical model they promoted and they had engaged in a “co-ordinated campaign” to develop guidelines creating “a facade of legitimacy”.

“Defendants’ reprehensible and immoral actions capitalize on the mental distress of children—as well as the natural affections and fears of their parents—to help their members sell lucrative surgeries and drugs that irreversibly mutilate and chemically alter children’s bodies without providing any credible medical benefit,” the complaint says.

Uthmeier said: “For years, these groups insisted the [treatment] recommendations were settled science, but behind closed doors, they knew the evidence was weak. They knew the outcomes [were] uncertain and the risks very real”. “Children were irrevocably harmed because truth was replaced with political activism. When organizations make medical claims, they have a duty to be honest. When they intentionally mislead families, their members and the medical profession, we hold them accountable.”

The complaint says the gender-affirming “house of cards” has collapsed as a result of the UK Cass review (which exposed the circular referencing of low-quality guidelines); leaked WPATH files with damaging admissions by gender clinicians; and evidence of scientific misconduct by the gender-affirming lobby revealed in US litigation discovery.

Dr Kurt Miceli, of the medical watchdog group Do No Harm, welcomed the lawsuit. “The years-long coordinated campaign by WPATH and other medical organizations to disregard the serious health risks of sex-change interventions on minors will go down as the most egregious medical scandal in modern history,” he told National Review.

“These groups have obfuscated risk and misrepresented the low quality of evidence to support puberty blockers, cross-sex hormones, and surgeries for children—interventions that can cause lasting harm. It is encouraging to see our elected officials hold these organizations accountable for spreading misinformation. This is a critical step to restoring public trust in medicine.”

In Texas, another Republican state that has outlawed gender medicalisation of minors, Attorney-General Ken Paxton said he had launched the first state action alleging healthcare fraud by gender doctors. The allegation is that two doctors concealed the fact of unlawful gender transition procedures for minors “by falsifying records, altering diagnosis codes, and submitting deceptive billing information”, thereby fraudulently obtaining Medicaid reimbursement.

Starved of sanity

Belgium | The death by suicide of “Aero”—a trans-identified 18-year-old girl who was allegedly approved for testosterone after a consultation lasting less than one hour—has led to a high-profile lawsuit against the AZ Groeninge Hospital in Belgium, Genspect has reported.

“The lawsuit concerns possible involuntary manslaughter or criminal negligence. The parents claim that the hospital displayed gross negligence by conducting insufficient psychological screening and failing to properly assess the family’s medical history. If Aero’s treatment is found to have been negligent, this could set a precedent and expose other Belgian institutions to legal liability. The repercussions for protocols, responsibility, and the wider field of transgender care could be considerable.”

Meanwhile, the Belgian media outlet La Libre has published an opinion article linking the tragedy of Aero to two other recent suicides of young females and the “massive social contagion” of trans identity. “The mental health of young Belgians is collapsing,” say the authors, writing on behalf of the women’s group Pour les Femmes/Voor Vrouwen. “And gender ideology, which sells transition to teenagers (and young adults in deep distress) as a magic solution to their unhappiness, bears overwhelming responsibility for these deaths.”

“These young people are not necessarily suffering because they are ‘trans’. They are suffering, truly, absolutely, desperately—severe depression, autism, self-harm, internalised homophobia, trauma—and they are being led to believe that ‘changing sex’ will solve everything. This is a criminal lie.

“Imagine, twenty years ago, that a doctor, responding to the profound suffering of a 15-year-old girl with anorexia, said to her: ‘You’re right, you were born in a body that’s too fat. We’re going to prescribe you appetite suppressants. We’re going to operate to insert a gastric tube for life and inject you with hormones to block your growth. You’ll finally be yourself’.

“There would have been an outcry. People would have talked about mutilation, medical crime, collective madness. Doctors would have lost their licences. Parents would have filed complaints. But today, that’s exactly what we’re doing with gender dysphoria. We call it ‘affirmation’. We call it ‘care’. And we allow teenage girls and young women to sterilise and mutilate themselves for life because a TikTok algorithm told them it was the solution.

“The anorexic wants to disappear as a sexual woman. So does the trans-identified girl. Same mechanism. Same hatred of the pubescent body. Same flight from impending femininity. Same refusal to grow up. The only difference? Anorexia has finally been recognised as a mental illness. ‘Rapid’ gender dysphoria is celebrated as a courageous identity. We are witnessing immediate validation by society.”

Maturation as disease

International | In a talk on the history of puberty blockers published in the UK Medico-Legal Journal, Oxford University sociologist Professor Michael Biggs suggested this novel use of medicine has the potential to unsettle our understanding of human development.

“I think the final broader cultural ramification of puberty suppression is that you begin to conceive puberty not as a crucial life stage that we all have to go through in order to become adults, but as literally a disease or almost like a disease. As [psychiatrist Professor Annelou] de Vries, the most published Dutch gender clinician, says, ‘Disallowing puberty suppression, resulting in irreversible development of secondary sex characteristics, may be considered unethical’.”

Video: US author Abigail Shrier on the hubris of bad therapy and its perils for youth

Bad education

Australia | An educator at the Queensland Children’s Gender Service told health professionals in a public webinar that gender dysphoria was innate, according to documents released to GCN under Right to Information law. A clinical psychologist who attended the webinar wrote to Children’s Health Queensland chief executive Frank Tracey to complain of “multiple factual inaccuracies” in the 2022 webinar and the inability or refusal of the educator and then the gender clinic to answer questions “about their most basic definitions, statistics or practices”.

The psychologist had never heard before the claim that gender dysphoria was innate; the educator offered no evidence to support this statement. GCN put the issue to Toronto-based clinical psychologist Dr Ken Zucker, a world authority on gender dysphoria. “Any ‘educator’ who claims that gender dysphoria is completely ‘innate’ is, I am sad to say, not very educated,” Dr Zucker said.

Other correspondence released to GCN shows that the Queensland authorities responsible for the Brisbane-based gender clinic have been alerted by health professionals to the full range of evidentiary, clinical, ethical and medicolegal concerns about the gender-affirming treatment model for vulnerable minors. Over this period, the authorities instead sought to silence, discipline and dismiss the Queensland whistleblower psychiatrist Dr Jillian Spencer, who had told them the treatment model was unsafe.

A report from an independent review of puberty blockers and cross-sex hormone use in Queensland was delivered on November 30, as scheduled, to the director-general of the state health department, Dr David Rosengren, according to the office of Health Minister Tim Nicholls. At the time of this Substack post, there was no announcement on the result of any Cabinet consideration of the report from psychiatrist Professor Ruth Vine, and a review-linked pause in new public sector treatment with blockers and hormones remains in force. It is unclear if the Vine report will be made public.

Winging it

International | In videos obtained and recently reported by The Free Press, gender clinicians are shown eager to accommodate an increasing number of extreme surgeries—such as “nullification” procedures for self-declared eunuchs or the creation of a pseudo-vagina while preserving the penis—pushing well beyond any safety data. One clinician in a video of the 2022 WPATH conference at Montreal, Canada, said she and other gender-affirming colleagues felt “we’re all just winging it, you know? And which is okay, you’re winging it too. But maybe we can just, like, wing it together.”

Data-averse science

Italy | Eight medical and gender-sexology organisations in Italy have issued a letter opposing a government draft law that would impose stricter controls over prescription of puberty blockers and cross-sex hormones for minors, and require national collection and reporting of treatment data. The draft law, under which these hormonal drug uses would require sign off from a national paediatric ethics committee, is being examined by a parliamentary committee. The Meloni government’s regulatory intervention followed concern about treatment practices at Florence’s Careggi hospital and a sobering report from the National Bioethics Committee.

In its December 12 coverage of the letter in opposition to the law, the liberal newspaper Domani declared: “Puberty does not wait for parliamentary deliberations, experts remind us. It proceeds inexorably, and any delay in treatment can have irreversible psychological and physical consequences”. The letter, according to Domani, “asks that decisions be made based on data, not fear”. The newspaper headline read: “The scientific community raises alarm over the ‘gender dysphoria’ bill: ‘It denies treatment to minors and violates European guidelines’.”

But the parents’ group GenerAzioneD said the signatories were a “self-referential” minority within the scientific community, noting that they did not include any of the scientific societies for the fields of psychology, psychotherapy or psychiatry, whose work offers a cautious first-line response to gender distress. The letter cited new gender-affirming but low-quality guidelines from Germany, while ignoring more cautious treatment policy from Finland, Sweden and the UK, all of which relied on gold-standard systematic reviews and took into account the weak and uncertain evidence base for blockers and hormones.

“In the face of such widespread scientific disagreement at the international level, one would expect authoritative scientific societies to adopt an attitude marked by prudence, epistemological caution and reporting of clinical outcomes,” GenerAzioneD said. “On the contrary, the statement [of the eight organisations] relies mainly on a generic reference to the right to self-determination, an ethical-legal category which, although relevant, cannot replace clinical analysis, especially when it comes to minors and potentially irreversible treatments.”

“The most critical point in the [letter opposing the draft law], however, lies in a fundamental contradiction: the signatory societies claim the existence of ‘scientific evidence’, but do not produce Italian data on access, treatment or clinical outcomes. Yet they criticise a decree establishing a national register of medicines, which would be the minimum tool needed to start collecting such information.”

On November 26, GenerAzioneD’s president appeared before the parliamentary committee inquiring into the draft law, stating that, “In Italy, there is no up-to-date systematic data [on the gender medicalisation of minors]: for this reason, our association considers it essential to establish a national registry, also in view of the fact that drugs are administered off-label. For truly informed consent, parents must have access to clear data on the evolution of therapeutic pathways, including hormone treatments, psychological support, surgical interventions, dropouts and detransitions.”

Kiwi tantrum

New Zealand | An NZ government decision to ban new prescriptions of puberty blockers for gender distress—due to take effect on December 19—secured 50 per cent support in an independent poll commissioned by Family First NZ. Just under a quarter of respondents opposed the ban, and just over a quarter were uncertain. Much of the NZ mainstream media coverage of the ban, announced by centre-right National Party Health Minister Simeon Brown on November 19, was emotive and heavy on identity politics, but weak on the scientific debate and the international shift towards more cautious treatment policy.

On December 1, the gender-affirming lobby PATHA filed a court application seeking to restrain the ban. In a statement, PATHA president Jennifer Shields, said: “These regulations are being enacted based on politics, not on clinical evidence or best-practice decision making. We won’t let transgender children in Aotearoa [New Zealand] be subjected to harm just to ‘win a war on woke’.”

“This is an ideological tantrum escalated to legal action,” was the response of NZ political commentator Ani O’Brien. “The decision [on the ban] by Cabinet was based on clinical evidence, lack of regulatory approval, other credible jurisdictions making similar bans, and, of course, observable reality.”

Shields is a trans-identified individual, not medically qualified, and self-described as “a queer and trans artist, activist, advocate and educator”. PATHA is New Zealand’s iteration of the World Professional Association for Transgender Health, meaning it too is a hybrid health-activist entity.

Update, December 17: NZ High Court judge Michelle Wilkinson-Smith has granted PATHA an injunction stopping enforcement of the puberty blocker ban until its judicial review case can be heard. The judge said the government’s handling of the ban “had the effect of taking PATHA and the whole transgender community by surprise”, despite a preceding consultation round. The judge accepted evidence from one of PATHA’s witnesses, a doctor whose identity was suppressed, that puberty suppression is reversible and allows the child time to think and mature.

The judge also stated there was no evidence that blockers harmed fertility. The NZ Health Ministry itself, three years ago, abandoned the claim that blockers are “safe and fully reversible”. Today’s 38-page High Court ruling makes makes no mention of international data that most children begun on blockers proceed to cross-sex hormones, a combination likely to sterilise them.

The judge relied on the lack of evidence before her of blockers doing immediate harm—scant data, after all, is one of the many red flags in paediatric gender medicine—yet gave weight to the opinion of a single anonymous doctor that no access to blockers would lead to “an increase in distress, anxiety and depression”. No mention of findings by the Cass review and Finnish researchers that the mental health claims for blockers rest on no good-quality evidence at all.

The judge highlighted PATHA’s judicial review argument that the outright ban chosen by Cabinet was not Health Minister Brown’s preferred position, nor the option advised by his ministry. The case suggests that gender-affirming talking points, at odds with the evidence base, remain influential within the various branches of NZ government. The judicial review points are to be heard “with all possible urgency”.

Polisci

America | A review commissioned by the US Department of Health and Human Services (HHS) is an unlikely opportunity to transcend the Left-Right distortion of the debate over paediatric gender medicine, according to liberal journalist Lisa Selin Davis. Unlikely because the HHS report is the result of an executive order by President Trump and has therefore been dismissed out of hand by many liberals. An opportunity because the revised HHS report now carries the imprimatur of peer review and its previously anonymous authors have been revealed as being anything but MAGA-central.

Davis appealed to those on the Left to consider the report on its merits: “We Democrats have to push past the Left/Right framing, because we claim to be the party of science, and this is where the science leads—away from calling gender-affirming care for youth ‘evidence-based’ or ‘lifesaving,’ and perhaps away from providing these interventions at all”.

In an article for the media outlet STAT, the HHS report authors said they understood the Trump-tied scepticism. “But we are a politically diverse group,” they said. “Most of us are liberals and longtime Democratic Party supporters. All of us share a commitment to evidence-based medicine and have been willing to stick our necks out, often at personal or professional cost, to speak the truth. We did not expect HHS to entrust this sensitive task to us; it could have chosen a team that was ideologically aligned with the current administration. We are grateful that the administration set aside coalition politics and chose us instead.”

Meanwhile, the watchdog group Do No Harm has issued a critical analysis of a May 2025 report in the state of Utah which appeared to vindicate the gender medicalisation of minors. That Utah report “fails to meet the basic requirements for being considered a systematic review,” Do No Harm said, adding that it had cited a large volume of data favouring gender-affirming care without acknowledging the low quality of the data, and uncritically relied on activist guidelines undermined by actual systematic reviews of the evidence base.

Backyard hormones

United Kingdom | As post-Cass restrictions bite, more British teenagers appear to be sourcing powerful cross-sex hormones from dubious sources, The Times has reported. “Some get them from online suppliers in India and Russia, others are using drug dealers who offer testosterone and oestrogen alongside party drugs such as ketamine and MDMA, while others are ‘home-brewing’ the drugs using raw ingredients bought for pennies, and sharing them among those they meet online,” the newspaper said.

At London’s Great Ormond Street Hospital for Children, 12 per cent of the minors in the new gender clinic owned up to getting hormones outside the National Health Service. Testosterone and oestrogen for youth gender dysphoria have not been banned within the NHS, but prescriptions have been tightened up.

Clinical psychologist Anna Hutchinson, a Tavistock clinic whistleblower now working privately in London, said 40 per cent of the minors in her practice were self-medicating. “I’m seeing a surge of the older adolescents—the 15, 16, 17-year-olds—just skipping all medical supervision entirely, which I’m really worried about,” she told The Times. “A lot of them are on testosterone and oestrogen, and usually not with parental approval or any medical oversight.” Meanwhile, consultation of a new NHS clinical pathway for patients who wish to detransition is to close on December 28.

Fully misinformed

America | US Medical societies and journals are guilty of misinformation, erroneous and unsupported claims, and censorship of justified corrections—all in order to maintain the appearance of consensus in favour of gender-affirming care for minors, according to an analysis in the Journal of Controversial Ideas by J Cohn of the Society for Evidence-based Gender Medicine.

Claims protected from challenge include overstatement of the likely benefits of these medical treatments, minimisation of the risks, and omission of less risky treatment alternatives. This not only corrupts the scientific literature but is also “medically dangerous,” Cohn argues. “In medicine, ethical informed consent means a person understands the benefits, risks, and alternatives (including ‘doing nothing’) before consenting to undergo treatment.”

A scandal for the ages

Ordinary people less alert to “quackery”; the effects of clever marketing and well-connected lobbying; and the failure of normal quality and safety checks—all these have combined to produce a “gender-affirming” medical scandal likely to be studied for decades to come, according to Australian whistleblower psychiatrist Dr Jillian Spencer.

“Gender interventions have been marketed as a highly sophisticated health treatment, which worked to put it outside the realm of public debate,” Dr Spencer said last week at Women Speak Tasmania’s forum on youth gender distress held at Parliament House, Hobart, and hosted by MP Carlo Di Falco.

Dr Spencer, who faces dismissal for raising concerns about the safety of gender-affirming treatment mandated at the Queensland Children’s Hospital, said this model’s “supposed basis in health expertise functions to set aside the reasonable reservations held by members of the general public based on their own experience of childhood and adolescence as a period of immaturity and experimentation with identity”.

“I think it was the enigma of psychiatry that has provided a cover to make it seem normal to transition children, and none of this could have happened without the small group of gender-activist clinicians who subscribe to bizarre false ideas that there are more than two sexes, that a child can be born in the wrong body, and that people can change sex.

“Unfortunately, these days, people aren’t so alert to quackery. With the scientific progress of medicine, the general public lost awareness of the phenomenon of doctors providing discredited interventions for their own personal or professional reasons. We all forgot about the issue of the snake oil salesman.

“But when members of the general public come to understand what has been done to children, they become alarmed and angry.

“The existence of a powerful and well-funded political lobby championing these interventions means that we require decisive political measures by politicians to stop the harm.

“In my opinion, state-sanctioned harm to children has a nasty stench that will permanently attach to any politician who has endorsed the gender clinics. So, I encourage politicians to get it on the record as soon as possible that they do not support the transitioning of children.”

Gender co-opts grief

Dr Spencer recalled the case of a patient encountered in the Queensland Children’s Hospital mental health unit whose plight first led her to put her concerns in writing to the authorities in 2019.

Admitted with suicidal ideation, this girl had suffered the sudden death of a parent.

“It was clear that she was grieving and feeling really miserable and isolated and really struggling to find her place in the world, and she told me that she was really a gay man,” Dr Spencer said.

“She was seen by the gender clinic. When I looked at the notes from the gender clinic, I saw that she had said very little during her appointment. Nonetheless, she was started on puberty blockers from that first appointment.

“At that time, I hadn’t looked into the research enough, so I was placated in my concerns by the gender clinic telling me that they knew how to identify those children who would have an enduring trans identity, and they said she was one of them.

“It took me a couple of years to figure out that this is absolutely untrue. There is no way to predict if a child will persist in their gender distress. Studies from before the affirmation model clearly show that the vast majority of children won’t persist in their distress.

“The people working in gender clinics internationally are activists, and they conduct dodgy research to justify transitioning children. There are so many studies that falsely claim to have proven that there are benefits.

“The studies have issues like small number of subjects, short follow-up time frames, high dropout rates, outcome measures that aren’t validated, and the reporting of marginal results as highly positive. If one small sub-scale on an outcome measure improves by a couple of points after a couple of months, they’ll tell you that the interventions are improving the patient’s mental health.”

Dr Spencer said that in the five years to 2022, she observed “the gradual intrusion of more and more gender ideology” at the Queensland Children’s Hospital that is home base to the statewide gender service.

There were staff workshops on gender and pronouns, the proliferation of “a ridiculous amount of LGBTIQA+ signage and transgender pride flags”, and clinical case discussions “where we were pretending the child patient was the opposite sex”.

“And it was considered transphobic if you wanted to try to assist the child to feel comfortable in their own body”.

She said trans pride flags and other symbols of gender ideology in the hospital workplace were intimidating for staff who dissented, and the associated new language of affirmation—such as sex assigned at birth, gender identity and cisgender—also exerted social pressure to conform.

“The special language interferes with the relationship with the child’s family, as it signals that the clinician is not willing to explore the child’s relationship to their biological sex,” she said.

It also “imposes the political agenda onto parents, and I am constantly contacted by desperate parents who are trying to find a non-affirming doctor or therapist for their child”.

This is not medicine

In his Hobart presentation, academic psychiatrist Dr Andrew Amos said the pursuit of political rather than medical goals explained the unusually “rapid roll-out” of paediatric medical transition.

“Gender-affirming care in Australia doesn’t actually require the diagnosis of an illness to start vulnerable kids on a treatment pathway of social transition, puberty blockers, hormones and eventually the amputation of sexual organs,” he said.

Instead, there were just two requirements.

“First, for a child to say or do anything that a clinician can interpret to mean that their gender identity, which has no fixed definition, does not match their biological sex, and second, for the child to request gender-affirmative treatment,” he said.

“So, this protocol lacks all of the traditional features of medical treatment designed to protect patient safety and improve patient health. It doesn’t require the diagnosis of the disease.

“Gender-affirming care is designed to affirm an identity, not to treat an illness. Not unrelated, it has never been reliably demonstrated to improve patient health or mental health, and in fact, its advocates are now starting to say openly that the goal of gender-affirming care should be respecting patient autonomy, not improving patient health. They are moving the goal posts.

“Given that gender-affirmative care is not medical treatment of an illness, what is it? Well, advocates have explicitly described access to gender-affirmative care as a human right, and consider the refusal to provide it—based on usual medical safeguards—as the denial of that human right.

“Now, demanding the provision of a human right is a political act, while refusing treatment because it will harm a patient is a medical act, and I think this proves that paediatric gender medicine has been set up across Australia in response to political demands, not in response to requests for medical treatment.”

Although Dr Amos said trans ideology had been adopted across the medical, legal and educational systems, he argued the highest priority for pushback should be reform of Australia’s federal Sex Discrimination (SDA) Act.

In 2013, under the country’s first female prime minister Julia Gillard, amendments to the SDA removed biological definitions of the terms man and woman, and introduced as a protected characteristic the subjective concept of gender identity unmoored from birth sex.

Asked after the Hobart forum why he gave priority to this legal reform above a prohibition on paediatric medical transition, Dr Amos said—

“The replacement of sex by gender in Australia’s Sex Discrimination Act in 2013 gives legal cover for clinical activists to ignore the reality that transsexualism is a form of mental illness. Without this legal fiction it would be self-evident that affirming a gender different from sex is as unethical as reinforcing an eating disordered patient’s delusion that they are overweight when in reality they are malnourished to the point of death.

“In my opinion, the harms done by paediatric gender-affirming care are just symptoms of a more fundamental disease, which is the replacement of sex by gender in Australian legislation. Sex describes a reality of human nature, which is that men and women are meaningfully different and have specialised in ways that are complementary, mutually beneficial to men and women, and essential for the physical and psychological health of children.

“Gender and gender identity are concepts without clearly defined meanings which were more or less explicitly created to obscure the realities that there are two sexes, that it is not possible to change sex, and it is psychologically harmful to pretend it is possible to change sex.

“Depending on your interpretation, changes to the SDA in 2013 either gave gender equal status with sex, or replaced sex as a protected characteristic in Australian law. In my opinion, this was the equivalent of giving legal protection to anorexic patients’ right to assert that their delusional self-perception of being overweight has equal status with a doctor’s medical evaluation that they are at risk of death due to malnourishment.

“In effect, replacing sex by gender in law obscures the reality that the belief that one has a gender that is distinct from sex is a form of mental illness that requires psychological treatment, and satisfies the fantasy that it is possible for human beings to change sex.”

Do no harm

Dr Philip Morris, president of Australia’s National Association of Practising Psychiatrists (NAPP), delivered his Hobart talk, via web-link, on the tension between the trans-depathologisation campaign of activists and the ethical duties of physicians.

“The history of homosexuality [which was removed from the diagnostic manual of mental disorders in 1973] has fuelled expectations among transgender advocates that a similar process of normalisation can occur for gender diversity, but the comparison is imperfect,” he said.

He pointed out that, unlike same-sex attraction where no doctors need be involved, trans identity not uncommonly comes with a demand for medical interventions, which in turn activates the principles of the Hippocratic Oath.

“The first is, Do no harm. The second is that the patient’s welfare is the primary focus of the doctor,” he said. This required a careful—and differential—diagnosis.

“The symptom of gender dysphoria is one thing, but the syndrome is another, and the syndrome may be caused by other underlying conditions, such as depression, in rare cases psychosis, or it could be because there’s substantial psychiatric comorbidity clouding the picture,” Dr Morris said.

He said the physician had to identify evidence-based treatment and be convinced that the benefits outweigh the risks—“and this is very difficult, because in the field of gender dysphoria treatment, the literature base is very weak”.

“The doctor has to be able to communicate the risks of the treatments to the young person and their parents, which means [the doctor needs] to know what the risks are to be able to communicate that,” he said.

Finally, “the doctor has to determine that there is capacity for both the young person and the parents to understand what the treatment is—and what the adverse effects might be—in order to be able to make fully informed consent”.

Dr Morris said this clinical framework had been encapsulated in the NAPP guide for “Managing gender dysphoria in young people”, which he said offered practitioners a beneficial, cautious, compassionate and non-ideological approach to treatment.

GCN does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable young people.