Schtum

Australia’s national regulator of health practitioners is refusing to identify which clinical guidelines it uses to detect misinformation and distinguish between truth and falsity in the contested domain of gender medicine.

Doctors have been warned by the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board that they may face disciplinary action if their social media posts spread “false or misleading information”. After an Ahpra investigation, the Board can refer doctors to a tribunal with the power to cancel their registration.

In one instance, the Board used its emergency powers to suspend a primary care doctor for his social media use, including one post which the board judged harmful because it was “likely to arouse contempt towards practitioners enabling gender-affirming care”.

The former general practitioner, Jereth Kok, was suspended for seven years before a penalty of 12 months’ further suspension was imposed in October 2026.

In overlooked remarks in the Senate earlier this year, Ahpra’s chief executive Justin Untersteiner said the regulator relied on “existing clinical guidelines” in healthcare, as well as the facts in a given case, when detecting misinformation about gender medicine.

Yet, through its spokesman, the regulator has refused to answer GCN’s request that it name the clinical guidelines alluded to by its own chief executive in a public parliamentary hearing.

At the same time as it imposes secrecy, Mr Untersteiner has complained about “selective media”, a reference to The Australian newspaper’s coverage exposing his organisation’s ties to ACON, a former AIDS council that now functions as a gender medicine lobby.

What is truth?

Mr Untersteiner’s reference to reliance on clinical guidelines came in response to One Nation Senator Malcolm Roberts, who had asked him in a June 3 estimates hearing how Ahpra staff “acquire the capacity to know what is true or false information in this highly contested area”.

Senator Roberts also wanted to know what Ahpra would consider “misinformation” in a social media post about paediatric gender medicine.

During the hearing Senator Roberts and Liberal Party Senator Sarah Henderson raised with Mr Untersteiner the case of psychiatrist Dr Andrew Amos, a critic of the gender medicalisation of minors who was ordered by Ahpra to cease social media posting about transgender issues including gender medicine. (The regulator used its emergency powers for this purpose.)

Mr Untersteiner told senators that practitioners had a right to engage in public debate about the gender-affirming treatment model, but the regulator would intervene if this went “beyond a debate about clinical pathways and treatments and moves into a place of hate or discrimination against individuals or groups”.

Senator Roberts asked: “How can a doctor fulfil their ethical obligation to inform the public of potential harms of gender interventions and gender ideology without being accused of discrimination against LGBTIQA+ people?”

“Is it discrimination for a health practitioner to refer to a person’s biological sex?”

Following a Freedom of Information request by GCN, Ahpra released a redacted briefing note used to prepare Mr Untersteiner for the June 3 Senate estimates hearing.

That document is headed “Discrimination—LGBTQIA+” and states that the right to free speech is “constrained if a practitioner comments, or supports comments, that can cause harm to groups or individuals … Harm is caused when some members of the community fear seeing a medical practitioner and do not access the healthcare they need.” This presupposes that gender medicine is healthcare.

The redacted briefing note makes no mention of “existing clinical guidelines” used by the regulator to police misinformation by practitioners.

The note does mention the January 2025 announcement by federal Health Minister Mark Butler that the National Health and Medical Research Council would develop new national guidelines for youth dysphoria care.

The note for Mr Untersteiner also cited Mr Butler’s statement that there would be a comprehensive review of the de facto national guidelines promoted as “Australian Standards of Care and Treatment Guidelines for Trans and Gender-Diverse Children and Adolescents”. These guidelines were first issued by the gender clinic of the Royal Children’s Hospital Melbourne in 2018.

This contentious document is the only Australian-authored clinical guideline on paediatric gender medicine available to Ahpra for its regulatory functions.

RCH gender clinician Dr Michelle Telfer is the first author of this gender-affirming guideline, which advises that psychosis in a minor is not necessarily an obstacle to medical transition with powerful hormones.

Trans Atlantic: American Scott Newgent, who struggled as a lesbian before transitioning, has joined the campaign against the proposed UK ‘anti-conversion therapy’ bill

Singing the same song

Children’s hospital gender clinics in Australia also cite international gender-affirming guidelines issued by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. These guidelines recommend puberty blockers and cross-sex hormones.

The WPATH guidelines, a key influence on the RCH Melbourne document, are also contentious. In preparing the current 2022 guidelines, WPATH allegedly suppressed systematic evidence reviews with inconvenient results, and gave into political pressure when abruptly abandoning minimum age thresholds for surgery on minors.

In Australia, apart from the WPATH document, the local guideline for adult patients is a fast-track “informed consent” document issued by another gender medicine lobby, the Australian Professional Association for Trans Health.

By contrast, Australia’s National Association of Practising Psychiatrists has declared that the best response to youth gender dysphoria is “a contested area of medical practice”. NAPP’s guide, which is not a fully developed clinical guideline, says the first-line treatment for minors should be psychological, warning that blockers and hormones are “potentially harmful” and rest on “very limited” evidence of benefit.

Ahpra has also refused to tell GCN its policy for handling a complaint against a doctor who is an author of a guideline on which the regulator relies when investigating.

In September last year Ahpra dismissed a complaint against RCH Melbourne’s Dr Telfer, citing her side of the story, including her “approach to providing informed consent for puberty blockers”. The regulator found she was “meeting accepted standards of practice”, but made no reference to any clinical guideline establishing those standards.

The complaint drew on adverse findings against Dr Telfer in a landmark 2025 Family Court case involving a 12-year-old boy, “Devin”, whose parents disagreed about whether their son should be given puberty blockers at RCH.

In court Dr Telfer testified that medical interventions for minors would be carried out in accordance with the RCH guideline. Justice Andrew Strum concluded that a gender non-conforming boy such as Devin would be offered no alternative treatment but puberty blockers and made orders protecting the boy from hormone suppression at RCH.

The judge also criticised the RCH treatment guideline as taking a concerning and “oddly binary” approach to children with its advice “to affirm unreservedly those [minors] who present with concerns regarding their gender, brooking no questioning thereof”.

He suggested the RCH guideline was misleadingly badged as “Australian Standards” when in fact this document had no “approval or imprimatur of the Commonwealth or any State or Territory Government, including any such government Minister for, or Department of, Health”.

He took a cautious view of Dr Telfer’s testimony in which she praised her own guidelines as the “most progressive and trans-affirming guidelines”, suggesting she had a conflict of interest “akin to being the proverbial ‘judge, jury and executioner’.”

As for her claim that the RCH document represented “best practice”, Justice Strum said Dr Telfer had conceded under cross-examination that this endorsement was “essentially tantamount to her agreeing with herself”.

After this judicial criticism of Dr Telfer, RCH issued a statement in her defence, describing her as “a highly respected paediatrician, expert in adolescent medicine, and fierce advocate for the health and wellbeing of all children and young people”.

Whose experts?

In written responses to some of Senator Roberts’s questions from June this year, Ahpra said: “All regulatory decisions are made impartially, based on evidence, public safety, risk and in accordance with the Health Practitioner Regulation National Law … Ahpra obtains clinical input on matters, including independent expert opinion, as appropriate.”

Ahpra refused to tell GCN whether this clinical input includes experts critical of the gender-affirming model.

In a 2025 tribunal ruling, some social media posts by Melbourne GP Jereth Kok were found to have “denigrated, demeaned and slurred” doctors who “recognise that people who identify as transgender are not suffering from a mental health condition”.

Treatment of a mental disorder is an essential element of the Family Court’s jurisdiction to approve the hormonal or surgical interventions for a gender-distressed minor whose parents are in dispute over the issue, according to Emeritus Professor of Law Patrick Parkinson.

In Mr Kok’s case, the Medical Board used its emergency powers to suspend him in 2019.

The tribunal found he had engaged in professional misconduct.

The Board, which makes decisions following an Ahpra investigation, used its emergency powers to suspend Mr Kok seven years ago. In the resulting case, the tribunal agreed with the Board that gender-affirming care involving hormonal treatment and surgery was “accepted medical practice”.

Suspended as a doctor since 2019, Mr Kok subsequently found a new career, ending his 16-year term as a GP.

None of the complaints against Mr Kok or Dr Amos came from patients.

On 12 October 2026, the tribunal handed down a penalty decision, setting a one-year period before he could apply for reinstatement. The Board had asked for a three-year term.

In the case against Mr Kok, the Medical Board relied partly on expert evidence from endocrinologist Professor Jeffrey Zajac, who is included in a directory of gender-affirming clinicians maintained by the Australian Professional Association for Trans Health.

That directory gives his pronouns as “They/Them”. Professor Zajac told GCN his preferred pronouns were in fact He/Him.

He is a co-author of a 2019 position statement for adults published by the Medical Journal of Australia. This document claims that, “Gender‐affirming hormone therapy is effective and, in the short term, relatively safe with appropriate monitoring.”

Asked if he was capable of giving objective expert evidence in a case such as Mr Kok’s, Professor Zajac told GCN that, “Any evidence I give as an expert witness is as accurate as I can make it and is evidence based whenever possible.”

GCN does not suggest any wrongdoing by Professor Zajac or Dr Telfer, just that there are serious questions about the impartiality of institutions including Ahpra.

“Medicine is a science of uncertainty and an art of probability.” Sir William Osler

Every generation of physicians inherits two legacies: the discoveries of medicine and its mistakes. The first is celebrated. We rightly honour those whose insight, perseverance and compassion have relieved suffering and saved, prolonged and transformed our lives.

The second legacy receives less attention. It resides not in our monuments but in our memory—in abandoned treatments, discarded theories and the sobering recognition that medicine has, at times, continued practices long after evidence of their harms had become known. Bloodletting continued for centuries despite mounting clinical observations that it frequently weakened and hastened death rather than healed. Lobotomy survived long after devastating cognitive and emotional consequences, including irreversible personality changes, had become evident and which rendered lobotomised individuals “ruined human beings”. Its originator, António Egas Moniz, was awarded the Nobel prize in 1949.

Mercury remained a treatment for syphilis despite its recognised toxicity. The horrific side effects—which included tooth loss, severe ulcerations, neurological damage, kidney failure and death—were often rationalised by doctors as the “disease leaving the body”. Heroin and radium-based patent medicines continued to be marketed long after their dangers were increasingly apparent. More recently, recommendations that infants sleep in the prone position persisted despite accumulating evidence of increased mortality by sudden infant death syndrome until systematic re-evaluation transformed neonatal care. These examples differ in their scientific context, but they share an uncomfortable lesson: medicine does not always abandon harmful practices as quickly as hindsight suggests it should. Why?

The answer is rarely ignorance alone. History reveals that the correction of medical error is often delayed by forces extending well beyond the evidence itself. Scientific evidence is indispensable, but for practice to change, evidence must first overcome the psychological, social, economic and institutional forces that resist its implications.

The challenge of gender distress

The lesson of history is not that new ideas should be feared, but that they should remain open to the same dispassionate scrutiny that ultimately distinguishes scientific progress from medical fashions. Few contemporary areas of medicine test these principles more profoundly than the care of children and adolescents experiencing gender-related distress. During the past decade, youth gender medicine has become one of the fastest-growing, most ethically contested and most socially charged areas of clinical practice. It has also become one of the most difficult environments in which to ask ordinary scientific questions.

Questions regarding long-term outcomes, developmental trajectories, informed consent, psychological assessment, adverse effects and alternative models of care have increasingly become intertwined with political advocacy, institutional reputation, professional identity and broader cultural debates. Under such circumstances, maintaining the habits of mind that have traditionally protected medicine from error becomes especially challenging. This essay does not seek to resolve every controversy surrounding youth gender medicine. Rather, it asks a more fundamental question.

What happens when the conditions that enable medicine to correct itself begin to erode?

Throughout the history of medicine, episodes of delayed self-correction have displayed recurring features. They have rarely resulted from a single cause or a single individual. More often, they have reflected the convergence of institutional, psychological, social and economic forces that made re-examination increasingly difficult, even after evidence of harm had begun to emerge.

Two-phase science: Science shifts into revolutionary mode when unexplained anomalies mount up and force the overthrow of a scientific paradigm, according to philosopher of science Thomas Kuhn.

Paradigm pitfalls

Thomas Kuhn observed that scientific communities work within paradigms—shared assumptions that determine which questions are asked, which observations are considered important and which explanations appear plausible. Paradigms are indispensable. Without them, scientific inquiry would become directionless. Yet paradigms also possess a remarkable capacity for self-preservation. Anomalous findings are often regarded initially as exceptions rather than invitations to reconsider prevailing assumptions. Only when contradictory evidence accumulates beyond a critical point does the profession begin the slow process of re-evaluation. Medicine is no exception.

Indeed, the stakes are often higher because therapeutic paradigms become intertwined with professional training, institutional reputation, public policy, regulatory frameworks and the understandable desire of clinicians to believe that they are relieving rather than causing suffering. Under such circumstances, abandoning an established model of care requires considerably more than new evidence. It often requires a willingness to question one’s own professional identity. Financial incentives can reinforce existing practices by rewarding their continuation and discouraging alternative approaches.

Recovered memory therapy illustrates how a compelling therapeutic narrative, reinforced by professional conviction and moral urgency, can become resistant to methodological criticism even after concerns regarding suggestion and false memories began to emerge. Each example differed in its particulars, yet each reminds us that medicine’s greatest challenge is not discovering new knowledge but relinquishing old certainties.

Regulatory environments create additional caution if clinicians fear that questioning accepted practice could expose them to professional sanction. There have been many recent examples of health practitioners losing their registration and facing court for expressing opinions in opposition to the prevailing zeitgeist. This is a major impediment to reversing harmful practices in gender medicine; that is, the institutional capture of organisations that create laws, policies and practices.

Equally powerful are the psychological forces that influence every human enterprise. Among the most important is identity-protective cognition. Social psychologists use this term to describe our tendency to interpret evidence in ways that preserve beliefs central to our personal or professional identity. Physicians are no more immune to this tendency than anyone else. When a particular model of care becomes closely associated with one’s understanding of compassion, ethical practice or professional integrity, disconfirming evidence can be experienced not merely as an intellectual challenge but as a threat to one’s moral identity.

Closely related to identity-protective cognition is moral identity investment. These are not accusations. They are ordinary features of human cognition. Clinical positions sometimes become woven into a physician’s sense of being a “good and compassionate” doctor. Under these circumstances, changing one’s mind carries a psychological cost extending well beyond scientific disagreement. It may feel like an admission of having failed patients, colleagues or deeply held moral commitments. Such pressures are rarely acknowledged explicitly, yet they can exert a profound influence on the interpretation of evidence.

The imperative to investigate

The rapid increase in presentations of children and adolescents experiencing gender-related distress has been one of the most striking developments in modern clinical practice. Particularly notable has been the demographic shift from predominantly natal males presenting in early childhood to predominantly adolescent natal females presenting during or after puberty. Such a dramatic epidemiological change should stimulate scientific curiosity. In medicine, unexpected changes in disease patterns are not inconveniences to be explained away. They are invitations to investigate. They encourage clinicians to ask what has changed, why it has changed and whether multiple causal pathways may be contributing to apparently similar clinical presentations.

Yet one of the most remarkable features of the contemporary debate about gender-related distress has been the extent to which ordinary scientific questions have themselves become controversial. Questions regarding developmental trajectories, spontaneous resolution, co-occurring psychiatric disorders, autism spectrum disorders, family dynamics, trauma histories, peer influences, and online communities have, at various times, been interpreted not simply as scientific questions but as moral or political statements. So, too, with questions about informed consent, long-term outcomes, fertility, sexual function, bone health, neurodevelopment and psychological formulation. Clinical caution has sometimes been portrayed as a lack of compassion or equity.

Medicine has always depended upon the freedom to ask difficult questions. The physician’s first responsibility is not to confirm or deny a patient’s explanatory framework, but to understand it. Curiosity is the beginning of diagnosis. It is also the beginning of psychotherapy, developmental formulation and scientific inquiry. Once curiosity is constrained by ideological expectations, and demands for conformity supersede scientific inquiry, medicine risks exchanging investigation for affirmation and hypothesis for conclusion. This concern extends beyond individual consultations. It raises broader questions regarding the conditions under which evidence can be examined objectively.

Advocacy’s trap

Youth gender medicine presents additional challenges. Unlike many areas of clinical practice, it has evolved within an environment characterised by extraordinary social and political attention. Advocacy organisations, professional colleges, governments, educational institutions, social media platforms, activist networks and traditional media have all become active participants in shaping public understanding of gender identity and appropriate models of care. Such involvement is understandable.

The welfare of vulnerable young people rightly attracts public concern. Yet the convergence of advocacy and medicine has historically required exceptional vigilance. Medicine functions best when clinical questions remain open to clinical investigation, even when they intersect with matters of profound moral importance. The profession must therefore guard against allowing therapeutic orthodoxy to become insulated from critical appraisal. This does not imply that current models of care are necessarily incorrect. It does imply that no model of care should be regarded as beyond re-examination.

Systematic evidence reviews in several countries including the UK, the US, Sweden, Finland, and Germany have all converged on the same conclusion regarding the very-low quality of evidence for the practice of youth gender medicine. Increasing emphasis on comprehensive psychological assessment and recognition of continuing uncertainty regarding long-term outcomes, illustrate that international medicine is already engaged in such reappraisal, demonstrating that medicine is attempting to perform one of its most important functions: the willingness to revisit accepted practice when evidence evolves and correct itself when shown to be in error. Whether that process continues will depend not only upon future research but also upon the profession’s willingness to sustain dispassionate collegial scrutiny despite social, political and institutional pressures.

History offers a consistent warning. Medicine is least able to correct itself when questioning prevailing orthodoxy becomes professionally costly. That warning deserves careful consideration today. The issues raised by youth gender medicine therefore extend beyond endocrinology, psychiatry or adolescent medicine. They concern the integrity of scientific medicine itself. They ask whether clinicians remain free to investigate complex developmental phenomena without predetermined conclusions; whether competing hypotheses may still be examined respectfully; whether evidence that challenges established practice can be discussed without fear; and whether the welfare of individual patients remains the profession’s overriding concern. These are not merely questions about gender medicine. They are questions about the future nature and practice of medicine.

Professor Dianna Kenny is the author of Gender ideology, Social Contagion and the Making of a Transgender Generation (Cambridge Scholars Publishing, 2024.) Use the code AUTHOR40 to get a 40 per cent discount. She is also the author of inTRANSigence: Gender Ideology, Social Contagion, and the Scandal of Youth Gender Medicine (Hexa, 2025.)

Bait-and-switch

The rise of gender medicine is a story of brilliantly executed identity politics and invasive treatment unjustified by short-term consumer satisfaction, according to Dr Stella O’Malley, the Irish psychotherapist who founded Genspect.

She said the hormonal and surgical interventions now marketed as “gender-affirming care” became the go-to response for youth gender distress despite the absent evidence of long-term benefit.

Like frontal lobotomies, medical transition should be judged “a failed intervention” alien to genuine healthcare, which has a duty to offer vulnerable people treatment directed at long-term improvement and recovery, Dr O’Malley said on Saturday at the second annual summit of the Coalition Advancing Scientific Care in Adelaide, Australia.

She said the success of the political campaign to depsychopathologise transgender identity as a healthy human variation had created a paradox: “Psychiatry removes the pathology while medicine intensifies the intervention.”

One of these things is not like the other

Dr O’Malley noted that in the mid-1990s, LGBT emerged as an expanded entity when the T was piggy-backed onto the LGBs.

“It was an absolutely brilliant political campaign,” she said. But this merger conflated two starkly different imperatives.

“Gay rights sought freedom from psychiatric and medical interventions,” Dr O’Malley said. “Trans activism sought access to medical interventions while simultaneously arguing that transgender identity was not pathological.”

And, she said, those trans interventions simply did not work, judging by real-world outcome measures such as suicide risk, mortality, dependence on specialist psychiatric attention, family relations, employment and residential stability. Improvement on measures like these is expected of normal healthcare.

Yet the thread running through the history of gender medicine is one of “elevated mortality, elevated suicidality, elevated homelessness, elevated psychiatric care—but the patient is happy,” said Dr O’Malley, who recently completed her doctoral research on parents’ perceptions of youth gender dysphoria.

(Note: The remarks in italics, interspersed throughout the article below, were taken from summit presentations other than Dr O’Malley’s.)

Bad theory: Irish psychologist and lecturer Ian Cox talks to Dr Stella O’Malley about a crisis in therapy and the academy

Worse after treatment

At the Adelaide CASC conference, Dr O’Malley cited an illustrative case dating back to the genital surgery experiments of 1930s Berlin. As Lili Elbe, a Danish man underwent a series of surgeries and declared his post-transition period to be “a whole and happy human life”. In 1931, three months after a fourth procedure, he died at 48 following surgical complications.

America’s trans surgeons came to the field later. In 1966, Johns Hopkins Hospital opened the first university clinic offering sex-reassignment surgery. Stanford University and others followed, marking an American heyday for “sex changes,” Dr O’Malley said.

She said the theme of subjective success and objective failure continued, as exemplified by the 1988 study by Bram Kuiper and Dr Peggy Cohen-Kettenis, as well as Kuiper’s 1990 dissertation follow-up in the Netherlands.

Of the 141 adults in this Dutch study, 16 suicide attempts were reported after the start of treatment. At follow-up, 11 of the 105 male-to-female patients had died (one by suicide), rising to 12 by 1995; a death rate of 11.4 per cent.

“This was far from [unregulated] affirmative care, and yet still we’ve got an 11.4 per cent [death rate],” Dr O’Malley said. “Don’t forget, not everybody got medical transition. You had to go through a lot of hoops to get it. They picked the people that were most suited back then.”

Kuiper’s 1991 dissertation noted complications such as fistulas, vaginal problems, pain and urinary difficulties. In a “loss to follow-up” characteristic of gender medicine, only 69 of the original 141 patients responded to the questionnaires. The adults not included in the study might well have had even poorer outcomes than those who did respond.

Yet Kuiper declared there was “no reason to doubt the therapeutic outcome”, and the earlier paper written with Dr Cohen-Kettenis claimed that treatment was “therapeutically effective”.

Hard times

As for America’s sex-change heyday, Dr O’Malley said the emerging objective data proved to be discouraging, no matter how happy the patients reported themselves to be.

After a 1979 review, the Johns Hopkins researchers declared that trans surgery “offered no objective advantages in terms of social rehabilitation, although it remains subjectively satisfying to those who rigorously pursued a trial period and who have undergone it”. The clinic was shut down.1

Two years later, Dr O’Malley noted, the US Department of Health and Human Services advised that trans surgery should not be covered by Medicare. Its 1981 report said—

“Transsexual surgery for sex reassignment of transsexuals is controversial. There is a lack of well controlled, long-term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism. There is evidence of a high rate of serious complications of these surgical procedures.

“The safety and effectiveness of transsexual surgery as a treatment of transsexualism is not proven and is questioned. Therefore, transsexual surgery must be considered still experimental.”

That caution was overthrown in 2014.2

Back from the brink

Dr O’Malley spoke of how politics rescued trans medicine from adverse policy and loss of funding.

In 2007, the Harry Benjamin International Gender Dysphoria Association—named for a German-born American endocrinologist with links to Berlin’s Institute for Sexual Science—was rebadged more attractively as the World Professional Association for Transgender Health.

“Despite no long-term replicable evidence to support medical transition, WPATH [in 2010] formally called for worldwide depathologisation,” Dr O’Malley said. “This was a political move.”

By 2013, the DSM diagnosis of “gender identity disorder” was supplanted by the supposedly less stigmatising “gender dysphoria”. A year later Time magazine heralded the Transgender Tipping Point, with Laverne Cox, a male-to-female actor, on the cover.

Around the same time, referrals at paediatric gender clinics began to grow exponentially, with teenage females overrepresenting in caseloads.

“The social contagion, I think, happened accidentally,” Dr O’Malley said. She points the finger at smartphones and social media.

“I don’t think anybody orchestrated that. It became bigger than activists had ever imagined—but they had depathologised the identity, they had made it normal and kind of cool.

“Young people are interested in cerebral concepts [and it’s] very alluring to think that ‘I could be a different person with a different body and a different name’.”

Dollars and sense

In 2016, WPATH proclaimed its doctrine of medical necessity. Dr O’Malley said trans identity might have become “completely healthy and normal, but it also needs medical treatment. Why? They needed insurance”. It was a financial necessity.

In 2018, the World Health Organization’s ICD diagnostic system pushed depathologisation further. Now “gender incongruence”, without the distress necessary to gender dysphoria, was supposed to justify medical interventions.

Meanwhile, Dr O’Malley said, gender-affirmative ideas had been penetrating child psychotherapy and schools “without any supporting evidence”.

“How did we come to a point where, after all these failures in adult transition, we decided to move into paediatric transition?” she asked.

In part, she said, it was the idea that if there were such a thing as a trans adult, there must also be a trans child.

The puberty blocker-driven treatment of “juvenile transsexuals”, introduced by the famous Amsterdam clinic, was reportedly ventured in the belief it would prevent the poor outcomes seen in adult patients, especially males, who transitioned after a normal puberty.

Here was another contradiction, raised on the conference floor by paediatrician Dr Dylan Wilson. If the Dutch acknowledged the dissatisfaction of their previous, adult patients, were they contradicting the upbeat message of their own research?

Dr O’Malley said she believed the Dutch clinicians would have been aware that “the rates of mortality and suicide [among adult patients] were worrying, and so they needed to think, ‘what is wrong?’ And rather than stopping, changing and offering other interventions, they chose to treat children.”

This, she said, was “a wildly inappropriate decision”.

Anything goes

By 2022, when WPATH released its latest standards of care, “safeguards had largely disappeared,” Dr O’Malley said. Minimum ages were abandoned for minors to be eligible for hormonal and surgical treatment.

Gender medicine had shifted “from medical diagnosis to civil rights. Psychiatric ‘gatekeeping’ was identified as a principal obstacle [to treatment],” Dr O’Malley said.

“It was a political campaign, and it was very well executed.

“Objectives changed from improving clinical evidence to securing access [to treatment] through self-declaration.

“The language of identity, stigma, discrimination and civil rights was adopted. Medical transition became framed as a human right rather than experimental medical treatment.

“Transition has moved from rare experiment to presumptive treatment, without establishing reliable evidence of long-term benefit.”

Wait, what?

What longitudinal research there was should have given clinicians pause for thought, according to Dr O’Malley.

She cited a sobering Swedish study, which had comprehensive coverage of those who had transitioned, something rare in the gender medical field with its missing ex-patients.

The 2011 paper, with Dr Cecilia Dhejne as first author, reported on all 324 adults who had undergone “sex-reassignment” in the country between 1973 and 2003.

After treatment, they had a suicide rate 19 times that of matched controls in the general population. Overall mortality, suicide attempts, psychiatric hospitalisation—all these were elevated when compared with the rest of society.

A striking, more recent study from Finland—highlighted by Dr O’Malley—found that young people under 23 were not doing well after transition. Again, this was a study using complete health register data, and therefore unaffected by the familiar loss-to-follow-up problem.

The resulting 2026 paper by Dr Sami-Matti Ruuska and colleagues reported that severe psychiatric morbidity among these young males rose from 9.8 per cent to 60.7 per cent after transition. For females, this morbidity increased from 21.6 per cent to 54.5 per cent.

Dr O’Malley’s conclusion: “Medical transition is a failed intervention. Across several decades, patient satisfaction coexisted with continuing or increased psychiatric, social and physical problems, as well as elevated mortality and suicidality.”

“Can we now go back to the drawing board, start looking at the objective long-term outcomes, for this pseudo-healthcare—and realise it’s not healthcare, it’s consumerism, and it’s destructive.”

Bedazzled

Dr O’Malley said that, especially early on, when eligibility for transition was more restricted, gender clinics “were offering a bedazzling, beguiling, alluring treatment to people who really wanted it”.

“The idea of healthcare is something ethically more responsible than consumerism,” she said. The fact that patients declare themselves happy soon after harmful gender treatment is not enough. Anorexics celebrate weight loss, Dr O’Malley pointed out. And there are compulsive alcoholics.

“There’s a lot of people who want something that isn’t good for them in the long term,” she said. “We can offer them a lot of really good, compassionate, careful, comprehensive treatment.”

“That doesn’t mean that we absolutely yield to the fact that what they want is what they should get. Arguably, consumer-driven healthcare has brought us to this place.”

She said patient-centred care had become patient-led, even child-led—another “seismic move”. And many therapists were abdicating their responsibility as if there were no shared outcomes such as a patient’s recovery or some improvement in life.

“You’re not going to therapy for me to just nod along to you—I’m not a nodding dog,” Dr O’Malley said.

She said the purpose of Genspect’s own repathologisation campaign—viewed by some as a mistaken move—was to restore a psychological approach and the hope of recovery to gender distress.

“We’re not interested in repathologising gender nonconformity,” she said. “We’re not interested in repathologising anything that doesn’t meet certain criteria for pathological behaviour.”

For Genspect, someone who seeks “medical alteration of sex characteristics” has a mental disorder falling into the category of an “overvalued belief”.

“We’re utterly unapologetic about it,” Dr O’Malley said. “We’re very clear. We’re offering a psychological approach. We believe this is a psychological issue, and this needs a psychological approach.”

“We’re offering what we would consider calm, compassionate, long-term care, rather than a flurry of medical interventions with a lot of pressure on the individual.”

In Dr O’Malley’s Ireland, there has been an activist push for draconian laws against so-called conversion therapy. Many jurisdictions elsewhere have already legislated penalties that make it risky to engage in normal exploratory psychotherapy with a confused child.

“Now we’ve kind of moved into a world where I’m being told wanting to help a person genuinely isn’t appropriate,” Dr O’Malley said. Instead, she said, the favoured affirmative handling of gender distress was akin to a “quick soundbite—patient is happy six months after treatment. Go, go, go”.

“And that’s where we’ve lost our way.”

Bad old days

When my parents were married in 1945, my mother’s best friend couldn’t come to the wedding because she was obviously pregnant at the time and it was considered socially inappropriate for her to be there.

This embarrassment about our sexed bodies and how they relate to reproduction meant that children were taught nothing at all about normal bodily functions such as menstruation and ejaculation, and the process by which a baby was made was a well-kept secret from not only children but older adolescents as well.

It made first menstruation and first ejaculation terrifying for many pubescent children. What did this mean? Were they dying? Boys had the better deal because most learnt that the ejaculation process was quite pleasurable, whereas girls were left dealing with the bloody mess with uncomfortable sanitary pads and often painful cramps.

Adults also suffered from this embargo on discussion of sex and reproduction, which left some couples with no idea what to do and how to do it: many women had no idea that the penis could become erect, many men weren’t sure where to put it. When I began practice as a clinical psychologist in the early 1970s, I saw many couples who had ongoing sexual problems from the trauma of their wedding night.

Over the years, sex education thankfully improved, and effective contraception allowed couples to explore sex for pleasure without the threat of an unwanted pregnancy. The classic book Where Did I Come From?, first published in 1973, gave parents a clear, age-appropriate explanation of how babies are made, with illustrations that were sensitively drawn.

All about trans

But now, unbelievably, talking about how babies are made is once again fraught with a range of social, ethical and political judgements. In today’s world, transgender issues get far more attention than sex education. The first requirement is to deny any association between a person’s sex and their stated gender, which makes any discussion about sex somewhat challenging.

The book recommended by trans advocates, What Makes a Baby, for ages 4-8, is likely to give a young child nightmares. It is described as a “gender-neutral, inclusive picture book explaining where babies come from that works for every kind of family”, without relying on traditional gender assumptions. There are no humans portrayed, instead there are figures that look like ghostly apparitions floating in the air. No genitals, and no description of intercourse, instead:

“When grownups want to make a baby, they have to get an egg from one body and sperm from another body … When an egg and a sperm meet, they swirl together in a special kind of dance … When their dance is done they are not two things anymore …”

Even an adult might find that confusing, so I shudder to think what a child takes from it.

The same focus on gender rather than sex is the dominant feature of a book You-ology: A Puberty Guide for Every Body recommended for older children. It is determinedly gender inclusive, puberty is described in terms of the function of hormones rather than related to the sex of the individual:

“During puberty there are hormones that tell your body to grow faster, hormones that tell your breasts or testes (also known as testicles or balls) to start growing, hormones that tell your hair to sprout in new places, and hormones that cause new smells to creep out of your armpits” and “during puberty, most girls and kids like Oliver start to develop breasts”.

The main message is clearly to reinforce gender beliefs, and like the first book, it avoids any clear explanation of how babies are made.

Blurred lines: Gender ideology confuses young children. This discussion features therapist Pamela Garfield-Jaeger, lawyer Vernadette Broyles, and paediatrician Dr Nikki Johnson of the group FAIR in Medicine, which combats the distortions of identity politics.

Indoctrination

The personal development programs of earlier times covered a range of topics, not just sex. They certainly weren’t perfect and had an agenda that was pushed: the sanctity of marriage and protecting the society from immorality. However, in my view the current programs are just as alarming and potentially damaging.

Many parents are concerned that programs across Australia are teaching a point of view that is highly contentious, yet attendance at these sessions is often mandated and complaints from parents are dismissed.

The National Respectful Relationships Education Framework is a guide for Australian primary and secondary schools and school systems to plan and deliver “age and developmentally appropriate, evidence-based and expert-developed respectful relationships education”. Each state can adapt the guidelines for their own education system. As a result, there is variation in the programs developed by each state.

Victoria is one state that has taken a politically motivated framework for their personal development and sex education program, presenting trans ideology as uncontested facts that all students and parents are expected to embrace without question. This approach denies any suggestion that an individual’s gender identity is based on their biological sex. The two essential, non-negotiable tenets of trans ideology are that if a child says they are trans, they are, and that gender derives from an internal sense of self, not body characteristics.

One of the contentious issues is the use of “inclusive language”, which has the determined goal of breaking any sex/gender connection. For example: presenters are told to avoid “gendering anatomy” because “not all boys have penises, not all girls have vaginas: Instead [one should] use: bodies with penises, testicles, bodies that produce sperm, bodies with vaginas, uteruses, ovaries, bodies that menstruate, etc”.

Contempt for parents

When parents express concern about any aspect of the program, for example that 5-year-old children are being taught that a person’s sex and gender are not necessarily the same and may change over time, they are labelled “reckless” and “irresponsible”.

In Victoria, the Parents of Adolescents with Gender Distress (PAGD) group disagrees with the approach taken by the Resilience, Rights & Respectful Relationships program:

“Our issue with the Victorian ‘Resilience, Rights & Respectful Relationships’ (RRRR) materials, particularly the components dealing with gender is that gender identity and ‘transgender’ in particular is not only presented as fact, but also as a complete state of being that requires no other explanation than a feeling about one’s body parts. The RRRR program components that address gender identity are dangerously simplistic and fail to address the complexity of our children, particularly the impact of neurodiversity on identity development.

“[We protest] the failure to acknowledge or hear concerns about damage inflicted on some of the most vulnerable students in the system, the complete lack of accountability or evidence of benefit after years of implementation and millions of dollars, and the utter arrogance of dismissing parental concerns as “resistance and backlash.”1

Add to this the education policy in some states that allows a child to be socially transitioned at school without the parents’ knowledge and consent, and it is understandable why so many parents are challenging the assumed authority of the government to take control of the child’s understanding of sex and gender identity.

Gender evolution

Early human survival required a practical division of labour. Since only women could bear and nurse children, they were often tied to camps, leading to a specialisation in the gathering of food and childcare. Men, who lacked these physical constraints, generally specialised in hunting and defence. Over time, different societies assigned different expectations and values to these gender related roles. An issue frequently overlooked is that the availability of safe and effective contraception allowed women to participate in society on a more equal basis, leading to a merging of social roles and expectations.

So how does “identity” develop in an individual? Is it innate and immutable as trans advocates claim?

What is identity? One resource states:

“Identity refers to our sense of who we are as individuals and as members of social groups. It also refers to our sense of how others may perceive and label us. We develop ideas about our identities and the identities of others through our interactions with people close to us, like our family and friends, our schools and other institutions, the mass media, and our encounters with other individuals …Our ideas about our identity are also influenced by the social groups to which we belong.”

Captive children

Cases of people raised in a race different to their own demonstrate the power of group influence on identity. During the colonial era of US history, many young white captives of American Indians fully assimilated, came to prefer Indigenous communal life over European society, and frequently resisted returning to their biological families when found. Only young people who were past adolescence at the time of capture hated their captors and sometimes risked their lives to escape.

A humanised chimp

I have thought a lot about whether to use the following examples, but I am doing so to make a point central to the argument about the interaction between biology and society.

Lucy was a chimpanzee adopted in 1964 by psychologists Maurice and Jane Temerlin, who raised her as a human daughter to study nature versus nurture.

It became apparent that because she was never taught chimpanzee behaviours, Lucy believed she was human. When Lucy was shown photos of humans, other chimps, and objects and asked to identify herself, she would consistently point to the humans, demonstrating that she viewed herself as one of them.

This confusion about her identity extended into her everyday life and habits. Raised completely like a human daughter, she learned to eat with silverware, dress herself, and even drink gin and tonics. She reportedly would look at other chimpanzees in magazines and identify them as “others” or “bugs”.

Because she had no chimp role models growing up, she rejected or was indifferent toward other chimpanzees, preferring human company. She was terrified of male apes and sexually attracted only to humans.

When she reached adolescence at age 11, she grew too strong and destructive to live in a suburban home. In 1977 the Temerlins, along with graduate student Janis Carter, took her to a wildlife reserve in The Gambia, West Africa, to rehabilitate her into the wild. Carter stayed in the jungle with Lucy for years to help her integrate. Over time, Lucy successfully learned to forage and bond with wild chimpanzees.

However, her trusting nature proved dangerous. Because Lucy had no fear of people, she was later killed by poachers in the jungle.

So, was Lucy ape or human?

The Kellogg experiment

The earliest cross-rearing experiment was staged in 1931 by comparative psychologist Winthrop Kellogg, who wanted to see if an animal’s genetic boundaries could be completely rewritten by environment.

Kellogg brought a 7-month-old female chimpanzee named Gua into his home to be raised alongside his 10-month-old infant son, Donald. The two babies were dressed in identical clothing, fed the same diet, given the same toys, and spoken to in the exact same manner.

While Gua initially excelled—learning to walk upright, use a spoon, and respond to verbal commands faster than Donald—the experiment had to be abruptly cancelled after just nine months. Instead of Gua becoming more human, Donald began behaving like a chimpanzee. The human infant began imitating Gua’s vocal grunts, barking for food, and biting his parents. Gua was quickly returned to an anthropoid research station, where she died of pneumonia just a year later.

Feral children

A feral child is a young person who lives isolated from human contact from a very early age. They lack human care, social skills and language. The Britannica definition of feral children details how these individuals grow up with minimal human interaction due to extreme isolation, severe abuse or abandonment.

Research into the impact of this experience suggests that these young people may not identify specifically as animal or human but are caught somewhere in between.

What do these cases tell us about identity?

They demonstrate that an individual’s sense of self, including what race they are and, disturbingly, what species they are is not innate and immutable. One publication states:

“Social influence is the process by which an individual’s attitudes, beliefs and/or behaviour are modified by the presence or action of others. This phenomenon is studied extensively in social psychology and includes various theories and types of influence, such as conformity, compliance, and obedience.”

Educators and health practitioners should be concerned about the dramatic take-up of a trans identity by adolescents from the early 2010s, the majority of whom are female. Instead, these two professional groups are party to facilitating the attraction of this identity rather than advocating for caution and sound evaluation.

These professional groups see at first hand the emotional turbulence that young people moving towards adolescence experience. Their search for autonomy and identity makes them particularly susceptible to any newly developed youth subculture. The Raising Children Network says:

“During adolescence, young people are working out who they are and what they stand for. That is, they’re working on identity. Experimenting with subcultures is a way of doing this because it helps young people decide what they identify with. It gives them a way of exploring new values and deciding how these fit with their family values.

“Also, subcultures can offer a set of unspoken guidelines about beliefs, behaviour, clothing and more. Beliefs, behaviour and clothing can be clear ways of signalling identity. They can also give young people a sense of belonging and a way to express ideas. The sense of identity, friendship and belonging that young people get from subcultures can help them feel good about themselves.”

Some of these subcultures are benign—the Goth period, for example—but others pose a significant threat to the young person’s wellbeing. I had direct clinical contact with adolescents suffering from anorexia who had online groups to share ideas and encourage members to continue to limit food intake. In a similar way, deliberate self-harm spreads by peer group contact and through websites that normalise this behaviour as a coping method for emotional distress. These conditions are resistant to treatment and usually involve a team approach.

Unfortunately, the development of platforms such as TikTok, Tumblr and Instagram has dramatically escalated the exposure of young people to discussion about and portrayal of a range of mental health conditions. This has created a new type of identity that has led to a dramatic increase in presentations to mental health professionals, some of whom recognise that the young person does not actually have the condition. The chosen disorders involve behavioural characteristics that can be observed by others, conditions such as attention-deficit/hyperactivity disorder; dissociative identity disorder; functional tic-like behaviours; Tourette’s syndrome.

For educators to not only deny the role of social influence in the rapid growth of young people declaring they are trans, but to actively promote it via enforced school-based programs is beyond my comprehension. The increasing number of detransitioners should give those in charge pause for reflection.

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.

New on stage

Next month in Manhattan, the organisation Therapy First will hold its inaugural conference. The name Therapy First encapsulates its purpose: to put psychotherapy before any medical treatment of young people who are gender-distressed. The conference theme poses a question—Identities in the Therapy Room: What is Unfolding?

“Therapy First sees the problems in youth gender care as part of a larger challenge facing the psychotherapy profession and young people,” says the group’s president Paul Garcia-Ryan, a therapist who is a licensed clinical social worker.

“These young people are developing in an environment that is unlike the environment that previous generations have developed in.”

For these reasons, “the conference is starting with questions as opposed to answers”.

Therapy First began in 2021 as the Gender Exploratory Therapy Association (GETA) but now disavows that therapeutic term. Fairly or not, gender exploratory therapy has been framed as unethical “conversion therapy” by advocates of the gender-affirming treatment model. In 2023, with Garcia-Ryan coming in as president, the organisation was rebranded to clarify its worldview, although that remains uncertain for some observers.

In any event, Therapy First has grown to 400-plus members from 21 countries. It also has a large network of clinicians associated with the organisation outside of membership, Garcia-Ryan says. He says inquiries from families looking for help are on the increase, reaching or exceeding 100 a month. Therapy First’s activities include training, webinars and membership retreats.

The New York City conference, over the weekend of October 17-18, is open to mental health practitioners only, and any recording or social media posts about the proceedings are “strictly prohibited”.

“We’re wanting to create the conditions for clinicians to speak openly with one another, in the moment, during that weekend,” Garcia-Ryan says.

He notes that two trans clinicians—psychologist Dr Erica Anderson and psychotherapist Joe Berger—will present at the conference.

“Therapy First has always supported transgender individuals, and this support is rooted in deeply held principles. We’ve always welcomed transgender clinicians, and several have played significant roles in the organisation.”

Broad church

The conference includes presenters as various as Sasha Ayad, a leading counsellor who thought it was mind-blowing when, early on, she heard of parents seeking out affirmation and medicalisation for daughters apparently under peer influence; Lisa Marchiano, a Jungian analyst who almost a decade ago pointed out what appeared to be a “psychic epidemic” among teenage girls adopting trans identities; Dr Laura Edwards-Leeper, founding psychologist at the first specialist paediatric gender clinic in the US; and Dr Anderson, a trans woman who has assessed young people for medical transition.

It’s worth adding that the latter two practitioners of the gender-affirming treatment model have spoken out, at some cost, against poor assessment and hasty medicalised transition of youth. And Dr Anderson discerns some group influence in the rapid uptake of trans identity among the screen-absorbed young, especially during the period of Covid-enforced home learning.

And, of course, therapists critical of gender-affirming care often pay a professional price, along with being smeared as bigoted transphobes.

Dr Anderson’s conference talk is on point. Its title: The Importance of Finding Common Ground. The panel discussion will include clinical psychologist Dr Anna Hutchinson, a whistleblower from the now-shuttered, London-based Tavistock gender clinic, which was the world’s largest of its kind. So, the conference, like the organisation, is presented as a broad church.

“We very intentionally chose clinicians from different perspectives as a way to start to open up some dialogue,” Garcia-Ryan says. “Every serious profession gets together to talk shop, and this just hasn’t really happened in the mental health field when it comes to youth gender distress and the care that the mental health profession is offering these young people.

“Controversies surrounding medicalized treatment have left many unsure of how to move forward. Families are seeking care they can trust, and professionals are seeking training they can rely on. Therapy First was formed to help address that need,” Garcia-Ryan says in the group’s 2025 annual report.

In a field beset by polarised views, he says “the only agenda we are for is an agenda of therapy first”.

Repackaging: clinical psychologist Dr Anna Hutchinson says one variant of the gender-affirmative approach may reframe potential coercion as care—for example, when parents are confronted with a choice between ‘a live trans daughter or a dead son’.

Contested connections

Therapy First has come in for some criticism over its choice of presenters. An ethics webinar last year featured Jamison Green, a trans man who had served as president of the World Professional Association for Transgender Health. Of the 2026 conference presenters, Dr Anderson served on the WPATH board—until she resigned over its attempt to stop any repeat of her frank comments to the press. And Dr Edwards-Leeper helped bring to America the puberty blocker-driven Dutch Protocol for the medical transition of minors.

Those connections trouble Pamela Garfield-Jaeger, a licensed clinical social worker. On X last month, she posted: “I want it on record that I am not affiliated with Therapy First. I removed myself from their website over a year ago. I had multiple conversations with the leaders about my disagreements, but they chose to continue on a path that I do not align with.”

It appears she is not alone. Her post generated some agreement in the replies and notched up about 3,500 views.

For Garfield-Jaeger, it is a question of values, or perhaps a lack of clarity about values. Her impression is that Dr Edwards-Leeper still believes that, with the right assessment, some adolescents may benefit from medical transition. (GCN understands that Dr Edwards-Leeper also makes any transition contingent on securing true informed assent or consent.) Dr Edwards-Leeper was a work group member for the adolescents chapter of WPATH’s current Standards of Care. And WPATH, as an organisation, faces accusations that go to its scientific integrity.

Garfield-Jaeger says her wariness has nothing personal about it. She likes a lot of the people involved with Therapy First and has had “positive interactions” with Garcia-Ryan.

She sees herself as pretty flexible, not one to police pronouns or to avoid collaborations just because they fall short of 100 per cent agreement with her views. But as Therapy First evolved, she had hoped it would, in time, set its face against hormonal and surgical transition, which she regards as “medically assisted self-harm”. Instead, she feels, the organisation is platforming the belief that some medical transition is a good thing.

“I used to think that maybe somebody would benefit from the cross-sex hormones and surgeries,” Garfield-Jaeger tells GCN. “But I don’t believe that anymore, now that I know more about the effects—not the side effects, but the effects—of cross-sex hormones and the surgeries, which really are very experimental, especially what they call the ‘bottom surgery’ for both men and women—it’s quite barbaric, in my opinion.”

For avoidance of doubt

Therapy First inherited from GETA the position that “medical interventions for gender dysphoria in children and teens are experimental and should be avoided if possible”, given the lack of long-term evidence and the risk of regret.

“We believe that psychological approaches should be the first-line treatment for all cases of gender dysphoria. Psychological interventions avoid the risks of social and medical transition, and support client autonomy by facilitating deeper self-understanding,” GETA said.

More recently, the values statement of Therapy First was changed. Now it reads that medical interventions for young people “should be approached with the appropriate caution”. Again, there is a nod to the limited evidence base, and this new content also highlights the risk of harm and the fact that “the identities and decision-making capacities of youth are still developing”.

But this updated position has caused some head-scratching.

Garcia-Ryan recognises that the revision “has caused some confusion and concern, and we have taken that in. We are reviewing the language [on the website] and the values statement to see if we can wordsmith things in such a way that makes it a little bit clearer what our intentions were.”

Meanwhile, two changes to Therapy First’s FAQs webpage have already been approved. First, an explanation of what is meant by “appropriate caution”. Citing systematic reviews that show the shortcomings of the research data, the new entry says “there is insufficient evidence to recommend hormonal and surgical interventions for gender-distressed children and youth. Clinical decisions—in both mental health and medical contexts—should be guided by the responsibility of healthcare providers to safeguard the young person from unnecessary harm”.

The second change addresses the question of Therapy First’s proximity to WPATH, which is a hybrid professional-activist body. Garcia-Ryan says his organisation’s references to WPATH—like those to the treatment recommendations of other guidelines—are limited to mainstream mental healthcare, not medical interventions, and focused on adolescents with gender dysphoria.

The WPATH recommendations, as understood by Therapy First, “specify that clinicians working with gender-diverse youth should have training and expertise in both gender identity development and general child, adolescent and family mental health across the developmental spectrum. This includes understanding typical and atypical development, family dynamics, and broader youth mental health issues.”

Notwithstanding these online content tweaks, Garcia-Ryan insists that in the real world the mission of Therapy First remains the same: to raise the quality of mental health care for youth experiencing gender dysphoria. However, the articulation of its values statement has shifted.

“Therapy First is balancing multiple imperative values: the safeguarding of our patients from medical harm, therapeutic neutrality and patient autonomy,” he says.

And he says the “references to established standards demonstrate that Therapy First is consistent with what the mainstream mental health establishment embraces for the mental healthcare of youth experiencing gender distress”.

But does Therapy First risk reputational damage if it is seen to be closer to WPATH than is the case? “It’s a good question,” Garcia-Ryan says. “I would say that we’re not worried about that.”

Is there something naive or utopian about fixing upon just those sections of the WPATH guideline that contain unexceptional mental health recommendations? After all, WPATH and the other guidelines and policies under its influence have not prevented the hasty medical transition of minors in significant numbers.

Garcia-Ryan says: “We train clinicians in accordance with the established standards of care. And when we say that, we’re referring to the legal standard of care for this population. We’re not referring to WPATH Standards of Care, which is a clinical guideline the very title of which can be very confusing.”

However, he says, the WPATH guidelines do have relevant recommendations for the elements of competent clinical practice with gender dysphoric youth. Therapy First also references related documents from the American Psychological Association, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry.

Garcia-Ryan says that each of the components of good practice in mental healthcare has its own standards that “contribute to whether the overall care provided meets the applicable legal standard of care”.

The term “care”, he says, is “broad and includes assessment, diagnosis and formulation, informed consent, treatment of co-occurring conditions, documentation, attention to developmental and family context, and the exercise of clinical judgment, among others”.

Sub-standard

Garcia-Ryan invokes the courtroom standard of care as set out in a landmark case awarding US$2 million in damages to American detransitioner Fox Varian. She had undergone a double mastectomy as a minor with mental health problems, journalist Benjamin Ryan reported in February for The Free Press. Lawyers for Varian’s psychologist and surgeon argued that WPATH’s treatment recommendations did not represent the legal standard of care against which the adequacy of a practitioner’s conduct is measured in court.

“The Varian verdict also clarified that affirmation of an adolescent’s current identity and the facilitation of the adolescent’s stated treatment goals do not constitute the legal standard of care for this population,” Garcia-Ryan says. “A clinician can be negligent in how identity is approached and discussed, just as a clinician can be negligent in other aspects of assessment and treatment.”

He says the legal standard of care is both a high bar for clinicians to meet and what, in any event, should be the norm: psychotherapy as the first-line treatment, a rigorous mental health assessment, and differential diagnosis to identify and treat co-morbid conditions with attention to the unique circumstances of each individual.

He says Therapy First is predominantly American in its focus, but also references the Cass Review and international guidelines from England’s National Health Service, Sweden and Finland. (The latter two documents outperformed WPATH’s Standards of Care in a global evaluation of guidelines commissioned by Dr Cass.)

“Therapy First has made consistent efforts to ensure Cass-aligned clinical training exists in the US,” Garcia-Ryan says.

He says that his organisation does not support bans on medical gender-affirming care for minors. Nor does it have a position on the utility of the term rapid-onset gender dysphoria, which has been popularised to capture the phenomenon of teenagers who, with no childhood history of gender nonconformity, suddenly declare a trans identity amid potential influence from social media and peer groups.

However, Garcia-Ryan says Therapy First does work with those clients “who have adolescent-onset gender dysphoria for a whole host of different reasons”.

In any event, he believes that mental health practitioners should not be making judgment calls on eligibility for puberty blockers, cross-sex hormones or surgery.

Cautionary tales

If, however, there are parents considering blockers for their child, Garcia-Ryan says the role of the therapist is to explain what “appropriate caution means”, and to set out the concerns arising from systematic reviews as well as the implications of an adolescent’s developmental stage.

Garcia-Ryan himself has experience with both transition and detransition. He says he did not get “developmentally informed, good psychotherapy” when he was affirmed at age 15.

“My personal experience played a role in my stepping into this work, but the work [of Therapy First] isn’t about me, and it shouldn’t be, as it shouldn’t be for any therapist,” he says.

He emphasises that practitioners helping clients in the therapy room must put aside their own beliefs and opinions, but says his own experience partly explains his decision to take on a leadership role with Therapy First.

“I was a shy, gender-nonconforming boy,” Garcia-Ryan says. “It’s not in my temperament, or really in my nature, to be the face of and the voice of an organisation that is in the centre of one of the most controversial issues, and [so, to step up as president], would have required me to feel I had a sense of duty and obligation.”

Therapy First supports US laws prohibiting conversion therapy that seeks to change sexual orientation or gender identity, according to its FAQs page. “However, misinterpretation and misuse of these laws has led to a chilling effect that has limited the care available to this population, and we hope this will change as the laws are more accurately understood and applied.”

Different strokes

One marker of difference between Therapy First and the group Genspect is the latter’s fundamental critique of conversion therapy prohibitions.

Genspect’s founder, Irish psychotherapist Dr Stella O’Malley, says “the mental gymnastics surrounding ‘conversion therapy bans’ have paralysed clinicians.

“They are no longer permitted to ask why a girl hates her body, or why a boy spends hours in the bathroom obsessively removing every hair from his body in a desperate attempt to feel female.

“Such questions are now labelled ‘conversion’, while approving mastectomy or castration is celebrated as affirmation.”

Genspect challenges WPATH’s depathologisation program with its own REPATH campaign: a “re-psychopathologization of transgender ideation and the drive to medically transition”, which Genspect categorises as an “extreme overvalued belief”. (This framing, first announced in September 2025, has been predictably attacked by trans rights advocates. Genspect promptly acknowledged some unease “about our choice of language”.)

Garcia-Ryan points out that Therapy First is “a clinical organisation, not an advocacy organisation”. Genspect is a vigorous advocate not afraid to ruffle feathers.

Dr O’Malley, who was a co-founder of GETA, tells GCN it is “entirely understandable that, as the movement matures, different organisations develop in different directions. I welcome this; it brings greater clarity to a complex issue.

“When I co-founded GETA and helped write its original principles, our stated position was one that ‘avoided medicalisation’. Therapy First has since moved from avoiding medicalisation to stating that ‘medical interventions should be approached with the appropriate caution’.

“This represents what I call the ‘third way’, or the Hilary Cass approach: it rejects automatic affirmation and restores psychotherapy as the first response, while retaining medical transition for a carefully selected minority. In that context, inviting clinicians such as Erica Anderson and Laura Edwards-Leeper [to present at the upcoming conference] is consistent with Therapy First’s mission; they are prominent representatives of that position.”

Pitfalls of compassion

To Garfield-Jaeger, it seems that Therapy First’s policy is “some transition is OK and if you don’t affirm, then you’re not compassionate”.

“They seem to be marketing themselves as a more compassionate bunch, which is really how we all got into this mess in the first place,” she says.

“It’s like a kindness umbrella, a shield to allow for harmful behaviour, allowing these kids and these adults to go down these really painful and destructive paths of living a lie and destroying their bodies.

“It’s like what’s happening to Therapy First is literally what happened to the rest of our institutions. Therapy First was supposed to be the exception, but they’re actually just going down the exact same path, which is being captured by these WPATH therapists.”

Hard ‘No’ to medicalisation

Genspect’s Dr O’Malley says her organisation believes that “children and adolescents should receive psychologically informed care and should never be placed on a medical pathway involving puberty blockers, cross-sex hormones or surgery.

“There is no reliable evidence that the benefits of these interventions outweigh their serious and potentially irreversible harms.

“We also believe that, while adults are free to seek elective body modification, personal choice does not make an intervention healthcare, and consumer demand is not a clinical indication. Clinicians cannot justify providing inadequately evidenced interventions simply because patients request them.

“Procedures that remove healthy organs, impair bodily functions or create lifelong medical dependency should not be offered through hospitals or clinical services—or funded by public healthcare systems—as treatments for psychological distress. The fact that many people who have medically transitioned continue to function well does not alter this position.

“People with anorexia may also remain outwardly functional, as may otherwise successful and well-adjusted people who self-harm. That does not make weight-loss drugs an appropriate or acceptable treatment path for anorexia, nor does it mean that clinicians should facilitate self-harm [as] healthcare, simply because the individual requests it.

“Adults may seek these medical interventions, but clinicians should not be free to provide them and call this healthcare. Such provision resembles a ‘buyer beware’ consumer model rather than medicine’s duty to diagnose carefully, treat illness, restore function and avoid unnecessary harm.

“Of course, differences of sex development, sometimes called intersex conditions, are separate physical conditions. Medically necessary treatment for them is legitimate healthcare and should not be conflated with transgender medicine.”

Play it safe

An independent expert committee advising Australia’s federal Health Minister Mark Butler recommended that he not allow the hormone suppression drug Triptorelin to be used as taxpayer-subsidised puberty blockers for children.

Dr Ruth Griffiths, secretary of the Pharmaceutical Benefits Advisory Committee, said PBAC had suggested this restriction on the drug aimed chiefly at women’s health conditions, according to her letter sent earlier today to a mother whose daughter has autism and gender distress.

Dr Griffiths acknowledged “concerns raised in relation to the use of Triptorelin as a puberty blocker”.

Triptorelin 3.75mg (sold as Diphereline) is to be listed on the Pharmaceutical Benefits Scheme from October 1, primarily to meet women’s health needs. It will serve as a substitute for another hormone-suppression drug, Goserelin 3.6mg (sold as Zoladex).

Zoladex is registered for use with hormone-driven cancers and women’s health conditions including endometriosis, but it is being withdrawn from the Australian market by its manufacturer.

In her letter to the mother, PBAC secretary Dr Griffiths also noted that doctors bear responsibility when writing a script for an “off-label” use, such as puberty suppression for children who reject their sex and identify as transgender or non-binary.

Off-label use means prescribing a drug for an indication—such as gender dysphoria—not listed with its registration by the Therapeutic Goods Administration. Safety data for a drug is specific to its registered indications.

Triptorelin’s registered uses include central precocious (or premature) puberty in girls before age 8 and in boys before 9. This use is distinct from the drug’s off-label use to suppress the naturally timed puberty of children under a diagnosis of gender dysphoria.

On September 17, Minister Butler cited women’s health conditions when announcing that Triptorelin 3.75mg would be listed on the taxpayer-funded PBS as unrestricted. Usually, that would be taken to mean that the subsidised use of the drug would not be limited to specified health conditions. (Mr Butler’s decision followed PBAC advice, although the public record of that recommendation said nothing about any exclusion from the unrestricted listing.)

The Australian Professional Association for Trans Health (AusPATH) seized on the term “unrestricted” to proclaim that PBS-subsidised Triptorelin could be prescribed at a sizeable discount on the cost now charged for a private prescription enabling off-label use of the drug as puberty blockers.

On Monday morning, AusPATH’s chief executive Eloise Brook emailed members of the association: “For trans and gender-diverse people, the significance of the word ‘unrestricted’ is important. Unlike a restricted PBS medicine, an unrestricted benefit is not limited by the PBS to particular clinical indications.”

During the day, AusPATH learned that gender dysphoria was in fact to be excluded from the “unrestricted” PBS listing.

Doctors put on notice

On Tuesday, a spokesperson for the federal Department of Health told GCN that the unrestricted listing of Triptorelin 3.75mg “is being implemented with an administrative note that says, ‘The listing of this medicine is not for the use in gender dysphoria in minors’.”

According to today’s letter from Dr Griffiths, it was PBAC that advised the addition of this administrative note excluding the puberty blocker use of Triptorelin.

“Noting concerns raised in relation to the use of Triptorelin as a puberty blocker, the PBAC advised that an administrative note should be included to prompt consideration of whether Triptorelin is appropriate for an individual patient, with prescribers responsible for applying their clinical judgement when making treatment decisions,” she said.

“Following this advice, an administrative note will be added to the Triptorelin PBS listing, indicating that the listing of this medicine is not for use in gender dysphoria in minors.

“Before a medicine is subsidised through the PBS for a particular condition it is assessed by the Pharmaceutical Benefits Advisory Committee. The PBAC assesses how well the medicine works and how safe it is compared to treatments that are already available in Australia.

“It also considers whether the benefits of the medicine are worth any additional cost [to taxpayers] above treatments that are already funded.”

In January last year, Mr Butler asked the National Health and Medical Research Council to preside over the development of a new countrywide treatment guideline for youth gender dysphoria. The NHMRC interim advice on the safety and efficacy of puberty blockers is expected next month.

Mr Butler, from the Australian Labor Party, commissioned the NHMRC project soon after he was advised that his UK Labour counterpart, Wes Streeting, had banned prescription of puberty blockers outside a clinical trial, which has now begun to recruit minors aged 11-16.

In the House of Commons in December 2024, Mr Streeting said: “The Cass Review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are safe or beneficial.

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

GCN global briefs

Unreliable intellects

International | Dr Richard Santen, a former president of the Endocrine Society, attributes the controversy over paediatric medical transition to intellectual conflicts of interest, a reference to a guideline author whose work may be “jeopardised or enhanced” by the guideline. In the crucial guidelines for paediatric medical transition, Dr Santen’s new journal article states that 9/10 authors of the Endocrine Society document had an intellectual conflict of interest, with the same conflict affecting 117/121 of the authors of the standards issued by the World Professional Association for Transgender Health (WPATH).

The Cass Review, he says, used an assurance committee of “individuals who were not involved in the care of gender dysphoric adolescents and, on this basis, apparently lacked intellectual conflicts of interest”. Dr Santen contrasts Dr Cass’s cautious treatment recommendations with the pro-medicalisation stance of WPATH and the Endocrine Society. He attributes this difference to the fact that the Endocrine Society and WPATH committees “had members with intellectual conflicts of interest and the Cass Review did not. My analysis also suggests that the [WPATH and Endocrine Society committees] leaned more on crafting recommendations based on expert opinion and the Cass Review on data from systematic evidence reviews.”

Take it down

South Africa | A group of professionals concerned about the medicalisation of minors took the novel step of seeking the retraction of a “gender-affirming” guideline published in 2021 by the Southern African Journal of HIV Medicine. The guideline promotes puberty blockers, claiming that, “The prospect of puberty and developing secondary sexual characteristics in conflict with experienced gender identity is often daunting and even traumatic for a [trans] adolescent. The [mental health professional] should work with the adolescent and their caregiver(s) and, if appropriate, facilitate access to puberty pausing treatment.” This “condensed” form of the guideline frames the medical treatment of minors with blockers, hormones and surgery as a constitutional right to health.

In March this year, the publisher instructed the journal’s editorial board to investigate the retraction request. According to FDNHSA, two authors of the guideline-article in question are members of the editorial board and sat on the committee to decide the retraction request. That request was turned down. However, the journal subsequently ran a disclaimer headlined “Editorial Expression of Concern for the Guideline ‘Southern African HIV Clinicians Society gender-affirming healthcare guideline for South Africa’”. The disclaimer acknowledged that the 2021 guideline-article “did not undergo the journal’s standard journal-led external peer-review process”.

In June, the journal also published a letter from retired paediatrician Dr Mark Patrick, who pointed out that the gender guideline was outside the scope of HIV medicine. “It is concerning that the Southern African HIV Clinicians Society and its journal, in publishing this guideline, recommend interventions that cause sterilisation and create lifelong medical dependency,” Dr Patrick said.

In August, the journal returned to the domain of paediatric gender medicine, publishing a “rapid review of gender-affirming healthcare for children and adolescents”. When that review first appeared as a preprint, FDNHSA wrote again to the journal, saying the review was “a record of a cherry-picking exercise in finding articles and using them to support the preconceived ideas and beliefs of the review’s ‘queer- and trans-led’ authors”. It did not amount to a review of the 2021 guideline, FDNHSA said.

The rapid review declared some funding from the South African trans rights group Gender DynamiX. This group, FDNHSA said, had received US$500,000 from the Arcus Foundation, an LGBTQ lobby group which had “explicitly prioritised” South Africa in its grants program. Like the 2021 guideline, the 2026 review was marked by apparent bias and conflicts of interest, according to FDNHSA. Some authors appeared on both documents, with the appearance of reviewers rating their own work.

The rapid review makes strong claims—for example, that “Adolescents who access puberty suppression and/or GAHT [cross-sex hormones] generally show reductions in depressive symptoms and suicidality, alongside improved appearance congruence and functioning, compared with their own baseline and with peers who want but cannot access treatment.” There is no firm basis for the implied causation. Several credible systematic reviews, run in a range of jurisdictions internationally, have found the evidence for hormonal treatment of gender-distressed minors to be very weak and uncertain.

Who’s in, who’s out?

United Kingdom | The Medicines and Healthcare products Regulatory Agency (MHRA), which approved the PATHWAYS puberty blocker trial, has confirmed that adolescents with the atypical sexual attraction known as autogynephilia (AGP) should not be eligible for the trial. Psychologist Dr Ray Blanchard describes AGP as a condition in which a heterosexual male is sexually aroused by the image of himself as female; some AGP males will seek medicalised gender transition. “From a parent’s perspective, autogynephilic gender dysphoria (which occurs only in natal males) often seems to come out of the blue,” Dr Blanchard and fellow psychologist Dr J Michael Bailey have argued.

The two agencies responsible for ensuring a safe and ethical trial of puberty blockers—the MHRA and the Health Research Authority (HRA)—appear to have contradictory positions on the AGP issue. When Orlando outlined his concerns in September 2025, the HRA said AGP was not relevant to the trial, in which eligibility focuses on the presence of gender incongruence.

In August this year, Orlando received a response from the MHRA, eight months after he put his case to that authority. The MHRA told him that it would ask those running the trial—led by Professor Emily Simonoff of King’s College London (KCL)—to notify the authority if any of the adolescents in the trial “are found to have autogynephilia post-enrolment … so this could be further followed up, as it is clear that they should not be included in the clinical trial from the explanation given by the PATHWAYS team and the trial eligibility criteria”. In the MHRA’s opinion, a potential participant in the trial who had autogynephilia without gender incongruence would be detected and not included in the trial.

Arguing that a diagnosis of gender incongruence does not exclude AGP, Orlando has sought a further response from the HRA. He said the question was whether KCL would update its trial protocol in light of the MHRA concession; also, which entity would be liable if adolescents with AGP do suffer harm in the trial?

“If the sponsor [KCL] says a boy with autogynephilia should not have been enrolled, the parent form should say so,” Orlando said. “The information sheet, as last published, does not. Parents cannot give informed consent if they are never told about something the medicines regulator treats as a reason their son should not be in the study.”

See you in court: Christina Woods and Courtney Schneider from the ‘Those Who Speak’ team talk detrans litigation with Lynn Chadwick and Kathleen Dooley of Themis Resource Fund.

Why the Germans?

Norway | The Norwegian Directorate of Health has been asked to examine the gender treatment guidelines of Germany, Switzerland and Austria. The Minister of Health and Care Services, Jan Christian Vestre, cited a specific request from two transgender advocacy groups that German-language jurisdictions be a possible model for Norway. In 2023, Norway’s independent healthcare investigator Ukom described the hormonal treatment of minors as experimental and recommended that the country’s 2020 gender-affirming guidelines be revised in the light of a “gold-standard” systematic review of the evidence. That revision is yet to happen.

The redirected focus on Germany, Switzerland and Austria in fact relates to a single, German-language guideline issued amid strong criticism in March 2025. Unlike evidence-based guidance in England, Finland and Sweden, the German-language project failed to carry out a systematic review of the evidence and ignored the European shift to a more cautious treatment policy.

The group Gender Identity Challenge (GENID) Norway, a critic of the gender-affirming model, said the decision to exclude the guidelines from Finland and Sweden—jurisdictions similar to Norway’s—was “particularly striking”. In an opinion article for the liberal-conservative newspaper Minerva, the GENID board called on Minister Vestre to explain the choice to examine the German-language guideline and not others, and to account for the failure to implement a revision of the 2020 guideline starting with the foundation of a systematic review.

Eminence-based liability

United States | The American Academy of Pediatrics, WPATH and the Endocrine Society have failed in their attempt to get a case against them thrown out of court. The allegations brought by Florida’s Attorney General James Uthmeier include false and misleading claims that puberty blockers are fully reversible, that credible evidence shows a reduction in suicidality in transitioned minors, and that the guidelines of these three organisations are evidence-based. In their defence, these organisations argue that their guidelines are speech protected by the Constitution’s free-expression guarantee.

In a separate legal action brought by the Federal Trade Commission, WPATH frames its standards as constitutionally protected opinions expressed in the contested debate over paediatric medical transition.

In WPATH’s own videos, gender clinicians openly discuss the misuse of non-gender diagnostic codes, journalist Benjamin Ryan reports. Critics of gender medicine, including the Trump Administration and the watchdog group Do No Harm, allege that gender medicine makes fraudulent use of incorrect billing codes in order to secure health insurance reimbursement and conceal the nature of medical interventions.

Mr Ryan cites the response of psychiatrist Dr Teddy Goetz when asked how to use a non-pathological diagnosis to justify medical transition. In the video, Dr Goetz says, “You could switch your billing code to ‘unspecified endocrine disorder’, for example, saying that their body produces less testosterone than it should for them to feel their best. So, there are different ways that you can work around that. And thinking about moving towards euphoria and away from dysphoria.”

Do No Harm has urged the Department of Health and Human Services to look into potential fraud by Planned Parenthood in its diagnostic coding for hormones and insurance billing. “Our investigation suggests Planned Parenthood and its regional affiliates may be perpetrating a nationwide miscoding scheme to conceal services for sex-rejecting procedures and to facilitate improper insurance reimbursements for cross-sex hormones,” says Dr Kurt Miceli, chief medical officer at Do No Harm.

Go to jail

Colombia | A Mexican YouTuber, Samuel Adrián, whose documentary made allegations about the gender medicalisation of minors in Colombia, was arrested on arrival earlier this month at Bogotá’s El Dorado Airport, The Washington Stand reports. His documentary, “Colombia: Factory of Trans Children”, caused a public furore and was followed by the closure of the gender paediatric clinic at the elite Valle del Lili Foundation hospital in Cali. In May, a court in that city imposed a 10-day arrest and a fine on Mr Adrián for his refusal to comply with a ruling that he remove specific clips from the documentary and related videos featuring Dr Mario Angulo Mosquera, the former director of the gender clinic run by the Valle del Lili Foundation hospital. Mr Adrián is expected to be released on September 24.

Errors to dodge

France | The Little Mermaid Observatory watchdog group has issued a new guide for parents and professionals responding to a teenager’s trans identification. In an introductory note for parents, the guide says: “Most families discover this phenomenon when it affects them directly, without any prior preparation, at a time when it is necessary to act early and without error. Time is of the essence, and two symmetrical errors precipitate the adolescent into medical transition. The first mistake, which appears well-meaning: immediate validation, social transition at home, and referral to an affirming healthcare provider—an approach which, in reality, locks in the clinical progression to such an extent that almost all children managed in this way end up receiving hormones and surgery, without further assessment.

“The second, symmetrical error: outright rejection, threats, ideological arguments and an emotional breakdown—an approach that drives the adolescent to seek refuge in the activist community and to wait until they reach the age of majority to undertake medical transition on their own, against their parents’ wishes.” The 35-page French-language guide can be downloaded free of charge.

Blockers blocked

Australia | A newly subsidised status for the drug Triptorelin 3.75mg will not include its use as a puberty blocker for minors with gender dysphoria, according to the federal Department of Health. There has been confusion about this. On September 17, federal Health Minister Mark Butler announced that the drug would be available from October 1 on the Pharmaceutical Benefits Scheme (PBS) for women’s health conditions including breast cancer and endometriosis. Triptorelin is a substitute for another hormone suppression drug, Zoladex 3.6mg, which is being withdrawn from the Australian market by its manufacturer.

Following expert advice from the Pharmaceutical Benefits Advisory Committee (PBAC), Triptorelin will be listed on the PBS as unrestricted, which usually means a drug would be available in subsidised form for any health condition. However, a Department of Health spokesperson told GCN: “The listing is being implemented with an administrative note that says, ‘The listing of this medicine is not for the use in gender dysphoria in minors’.”

As recently as the morning of September 21, members of gender medicine lobby the Australian Professional Association for Trans Health (AusPATH) were told that gender dysphoria was to be included. This would price a PBS prescription for Triptorelin at no more than $25 per subsidised script for a month’s supply. The cost for a private, non-subsidised prescription is $264-$271 a month. (Gender clinics in state children’s hospitals outside Queensland typically pay for puberty blockers.)

On Monday morning, AusPATH chief executive Eloise Brook emailed members: “For trans and gender-diverse people, the significance of the word ‘unrestricted’ is important. Unlike a restricted PBS medicine, an unrestricted benefit is not limited by the PBS to particular clinical indications [or diagnoses].”

Ms Brook, a transwoman, cited Mr Butler’s September 17 media release, although it focused on women’s health and made no mention of gender dysphoria. “AusPATH has also confirmed the change directly with [the drug company] Ipsen, the Australian sponsor of [Triptorelin 3.75mg],” she said.

(Update, September 25: A spokeswoman for Ipsen said: “Until it was made aware of the Government’s administrative note, it was Ipsen’s understanding that the listing would be unrestricted as per PBAC’s outcome; meaning there would be no therapeutic restrictions.

“Nevertheless, at no time has Ipsen made claims about the use of Diphereline 3.75mg [Triptorelin] intramuscular injection in indications in addition to its only [Therapeutic Goods Administration] approved use in prostate cancer, as it pertains to the unrestricted listing which is due to be effective on 1 October 2026.”

In October, the National Health and Medical Research Council (NHMRC) is due to issue interim advice on the use of puberty blockers for gender distress. A range of jurisdictions internationally have restricted or banned the use of hormone suppression drugs for this purpose, citing insufficient evidence about their safety and long-term effects.

On August 19, a news report in The Guardian claimed that the PBAC experts had recommended that gender dysphoria be included in the unrestricted listing. In fact, the PBAC advice from July cited “a number of women’s health conditions”, and made no reference to gender dysphoria. The Guardian is yet to correct its coverage. GCN has sought comment from the Minister’s office and The Guardian.

Coercive medicine

Canada | A human rights tribunal in British Columbia has ordered a physician, Dr Henry Ajaero, to pay $28,100 for discrimination because he declined to inject a 14-year-old with a puberty blocker. He had cited conflict with his religious beliefs and said puberty suppression was beyond his scope of practice. The ruling is part of a trend whereby “prevailing progressive social consensus” will trump Canada’s constitutional guarantee of freedom of religion, according to retired lawyer Peter Sim. Worse, he says, the tribunal in effect substituted its own opinion for Dr Ajaero’s, failing to show the customary deference to medical judgment.

DIY hormones

United States | The website diyhrt.wiki is one among various online portals potentially allowing minors to access hormones without prescription or safeguards, Do No Harm reports. The website’s “Transmasc Guide” says: “Ideally, you would be on T [testosterone] through legal means. However, you may not have the privilege, so this guide may be of better use for you.” Entry to the website simply requires visitors to click a button stating, “I am 18 or older”. The page on Injection Supplies offers sources of syringes and needles in the US, UK, Australia, Canada, Sweden and France.

Beyond consent

Netherlands | Researchers including Dr Annelou de Vries of Amsterdam clinic fame have devised a novel response to international concern that minors may lack the capacity to consent to paediatric medical transition. In a new paper, the Dutch authors suggest the problem lies with the medico-legal concept of informed consent. Rather than expecting consent before medical intervention, they say, the reality is that adolescents will not get the requisite understanding until afterwards.

“While [the teenagers who were interviewed] describe receiving information about medical treatment and its possible risks during clinical consultations, their (embodied) understanding of gender-affirming treatment was mostly established through medical transition itself. In other words, the very effect and meaning of treatment often became intelligible only through lived experience.”

Reasons not to transition

Australia | Within nine months, the model of care at the Perth Children’s Hospital gender clinic underwent a striking change, according to documents obtained under Freedom of Information law. In December 2020, families considering social transition of a child before puberty were to be told “that current evidence suggests that of children who express significant gender dysphoria in childhood, more than half identify with the birth-assigned sex in adolescence and adulthood”.

The model noted “the importance of not allowing a child to be pushed into social transition by adults who may be uncomfortable with gender nonconforming behaviour”. The model also said: “Published case studies of ‘successful treatment’ of children expressing gender incongruence must be interpreted while keeping in mind that gender identity does often continue to evolve during development, and many children with prepubertal gender incongruence will spontaneously identify with the birth-assigned sex as puberty approaches, without any kind of ‘treatment’.”

Those passages advising restraint did not appear in the ensuing September 2021 model of care, which appears to still be in use. That new model of care recommends that social transition be child-led, and says that, “A small body of evidence suggests that children living in social transition can have good mental health.” However, the 2021 model was more prescriptive about the legal rules governing the medical transition of minors, urging uncertain clinicians to consult the State Solicitor’s Office.

An affirmative medicine chest

Canada | A First Nation group in the province of Alberta has announced a “safe haven” on its reserve land for youth seeking gender medicalisation. In 2024, the provincial government led by Premier Danielle Smith sought to protect young people by banning puberty blockers and cross-sex hormones under age 16 and restricting trans surgery to those 18 and older. To justify its challenge to provincial law, the Saddle Lake Cree Nation invoked the “medicine chest clause” of an 1876 treaty.

Bloody obvious

United Kingdom | Transgender surgery has been suspended, pending review, at the only National Health Service (NHS) adult gender clinic in Wales, journalist Nick Wallis reports. “This is no longer just a debate about the ethics of the NHS helping unwell people chop up their genitals or slice off their breasts,” Mr Wallis says. “This is about basic clinical competence. And it looks like the Welsh Gender Service couldn’t even manage that.”

The initial concern was a surgery referral rate significantly higher than English gender clinics. It emerged later that, compared to English patients, a lower proportion of the Welsh were progressing to surgery. “This raised questions about why more patients were being referred from Wales and whether some patients who were not going on to have surgery had been appropriately assessed before referral,” NHS Wales said.

“Furthermore, information provided by clinicians and correspondence received, raised concerns about whether some aspects of the assessment process before referral had been completed appropriately. These concerns included whether some patients met the basic requirements for surgery, including factors such as BMI and overall surgical fitness, and whether wider health needs had been fully considered before referral.”

Prompted by the revelations in Wales, a mental health clinician spoke to Mr Wallis about her experience working as a team leader at an NHS adult gender clinic. Speaking anonymously as “Anna”, she had expected the clinic to do psychological formulation, starting with an understanding of why the patient wished to transition. Instead, she found the process involved a fixation on diagnosis alien to mainstream practice.

Justice on the case

United States | Mount Sinai Health System in New York has agreed to cease the provision to minors of puberty blockers, cross-sex hormones and trans surgery, as part of a settlement with the Trump Administration’s Department of Justice. “Mt Sinai will also pay a monetary penalty and dedicate US$2 million to providing free medical care to individuals suffering harmful consequences of ‘gender affirming care’ they received as children,” the Department said. Commentator Leor Sapir has analysed the controversy over the Mt Sinai agreement.

Similar settlements—following investigations of what the Department describes as “sex-rejecting procedures” on minors—have been reached with other hospitals. On September 22, The New York Times reported that “at least six hospitals have struck agreements with the Trump Administration to pay fines and stop providing gender-transition treatments to minors”.

The Department of Justice has also begun action in what may prove a test case to prevent schools presiding over social transition of pupils without telling parents. The argument is that guidance used in Kansas City, Kansas Public Schools (KCKPS) breaches the Family Educational Rights and Privacy Act, which guarantees parental access to student records, and the Protection of Pupil Rights Amendment, which stipulates that minors cannot be required to do a survey or evaluation revealing sensitive material without prior consent of their parents.

Pole position

The Netherlands | The activist group Transvisie was involved at an early stage in the development of the 2019 Dutch Quality Standard for Somatic Transgender Care, while insurers were kept at a distance, according to Freedom of Information documents reported by Hermes Postma. Writing for Inspecting Gender, he says: “Insurers were the party most likely to ask hard questions about long-term outcomes, complications, evidence quality, controllability of indications, aftercare, and whether treatments can responsibly be purchased as insured care.”

Blowback

Australia | A draft law criminalising “conversion therapy” in the state of Tasmania may catch practitioners of gender-affirming care, including those transitioning minors at the government-run Tasmanian Gender Service, according to Emeritus Professor of Law Patrick Parkinson.

In his analysis of the bill proposed by the island state’s Greens Party, he says: “The nature of the irreversible treatments of hormone therapy and surgery is that the body is changed to be congruent with the sex with which the person identifies. The effect of that, in turn, is to change their sexual orientation …

“It has been a very common complaint of those who regret their gender-affirming care that the treating clinicians did not recognise that their gender non-conformity was really just an emerging same-sex orientation. The adolescent years are a time of identity formation and development, and all the research shows that sexual orientation, at this stage, is quite fluid and changeable.”

Damage done by ‘T’

Rachel Hannam

Complexity and the limits of medicalisation

Confusion and ambivalence about gender and sexuality have long been recognised as common features of adolescent development. Erikson’s stage of identity versus role confusion conceptualised this period as one in which exploration, complexity, and uncertainty were expected (Erikson 1968). What has changed is not the existence of distress itself, but the interpretive framework now applied to it.

Increasingly, adolescent distress is absorbed into a medical model whose primary tools are diagnosis, pharmaceuticals—including hormones—and surgery. In this process, psychosocial and developmental complexity is collapsed into medicalised and politicised labels, resolving uncertainty prematurely rather than engaging with it. Insights from systems thinking caution against collapsing complex phenomena into simple explanatory narratives, particularly in contemporary adolescence, where identity formation occurs within dense digital and social ecologies layered with meaning.

As Meadows (2008) notes, simplifying complicated problems can be helpful but simplifying complex problems always results in errors. Over-simplification distorts causality in complex systems, reductionism obscures feedback loops, and interventions based on oversimplified models cause harm. A historical parallel can be drawn with the mid-20th century adoption of prefrontal lobotomy, which was promoted through moral urgency, institutional pressure, and genuine belief in benefits despite limited evidence and severe long-term harms. The lesson here is not equivalence, but structural similarity: good intentions do not prevent harm when uncertainty is foreclosed and irreversible interventions outpace the evidence.

Cultural shifts that demand ethical scrutiny

Several broader cultural shifts recur across researcher, clinician and family accounts. The first is the sharp rise in adolescent presentations of gender distress since approximately 2012, coinciding with smartphone and social-media saturation and occurring disproportionately among adolescent girls. This increase parallels broader rises in adolescent anxiety and depression, particularly among females (Haidt 2024).

A third observation concerns the accelerating pace of medical transition. Contemporary clinical guidelines no longer universally require extended periods of real-life experience or prolonged psychotherapy prior to initiating gender-affirming hormones. In some settings, adolescents aged 18—or younger—can begin hormone treatment within months of first seeking care, and surgeries soon after.

Parents repeatedly echoed this shift when describing rapid access to medical transition by their young adult children in Australia, New Zealand and North America. The removal of prolonged eligibility requirements in the 8th edition of the Standards of Care issued by the World Professional Association for Transgender Health and other protocols suggests the confluence of moral urgency and broader social pressures, which simultaneously reduce opportunities for maturation and therapeutic exploration.

Counter-arguments and ethical responses

A common counter-argument holds that affirmation is ethically necessary to reduce suicide risk and that deeper exploration constitutes harm. This claim rests on contested assumptions. Longitudinal data do not demonstrate elevated suicide mortality attributable to non-affirmation. A Finnish cohort study found no increased suicide mortality among adolescents referred to gender services compared with matched controls (Ruuska et al. 2024). Distress is in fact better understood as reflecting broader psychiatric vulnerability.

Another counter-argument asserts that biological sex exists on a spectrum. This claim conflates disorders of sex development with sex itself. In mammalian biology, sex is organised around a bimodal reproductive system; intersex conditions represent atypical development within that framework and do not constitute additional sexes. While gender identity varies widely, this variability does not negate binary sexed embodiment or justify medical alteration of healthy bodies in the absence of pathology.

More recent counter-arguments also emphasise individual autonomy: “It’s your body.” While autonomy is an important ethical principle, appeals to autonomy in this context may be grounded in extra-factual beliefs—that is, metaphysical or philosophical claims about unobservable realities, such as the existence of a core gendered self or essence that exists independently of the body and must be aligned with social and medical affirmation. While such beliefs may provide existential meaning, they are not empirically testable and, when emotionally overinvested or socially amplified, function as overvalued ideas that privilege self-assertion over caution and reduce tolerance for uncertainty (Schroeder 2021).

Evidence also suggests that social transition is not a neutral act but a significant intervention that alters developmental trajectories and increases the likelihood of medical treatment (Cass 2024). Zucker (2020) has described a “lock-in effect” whereby early social transition can consolidate an identity that might otherwise have remained fluid, rendering later lifelong medicalisation more likely. These iatrogenic effects—induced unintentionally by the system—can operate clinically, socially, and culturally.

Clinical ethics and exploratory therapy as skilful care

Viewed through a clinical ethics lens, the suppression of exploratory psychotherapy raises serious concerns regarding non-maleficence, beneficence, autonomy, and informed consent.

Exploratory psychotherapy is still mis-characterised as passive, or even harmful. Indeed, at the time of writing, the Wikipedia entry on gender exploratory therapy defined it as a type of conversion therapy (see Gender exploratory therapy n.d.). In reality, these approaches are ethically and clinically distinct, with conversion therapy aiming to change sexual orientation, whereas exploratory therapy is a neutral process that investigates the psychological roots of beliefs and distress. As one of my psychology colleagues noted: “All therapy with all clients should be exploratory, by definition.”

Non-maleficence—avoiding long-term harms—requires playing the long game, exercising caution and curiosity about potential blind spots when risks are uncertain and potentially irreversible. These decisions are made in moments that young people and their parents will remember for the rest of their lives. Acting in their best interests requires doctors, teachers and therapists to hold attention on the child’s long-term wellbeing, not just short-term distress reduction.

Respect for autonomy depends on non-coercive framing and recognition that identity development is extremely dynamic in adolescence and emerging adulthood. Ethical exploratory therapy is active, skilled, and demanding. It prioritises patience over panic and formulation over protocol, strengthens reflective capacity, and tolerates uncertainty. Crucially, it does not presume a predetermined endpoint. It allows for multiple developmental trajectories, including resolution without transition, or later transition in adulthood, undertaken with much greater stability and decisional capacity.

Practical guidance for clinicians to undertake this work already exists. Ayad et al. (2022), in A Clinical Guide for Therapists Working with Gender-Questioning Youth, outline a developmentally informed approach emphasising curiosity and comprehensive assessment; attention to anxiety, trauma, neurodevelopmental differences, family context, and social influences; building distress tolerance; and showing support for exploration without presuming outcomes.

These frameworks demonstrate that ethical, non-foreclosed care is neither novel nor theoretical but has long been part of responsible clinical practice. As several parents I interviewed observed, when a young person’s mental and social wellbeing improved, their concerns or distress around gender often diminished.

Of course, this does not preclude respectful and open discussions about sex and gender. Two examples of exploratory tools may be clinically useful. One is the freshwater stream analogy, shared with me by a colleague. We use it to explore beliefs about biology, sex, and embodiment. A therapist might ask: “If you were responsible for caring for a freshwater stream, but preferred swimming in saltwater and had access to abundant salt, would you change the stream?” Most patients respond no. Reflecting on why allows consideration of how introducing a single variable can impact an entire ecosystem over time.

Construing the body as something precious, its own ecosystem, invites reflection on how medical interventions such as oestrogen or testosterone may affect the interconnected systems of the body, without asserting a conclusion.

Another approach draws on Socratic questioning and metacognitive inquiry to explore how deeply held beliefs are formed and maintained. When I use this technique, my aim is to expand the conversation and explore deeply held beliefs with epistemic humility. The focus is not on changing beliefs, but on supporting self-reflection and evaluating confidence in one’s reasoning. A therapist might ask questions such as: “What does ‘wrong body’ mean to you personally?” or “When did this explanation first start to feel true?” Exploration may also include:

• What experiences helped this belief take shape?

• Were there moments when it felt especially relieving or clarifying?

• Have there been times when it felt less fitting, even briefly?

• Does part of you feel this explains everything, while another part remains unsure how permanent it is?

• How confident do you feel about the reliability of this belief?

By normalising ambivalence, slowing decision-making, and supporting mentalisation and emotional regulation, psychotherapy functions not as a barrier to care, but as an ethical safeguard—particularly during periods of developmental vulnerability.

Conclusion: From moral certainty back to ethical care

Writing this as both a clinician and a mother myself, I remain acutely aware of how little certainty is available when a child is suffering, and how much responsibility lies with parents and those entrusted to help them traverse this complex and layered terrain.

What families so often encounter is not an absence of compassion for young people’s suffering, but an absence of clinical openness. Vital questions ordinarily central to ethical psychotherapy concerning development, comorbidity, uncertainty, and reversibility are treated as impediments rather than necessities. The suppression of exploratory psychotherapy does not require a conspiracy to explain it. It can be understood as the predictable outcome of a convergence of moral urgency, institutional risk aversion, professional conformity, epistemic injustice, and medicalised responses to complexity—none of which confer ethical legitimacy.

Ultimately, this debate is not about whether distressed young people deserve our love and support, but whether current practices adequately protect them when our knowledge is incomplete and consequences are lifelong. Ethical psychotherapy remains essential to that protection. Its marginalisation represents not progress, but a retreat from the core principles of care, humility, and responsibility that psychological and medical practice are meant to uphold.

Dr Rachel Hannam is a Brisbane-based psychologist.

This article is a book extract from Over the Rainbow: A Challenge to Cancel Culture published by permission of Spinifex Press. Edited by Drew Hutton and Libby Connors, the book is to be launched on September 17 by Sall Grover, a prominent Australian critic of gender ideology and founder of the female social media platform Giggle.

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Ayad, Sasha, Roberto D’Angelo, Dianna Theadora Kenny, Stephen B Levine, Lisa Marchiano and Stella O’Malley (2022) A Clinical Guide for Therapists Working with Gender-Questioning Youth (Version 1). Gender Exploratory Therapy Association / Therapy First.

Cass, Hilary (2024) Final Report of the Independent Review of Gender Identity Services for Children and Young People.

Cohen, Stanley (1972) Folk Devils and Moral Panics: The Creation of the Mods and Rockers. London, UK: MacGibbon & Kee.

de Vries, Annelou L. C., Jenifer K. McGuire, Thomas D. Steensma, Eva C.F. Wagenaar, Theo A. H. Doreleijers and Peggy T. Cohen-Kettenis (2014) ‘Young adult psychological outcome after puberty suppression and gender reassignment’, Pediatrics, 134(4), pp. 696–704.

Erikson, Erik H. (1968) Identity: Youth and Crisis. New York: W. W. Norton.

Festinger, Leon (1957) A Theory of Cognitive Dissonance. Stanford, California: Stanford University Press.

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Haidt, Jonathan (2024) The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness. New York: Penguin Books.

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Ruuska, Sami-Matti, Katinka Tuisku, Timo Holttinen and Riittakerttu Kaltiala (2024) ‘All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: A register study’, BMJ Mental Health, 27(1).

Schroeder, Mark (2021) ‘Emotivism’ in Edward N. Zalta (Ed.) The Stanford Encyclopedia of Philosophy (Fall 2021).

Zucker, Kenneth J. (2020) ‘Debate: Different strokes for different folks’, Child and Adolescent Mental Health, 25(1), pp. 36-37.

Gary Geelhoed

In January, a four-year-old model of care for the gender clinic at Perth Children’s Hospital finally reached daylight. After months of resistance, the Western Australian government had tabled the document in parliament. It showed that the public clinic will connect interested girls under 18 who identify as boys with private surgeons for double mastectomy—“top surgery”—while placing “personal responsibility” on the child and her family. Freedom-of-information figures showed minors on puberty blockers at the clinic rising dramatically from 2016 to 2025, a jump of more than 400 per cent. There is still no reliable public count of how many Australian teenagers have had healthy breasts removed.

I said in The Australian that it is unethical to refer female minors for mastectomy; that children who cannot vote, drive or enlist cannot meaningfully consent to lifelong medication and irreversible surgery; and that a 13-year-old cannot grasp the loss of fertility, sexual function and the unknown long-term effects. I used the plain word “mutilating” for the removal of healthy breasts. In a companion essay for Gender Clinic News I called the medicalisation of gender-distressed minors the biggest scandal of my time in medicine and asked the profession to press for a ban on puberty blockers, cross-sex hormones and surgery in this group. I also said, and still say, that adults should be free to live as they wish. The argument was about children.

On February 9, a confidential complainant took those comments to the Australian Health Practitioner Regulation Agency. In July, AHPRA wrote to me. (I am retired and hold non-practising registration.) The enclosed summary said the comments were “inflammatory”, invoked rapid-onset gender dysphoria and England’s Cass Review, and were “reasonably likely to damage the reputation of the medical profession” and “adversely impact public health for a vulnerable patient population”. The complainant treated a call for a ban as if it implied that genital surgery on under-18s is routine in Australia. It is not. That is a quarrel with a sentence, not with a clinic’s documented pathway to mastectomy.

The authoritarian impulse: Andrew Doyle predicts that woke identity politics will intensify as it comes under pressure.

A distinction without difference

The regulator’s public line is now familiar. Practitioners may speak. They may debate clinical pathways. They will not be investigated “purely for holding or expressing their views”. Then comes the rider: speech that causes harm, or potential harm, will not be tolerated. In April, AHPRA’s chief executive and the chair of the Medical Board of Australia put it in writing. Free speech is “constrained if a practitioner comments, or supports comments, that can cause harm to groups or individuals”.

The harm they name is erosion of trust, and the fear that some people will not seek care. In private briefings the same logic is stretched further. An opinion against a group, even if expressed privately on social media, can be “inflammatory” or “derogatory” and therefore harmful, because someone might stay away from a doctor. Around gender, they say, debate about the management of young people is legitimate—the National Health and Medical Research Council (NHMRC) is examining the evidence—but “targeting” transgender people will bring the regulator in.

That is not a boundary. Almost any serious criticism of a treatment model can be redescribed as targeting the patients who receive it. A psychiatrist who questions whether every trans identification is distinguishable from other psychopathology; a paediatrician who says a girl cannot consent to mastectomy; a researcher who cites the Cass Review: each can be cast as making a class of people feel unsafe. The test is no longer falsehood, incitement or a refusal to treat. It is the anticipated feeling of a hypothetical patient who has not been seen.

A society that treats the upset of the status quo as a public-safety event does not become more compassionate. It becomes more closed-minded.

Here is the irony that AHPRA’s formula cannot digest. The “status quo” in youth gender medicine is not an ancient pillar of the profession. It is a recent import. For most of the last century the typical presentation was a small number of young boys; most desisted. The caseload that now fills clinics—overwhelmingly adolescent females—is a phenomenon of the last fifteen years, coincident with social media and with a treatment model that treats affirmation as the ethical default and exploratory therapy as suspect.

The Cass Review found that evidence for puberty suppression and hormones in this group was remarkably weak and that the Tavistock’s Gender Identity Development Service was “not safe”. The UK ended routine puberty blockers outside a trial. Sweden, Finland, Norway, parts of the US, New Zealand and Queensland have adopted policies to restrict or pause the same pathway. Australia’s own NHMRC, at the request of federal Health Minister Mark Butler, is writing national guidelines. Interim advice on puberty suppression is due for public consultation late this year. That is an official admission that the evidence is not settled.

Yet contrary evidence is still handled as contamination. Cass is waved away as “widely critiqued”, as the complainant did, citing a 2025 Medical Journal of Australia commentary. Rapid-onset gender dysphoria is treated as an unmentionable. Detransitioners are anecdotes. European reversals are politics. The model that arrived yesterday demands the deference owed to antiseptic surgery.

AHPRA says it has tightened rules on vexatious complaints and that lived-experience is considered. Given AHPRA’s documented close links to the trans lobby we can assume it is not the lived experience of detransitioners. The bar now appears to be not a slur, not a refusal of care, but an opinion that might keep someone from the waiting room. A lobby that has had success in an institution will always prefer that test. A regulator that accepts it will always be pulled toward the most organised complainant.

The Medical Board is entitled to punish fraud, indecency and genuine incitement. It is not entitled to treat a retired paediatrician’s newspaper sentences as a threat to public health because a confidential reader disliked the nouns. I was asked what I would do differently. I would use the same words, and I would add one more. The harm that should keep AHPRA awake is not the hurt of being argued with. It is the child who cannot consent, the breast that cannot be put back, and the profession that learned to call dissent unsafe. Without the right to question a new orthodoxy, medicine does not become kinder. It only stops being a science.

Professor Gary Geelhoed is a retired paediatrician and researcher who served as Chief Medical Officer of Western Australia, Assistant Director General of Clinical Services and Research for the Western Australian Department of Health, and director of the emergency department at the Princess Margaret Hospital for Children, which was succeeded by the Perth Children’s Hospital, home to a gender clinic.

Inside info

The Australian Health Practitioner Regulation Agency has uncritically embraced the contentious gender-affirming worldview as part of developing its “LGBTQIA+ Equity and Inclusion Strategy”, judging by documents obtained under Freedom of Information law.

Joe Goddard-Williams, state manager for Victoria and co-chair of the steering committee for the strategy, has been upfront about a personal interest.

On social media Mx Goddard-Williams said: “As a masculine-identified queer person, like many other LGBTQIA+ people, I’ve had trouble finding safe and inclusive support across healthcare and other institutions. Really proud of the work AHPRA is doing to be an accessible and safe regulator for LGBTQIA+ people.”

The AHPRA website said: “Joe did a Master of Critical Theory in the UK before moving into regulation …”

In the FOI documents, steering committee minutes from December 2024 cite a workshop, with the comment, “We heard about the importance of gender-affirming care.”

“AHPRA not only responds to complaints, but we also set the standards for practitioners. If we get the standards right, and ensure more identity-affirming care, we won’t receive the complaints in the first place,” the minutes for an October 2024 meeting say.

This suggests that AHPRA’s fidelity to the affirmative model is not limited to its LGBTQIA+ strategy but extends to the setting of standards for practitioners and the handling of complaints against them.

A 2025 summary document for the strategy refers to case studies of regulatory action against “several practitioners who displayed conduct that breaches professional standards and codes of conduct, pertaining to derogatory and inappropriate comments directed towards LGBTQIA+ people”.

Also consulted by AHPRA were trans rights organisations such as ACON and Thorne Harbour Health, both of which have launched gender clinics that offer irreversible cross-sex hormones to young people. AHPRA is a member of ACON’s Pride in Diversity program.

Framing those organisations as “community” representatives rather than lobbies, the FOI documents suggest an unguarded adoption of an external agenda.

“Initial feedback on this [strategy] draft has been sourced from three community peak/support organisations—ACON’s Pride in Diversity, Transgender Victoria, and Thorne Harbour Health … Their feedback indicates the draft is strongly aligned with community expectations,” says an April 2025 executive summary on the strategy.

That same month, the working draft was said to provide “a framework to achieve our commitments to community (e.g. pre-existing commitment to Rainbow Tick and AWEI in People Plan)”. [Emphasis added]

AWEI is ACON’s Australian Workplace Equality Index, in which employers compete to implement the lobby group’s agenda. Rainbow Tick is an “LGBTIQ inclusion” scheme that emerged from a La Trobe University research centre which urges an expansion of “affordable, accessible gender-affirming medical care”.

Also last year, an executive summary for AHPRA’s strategy said its purpose was “to elevate and reinforce existing programs of work to achieve accreditation against recognised standards and benchmarking tools—namely Rainbow Tick and the AWEI—to influence positive systemic, attitudinal and cultural change across the National Scheme for LGBTQIA+ peoples”.

Language games

The AHPRA documents released under FOI law include an activist-sourced list of terms and definitions.

This ignores the poor benefit to risk ratio of the gender-affirming approach, which it says “may include medical treatment (surgery, hormone therapy and other treatments) …”

The practice of prescribing opposite-sex levels of hormone drugs is dignified as “hormone replacement therapy” as if normal male and female hormone levels put patients in need of therapy.

In the AHPRA FOI documents, there are notes on how to deal with “resistance” from “minority fringe groups”, “potential backlash”, “the risks of the vocal minority” and “potential misinformation”.

“Globally, but with particular reference to the USA, there has been an escalation of anti-LGBT sentiment that has contributed to increased discrimination against LGBTQIA+ peoples, heightened risks to their personal safety, and removed access to critical health services,” according to a 2025 summary of the AHPRA strategy.

This implies that AHPRA regards the affirmative approach as the only possible health service for the gender-distressed, and that evidence-based criticisms of the gender-affirming model, or decisions to restrict it for safety, amount to discrimination that makes trans individuals feel “unsafe”.

The 2025 summary continues: “The politicisation of identity has contributed to increased public and social discourse and the dissemination of misinformation about marginalised communities, under the guise of ‘anti-woke-ism’.”

“While Australia’s legal and cultural landscape differs significantly to that of the USA and other countries that have wound back legal rights for LGBTQIA+ peoples, the global debate suggests that the benefits of equity and inclusion are misunderstood, driving increased activity by fringe minority groups that seek to advocate views and actions that are not grounded in peer-based research, to the detriment of the LGBTQIA+ community.”

AHPRA says its response to potential misinformation will include “Data-driven and research-informed approaches to public health”.

But there is no reference in the FOI documents to the highest quality data, namely the multiple systematic reviews commissioned independently in several countries. These gold-standard reviews confirm that the evidence for hormonal treatment of gender-distressed minors is of low quality, meaning there is no firm basis for gender clinicians in public or private health to claim beneficial outcomes for young people.

Nor is there any acknowledgement in the documents of the good-faith concerns of clinicians and researchers internationally who are not “anti-LGBTQIA+” but regard the gender-affirming treatment model as unsafe, including for gays and lesbians whose same-sex attraction is undermined by the concept of gender identity.

Minutes from an April 2025 AHPRA meeting note concerns “about the current social climate, including rising anti-LGBTQIA+ sentiment and its impact on healthcare access and mental health”. [Emphasis added]

Health authorities in jurisdictions including the UK, Queensland, Finland, New Zealand, Sweden and US Republican states have adopted policies restricting paediatric medical transition because of the inadequate evidence of safety. This trend goes unmentioned in AHPRA’s FOI documents, apart from the implication that the regulator views such restrictions as discriminatory.

And then they changed: UK lobby Stonewall was the inspiration for ACON’s Australian Workplace Equality Index. AHPRA regards that index as a benchmark. Both ACON and Stonewall are former gay rights/AIDS organisations that pivoted to radical trans lobbying. Starting in the UK, LGB Alliance groups have emerged to reassert same-sex attraction against the conflicting concept of “gender identity”.

Free speech, with undefined limits

During a Senate estimates hearing in June, One Nation Senator Malcolm Roberts raised the case of psychiatrist Dr Andrew Amos, noting that one of the complaints leading to Dr Amos being silenced by AHPRA was his “misgendering” of a UK trans activist.

Senator Roberts asked AHPRA’s chief executive Justin Untersteiner whether “a health practitioner [has] the right to refer to a trans person’s biological sex?”

Mr Untersteiner: “I’m struggling a little bit with that question in regard to our role as the regulator. I don’t know.”

Senator Roberts: “Is it discrimination for a health practitioner to refer to a person’s biological sex?”

AHPRA general counsel Dr Jamie Orchard: “In respect of public comments by practitioners, you’ve heard earlier the discussion around the right of free speech and the fact that AHPRA and the boards are committed to those ideals, but there are limits to free speech and how people express themselves.”

Senator Roberts: “How can a doctor fulfil their ethical obligation to inform the public of potential harms of gender interventions and gender ideology without being accused of discrimination against LGBTQIA+ people?”

Mr Untersteiner: “Health practitioners have a right to have public debate about a range of different issues, which includes, again, gender-affirming treatment, gender blockers [sic] and other like treatments. And we would not be taking regulatory action on that basis.”

“We will intervene where this goes beyond a debate about clinical pathways and treatments and moves into a place of hate or discrimination against individuals or groups.”

Senator Roberts: “Given AHPRA’s affiliation with the Rainbow Tick scheme and ACON, a high-profile gender identity organisation, how can a doctor be sure that AHPRA is neutral and not biased against them?”

Mr Untersteiner cited the “need to be engaging with all sorts of communities to understand their experiences in the health system”. He was silent on the lobbying function of a trans rights organisation such as ACON.

Senator Roberts: “Have you conducted any formal assessment of whether these relationships create actual or perceived conflicts?”

Mr Untersteiner: “No formal assessment.”

Senator Roberts: “How does AHPRA reconcile its statutory obligation to act as an independent regulator with participation in programs designed to influence institutional behaviour toward progressive inclusion strategies?”

Mr Untersteiner: “… there is a very robust regulatory and legislative framework that ensures that there isn’t a conflict of interest that occurs as a result of us listening to different members of the community to understand their experiences.”

Senator Roberts: “Has AHPRA received advice, internal or external, on whether alignment with advocacy organisations risks regulatory capture or bias?”

Mr Untersteiner: “I’ll take that on notice.”

“AHPRA does not have a partnership agreement or advisory relationship with ACON … AHPRA has an arm’s-length organisational membership (essential membership tier) with Pride in Diversity, as do nine out of 10 of Australia’s largest employers,” Mr Untersteiner said.

Last week, Queensland’s Education Department said it was leaving Pride in Diversity because it did not “align with its current requirements”, The Courier Mail newspaper reported. The Department won platinum status this year in Pride in Diversity’s Australian Workplace Equality Index.

On August 20, a mother from Queensland’s Sunshine Coast, Nerissa Pace, launched a petition calling on the Department to remove itself from ACON and Pride in Diversity. Ms Pace told The Courier Mail that “transgender ideology is contentious and not settled”, and the vast majority of parents agreed that “gender and LGBTQ+ education did not belong in schools”.

Michelle Rider, a petition supporter, was quoted as saying: “Parents are angry. We are watching our children being sexualised through school and arts programs that expose them to adult sexual and gender themes.”

“Many parents see this pattern as grooming: the gradual normalisation of adult sexual content and contested ideologies to children who are not developmentally ready.”

ACON’s projects are modelled on the UK charity Stonewall—a gay liberation campaigner turned trans rights lobby—and its Diversity Champions program and Workplace Equality Index. But the credibility of Stonewall, which promotes gender identity over biological sex, has been seriously damaged.

Many of Stonewall’s members have withdrawn from its lobbying vehicles in recent years, among them the BBC, the UK Cabinet Office, the Ministry of Justice, the Department of Health, the Equality and Human Rights Commission, the school standards regulator Ofsted, NHS England, the Royal College of Paediatrics and Child Health, Police Scotland, and the media and communications regulator Ofcom.

Stonewall has been criticised for its unbalanced trans rights demands at the expense of women and (same-sex attracted) gays and lesbians, and its promotion of the gender medicalisation of minors based on alarming but unreliable data on attempted suicide. For these reasons, together with the conflicts of interest occasioned by competing to implement Stonewall’s ideological agenda, many employers have decided the reputational and legal risks of membership are too high.

Writing for Legal Feminist in 2021, lawyer Naomi Cunningham noted that more than 850 companies, charities, government departments and public authorities had signed up with Stonewall in its heyday.

“It’s easy to see what’s in it for Stonewall. They’re a lobby group. Persuading people to their way of thinking is what they’re for; and if people are willing to pay them substantial sums of money for the privilege of being intensively and elaborately lobbied and then catechised on the degree to which they have absorbed and implemented the lobbying, what’s not to like?” she said.

“What’s more mysterious is why serious organisations full of serious grown-up professionals are willing to submit to these time-consuming indignities. How does it come about that magic circle law firms, government departments, universities and the rest are prepared to be so publicly suckered?

“You might think employers would discern a significant reputational risk—not only from being associated with an organisation that has suffered Stonewall’s recent run of startling lapses of corporate judgment (their extraordinary attempt to silence a black lesbian barrister by complaining to her chambers and their irresponsible promulgation of scaremongering claims about effects of the recent High Court decision in Keira Bell’s case on the mental health of young people are just two examples)—but also simply in being publicly taken for this ride.”

Armour for dissidents

Doctors in trouble for criticising the “gender-affirming” treatment model can invoke in their defence a landmark statement from Children’s Health Queensland (CHQ) recognising the legitimacy of debate about this model, according to lawyer John Steenhof.

Mr Steenhof represented Dr Jillian Spencer, a strong critic of the affirmative treatment approach whose settlement with her former employer last month included a CHQ statement acknowledging that her concerns were “grounded in her training and background as an experienced child and adolescent psychiatrist”.

CHQ, which runs a Brisbane-based gender clinic, also put on the public record that a child should not be directed down “a pre-determined treatment pathway” but be given comprehensive assessment and “a holistic clinical approach”.

Mr Steenhof, principal lawyer at the Human Rights Law Alliance, said the CHQ statement on July 17 was a “landmark” and could help doctors facing disciplinary action or complaints to regulators over comments about the shortcomings of the gender-affirming treatment model.

No hate here

“The statement shows that you can have grave concerns about the [gender-affirming treatment model] that fast-tracks kids down a pathway of medical intervention, and this doesn’t constitute some sort of discrimination or hate,” Mr Steenhof said.

“It arises from training, background and experience in the field of medicine, and an understanding of general clinical practices that apply to all [other] childhood conditions, but which somehow are supposed not to apply when a child presents with gender confusion.”

Capture by ideology: Campaigner Helen Joyce says gender clinics in Australia and Canada are “much, much worse” than the London-based Tavistock Gender Identity Development Service, which was bad enough to be shut down in March 2024

Silence from the regulator

The Australian Health Practitioner Regulation Agency has refused to answer questions from GCN on the potential significance of the July 17 statement for practitioners facing complaints over their public criticism of the gender-affirming treatment approach.

The CHQ statement accepts that the right response to youth gender distress involves “matters of legitimate professional and public debate, and that clinicians play an important role in raising concerns about patient safety and clinical practice”.

“Dr Spencer has been a strong advocate for change in Queensland in the model of care for children and adolescents experiencing gender dysphoria.

“One of the features of the clinical approach that Dr Spencer has sought is the delay in medical interventions for such patients until adulthood, including puberty blockers and cross-sex hormones, because they are serious decisions regarding their body and long-term health.”

In the statement, CHQ “acknowledges that health practitioners must take a clinical approach to the treatment of gender dysphoria that focuses on the best available research and the child’s best interests rather than directing a child down a pre-determined treatment pathway”.

“Health practitioners must employ a holistic clinical approach that comprehensively assesses all relevant factors—including any co-morbidities or other mental health conditions—and use information gathered from that process to determine the best available mode of treatment and care for the patient.”

Mr Steenhof said the CHQ statement is “something that doctors who are facing opposition by the transgender activist movement are able to point to, to rely upon, and to use to defend them against the assertions that they’re not allowed to speak up about what they see happening in gender-affirming care”.

“In any of the legal fora in which a doctor is going to be facing some sort of sanction or negative outcome for having spoken in criticism or scepticism about the medical-intervention model for kids, this statement is going to be useful.”

Some guidance, please

Professor Philip Morris, president of the National Association of Practising Psychiatrists, which advocates a cautious response to youth gender dysphoria, invoked the CHQ statement in a July 25 email to AHPRA and Dr Susan O’Dwyer, chair of the Medical Board of Australia.

He suggested that after the July 17 statement, doctors who question the medical affirmation of young people “should not be subject to censure from AHPRA or the Medical Board of Australia as long as their comments in public, in professional forums or on social media are respectful and temperate”.

“I would be grateful if the Medical Board of Australia notifies doctors and the public of this situation. This action by the Board should lead to a reduction in complaints made against doctors who are doing nothing more than what [CHQ] regards as ‘legitimate professional and public debate’.”

AHPRA’s August 25 response to Professor Morris runs to 1,270 words but avoids any mention of the CHQ statement. The reply does say that “AHPRA and the National Boards recognise the freedom of expression for practitioners and their right to communicate, including advocating for causes via social media, provided their activities do not involve the abuse or discrimination of others, or present a risk to the public.”

“[Guidance issued in February 2025] states that registered practitioners will not be investigated purely for holding or expressing their views.

“All regulatory decisions are made impartially, based on evidence, public safety, risk and in accordance with the Board’s codes and guidelines and the National Law.”

Australia now has a confused generation of teenagers raised in the shadow of gender identity divorced from biological reality, according to Professor Emerita of Psychology Dianna Kenny.

She was addressing a women’s rights rally in Sydney’s Martin Place held on Sunday to protest amendments to the federal Sex Discrimination Act in 2013. The definitions of “man” and “woman” were removed from the law. As a new protected attribute, the concept of gender identity uncoupled from biological sex was introduced.

Single-sex spaces for women and girls have been thrown open to transgender-identifying males, while adolescent girls are prominent in the exponential growth since the 2010s of new referrals to gender clinics offering life-altering puberty blockers and cross-sex hormones.

“The generation raised after 2013 is different from preceding generations,” said Professor Kenny, who uses psychotherapy and psychological interventions with young clients distressed or confused about gender and sex.

“A child born in 2010 was three when the [sex discrimination] legislation changed, and is 16 today. These are the children who are streaming through my door, confused about who they are. They’re not sure whether they’re a demiboy, a demigirl, asexual, aromantic, pansexual, omnisexual, transgender, demigender, and so forth.

“Today’s adolescents are the first Australians to have spent their entire conscious childhood within a legal and institutional culture in which gender identity is formally separated from biological sex. This has affected the categories available to children for understanding themselves.

“I have observed youth surveys of gender identity that offer young people 46 categories of gender identity. Is there any wonder why children are confused?”

Public intellectual Dr Clive Hamilton, a former professor of public ethics at Charles Sturt University, spoke of the restriction of free speech in the name of gender identity.

“Australians typically are a pretty tolerant bunch. We’re fine with other people living their lives in all kinds of ways that might be quirky or niche, and we typically let them get on with it—until, that is, they infringe on our own rights by a demand that we must change how we speak and act to conform to their beliefs,” he said.

“Gender ideology is the politics of the one per cent. It demands compliance from the 99 per cent. It’s captured our institutions, and individuals who do not conform are punished, sometimes harshly.”

He highlighted the case of psychiatrist Dr Andrew Amos, whose membership of the Royal Australian and New Zealand College of Psychiatrists was suspended after the regulator ordered him to cease his social media criticism of the medicalised gender-affirming treatment model.

“So, now, doctors across Australia who follow the evidence risk losing their jobs,” Dr Hamilton said.

The rally also heard of Sall Grover’s struggle to keep her platform Giggle female only. She was to speak at the rally but pulled out, saying she had received death threats from a trans activist.

The stories of other critics of gender ideology were cited on Sunday, including—

the damages penalty facing Kirralie Smith of the group Binary Australia for “vilifying” males playing in women’s sport

the Lesbian Action Group requiring approval from human rights bureaucrats to hold a public event limited to lesbians

the harrying of child and adolescent psychiatrist Dr Jillian Spencer who spoke out about the risks of paediatric gender medicine

philosopher Dr Holly Lawford-Smith needing a security guard outside her feminism class

and former breastfeeding counsellor Jasmine Sussex accused of “vilification” for criticising males who claim they can breastfeed

Dr Hamilton said: “We are in Australia in the midst of a great silencing. Critics of gender ideology, or those who simply want to protect the hard-won rights of feminism and gay activism, are now subject to legal sanction, loss of employment, bans from public facilities, deplatforming, institutional discipline, reputational damage, campus intimidation, online slander and threats, and even physical attack.

“Just think how much institutional machinery and bureaucratic energy has been mobilised to stop people saying something that, in every culture for millennia, is the most ordinary observation: men are not women.

“The punishment of one silences thousands, and a cloud of fear now hangs over this debate. It’s no wonder that academics, journalists, doctors, public servants, and everyday citizens have learned to keep their mouths shut.

“In recent times, science has been under attack on several fronts. Now, gender activists use the techniques refined by climate science deniers to suppress the material fact of biology,” Dr Hamilton said.

“You don’t have to agree with everything each speaker says here today. You only have to agree that voices critical of gender ideology and trans fanaticism should be heard, because the chilling effect on [the] free speech [of] concerned citizens goes against everything a liberal society is supposed to stand for.

“When what can be said around the kitchen table cannot be said in the office, the school, the hospital, or the university, something has gone badly wrong in democratic life.

“Without courageous people willing to exercise the right to free speech, we would never have had a women’s movement. We would never have had a gay liberation movement, and now we have a deformed outgrowth of those movements, shutting down free speech. To protect our democracy and our right to express ourselves, we must resist, we must speak out.”

Catharsis: Saying out loud the things that everyone knows are true

Confusing the young

Professor Kenny said she saw “rampant social contagion among youth and public institutions [as] the only viable explanation for the exponential increase in transgender identifying young people in this century. Teaching gender ideology and gender identity confuses children about basic biology and social roles.

“An adolescent experiencing discomfort with puberty, same-sex attraction, gender non-conformity, alienation from peers, body dissatisfaction, or a more diffuse uncertainty about gender identity, now encounters a vocabulary of transgender, non-binary, gender fluid, genderqueer, gender diverse, gender expansive, gender questioning that was far less socially available to Australian adolescents 20 years ago,” she said.

“Prioritising self-declared gender identity over biological sex in law and policy leads to the medicalisation of youth who might otherwise simply be gender non-conforming, or coming to terms with same-sex attraction, or who have autism spectrum disorder.

“Our very own Sex Discrimination Commissioner, when asked to define a biological male, said she could not do that, and the questioner and she were speaking a different language,” Professor Kenny said.

“I have tried to speak with some of the state human rights commissioners over the past six or seven years.

“I walked into the office of one commissioner whose office was adorned with rainbow flags and badges and so forth, and I launched into my extremely simplified, two-syllable explanation of why gender ideology was nonsense.

“She stopped me halfway through, and she said, ‘I’d like to seek a point of clarification. Could you tell me the difference between sex and gender?’

“We require not only the urgent reinsertion of biology, reality, and logic into the Sex Discrimination Act. I call on the Education Minister to completely revise the sex education curricula in government schools. Currently, children can leave home as male and change their sex to female or vice versa at the school gates.

“Some schools are providing alternative school uniforms for these self-declared transgender young people, including using their preferred names and pronouns completely without parental knowledge or consent. Some parents have told me that they have only found out that this is happening at the end of the year when school reports come home in the child’s preferred name.

“The current policy and curricula, and the wider legal framework, and organisations such as [trans lobby] ACON, the [Australian] Human Rights Commission, and the Sex Discrimination Office are destroying children, adolescents, and their families.”

Affirmative taxpayers?

A former president of Australia’s transgender medical lobby has claimed that puberty blocker drugs will now attract federal subsidies under the Pharmaceutical Benefits Scheme (PBS).

“So, the maximum monthly price will be $25! That’s right, you read it correctly! These are scripts that can be written by GPs [in primary care],” Brisbane GP Fiona Bisshop, a past president of the lobby group, the Australian Professional Association for Trans Health, said on Facebook.

“Trans youth deserved some good news, and this is the best in a long time!” One comment on her post says: “Awesome, life-saving stuff”.

If Dr Bisshop is right, this federal intervention could sidestep the Queensland State Government’s policy to prohibit any new referrals of minors for hormonal treatment with puberty blockers in the public health system. “It kind of makes [the ban] a joke, really … it makes it laughable that the PBS is saying you can prescribe this for anything,” Dr Bisshop told The Guardian.

Multiple systematic reviews overseas have found the evidence to be weak and uncertain for the use of puberty blockers with gender distress. In addition to Queensland, other jurisdictions with policies to restrict this use of puberty blockers include New Zealand, the UK, US Republican states, Finland and Sweden.

In 2024, the UK Labour government’s Health Secretary, Wes Streeting, said it was “a scandal that [puberty blocker] medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial”.

Any therapy goes

After an emergency “out-of-session” meeting on July 30, Australia’s federal Pharmaceutical Benefits Advisory Committee (PBAC) has recommended that the puberty blocker Triptorelin be given “unrestricted” status on the PBS. An unrestricted drug attracts a federal subsidy “for any therapeutic use”. The PBAC recommendation requires the approval of Minister Butler.

Asked if puberty blockers will be made available on the PBS, Mr Butler’s department did not answer directly, but a spokesperson said the PBAC had recommended unrestricted listing of Triptorelin “to support its use in the treatment of other conditions, including breast cancer and endometriosis, and [to] help address the imminent de-listing of [another hormone suppression drug], Goserelin 3.6mg (Zoladex), from the PBS”.

The PBAC itself cited the need to cover “a number of women’s health conditions” following news that Goserelin was being withdrawn from the market by its manufacturer for commercial reasons. Hormone suppression can help stop breast cancer cells from growing.

Without a PBS subsidy, Triptorelin would cost up to $3,168 for a year’s supply on private prescriptions of the kind that Dr Bisshop and others have been writing. The cost of puberty blockers has been subsidised by the gender clinics of state-run children’s hospitals. This use of blockers has been promoted, without robust evidence, as a potentially “life-saving” mental health intervention for trans-identified minors.

There is no comprehensive data on this use of puberty blockers, so it is not possible to calculate the impost of any cost-shifting from the states to the Federal Government.

In its recommendation earlier this month, the PBAC referred to Triptorelin being used with unspecified “women’s health conditions”. It did not make any reference to the drug being prescribed for gender dysphoria or gender incongruence.

The drug being withdrawn, Goserelin 3.6mg, was restricted to carcinoma of the prostate, endometriosis, breast cancer, and anticipated premature ovarian failure. It is unclear if other relevant conditions in women’s health were not covered. Nor is it clear why Triptorelin warranted an unrestricted status, rather than modifying its restriction to limit extra coverage to specific women’s health conditions.

“The PBAC advised that an unrestricted listing [of Triptorelin] would align with contemporary and evidence-based clinical practice,” the expert committee said in its “outcome details”.

“The PBAC advised that a review of Triptorelin 3.75 mg utilisation should be completed around two years after the amendment to the PBS listing to determine whether there are any changes to the expected utilisation.”

The agenda for the July 30 meeting said: “The PBAC has already received a significant number of clinical and consumer inputs from a range of organisations and individuals in relation to this matter. Given the timing of the meeting, further public consultation will not be possible to be undertaken.”

It is unclear whether LGBTQ+ or trans medical lobbies were among those “consumer inputs”.

Gender clinicians have reportedly been using the diagnosis of “androgen deficiency, testicular disorder” to access PBS-funded testosterone for trans-identified teenage girls who wish to masculinise their bodies.

GCN global briefs

By any other name

America | US hospitals and clinics have been referred to the Trump Administration’s Department of Justice for possible breaches of federal law following a report on potentially fraudulent insurance claims for paediatric medical transition. The Wolves in White Coats report, commissioned by the Department of Health and Human Services (HHS), identifies US$50 million in insurance claims for puberty blockers billed with the misleading diagnosis of “endocrine disorder, unspecified”. The HHS report says that using this code instead of a gender-related diagnosis violates the Centers for Medicare & Medicaid Services guidelines “for the simple reason that gender dysphoria is not an endocrine disorder, since it exhibits no hormonal abnormalities. In fact, the only endocrine disorders these patients have are the ones created by their doctors through the use of sex-rejecting interventions”.

“[T]here is reason to believe that some (perhaps many) providers of sex-rejecting procedures systemically diagnose minors with physical conditions they did not have in order to secure insurance coverage for ‘treatments’ (like breast removal or hormonal treatment) that insurers (including Medicaid and Medicare) might not otherwise have covered, had they been provided with full and accurate information. If true, the entities that took these steps face potentially serious criminal and civil liability.” (In Australia, clinicians use the diagnosis of “androgen deficiency/testicular disorder” to access taxpayer-funded testosterone for teenage females who identify as male or non-binary.)

America | The US Centers for Medicare & Medicaid Services (CMS) has announced a new rule intended to cease federal funding of paediatric medical transition through Medicaid and the Children’s Health Insurance Program from October 13. “Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” CMS Administrator Dr Mehmet Oz said. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”

Texas surgeon Dr Eithan Haim, a whistleblower, said the change was “a big deal”. “Before the rule, if a gender doc wanted to sterilize a child with blockers, 50 per cent of the cost would be covered by federal Medicaid dollars. Now that’s gone. States will pay 100 per cent of the cost.”

Financial appetite: The “wolves in white coats” got revenue, while harm accrued for detransitioners.

ROGD milestone

International | Dr Stella O’Malley, founder of Genspect, and Mia Hughes, director of Genspect Canada, have hosted a webinar on the importance of Dr Lisa Littman’s 2018 research paper in which she coined the term “rapid-onset gender dysphoria”. The occasion for the webinar was ROGD Awareness Day, marked on August 16, eight years on from the Littman paper.

Visibility

International | From October, people who desist or detransition will be recognised in the ICD diagnostic system with updated categories including “gender dysphoria, in remission (desistance)”. The new diagnoses are meant to generate better data, identify treatment and secure insurance coverage. This will correct “a lamentable official blindness to the very existence of detransitioners,” according to the medical watchdog group Do No Harm.

Big as Texas

America | The first US detransition clinic is to open by October under a US$10 million settlement between the Texas Children’s Hospital and the state’s Attorney General Ken Paxton. The hospital, accused of Medicaid fraud in pursuit of gender medicine, has issued a statement declaring it has “permanently and irrevocably” stopped providing “sex-rejecting procedures”. Whistleblower nurse Vanessa Sivadge said she had witnessed doctors who “allegedly falsified medical records, used vague diagnosis codes to conceal sex-rejecting hormones, and misdiagnosed patients so Medicaid would reimburse treatments it otherwise shouldn’t”.

These alleged practices stretched back to 2010, according to Burke Law Group, which was involved in the settlement. The firm said the detransition clinic “will provide free multidisciplinary services, including endocrinology, surgery, primary care, fertility counseling, psychiatry, psychotherapy, social work/case management, and speech pathology”.

Meanwhile, Connecticut Children’s Medical Center has become the third hospital to reach a settlement with the Trump Administration’s Department of Justice. The Center has agreed to end sex-rejecting procedures for minors and will pay a US$500,000 penalty towards treatment for patients harmed by those procedures.

Not rare enough to ignore

America | The need for protocols to help detransitioners has been admitted in member-only forums of the World Professional Association for Transgender Health. WPATH’s standards of care claim that “the decision to detransition appears to be rare”.

No informed consent

America | Sinead Haupt, a male with a mental health history who identified as a woman and had his testicles removed at age 24, has filed a claim in the Superior Court of New Jersey alleging that practitioners were negligent in allowing him to go ahead with the surgery, The Sunday Times reports. Mr Haupt, now a detransitioner, says his mental health was not adequately evaluated, and the severe side-effects of the surgery were not properly explained, meaning he was unable to give informed consent.

Just an opinion

International | The WPATH standards of care—promoted as the gold standard, settled science, and the north star of trans health—are in fact one-sided opinions in an “intense public debate,” WPATH has argued in a US court case. “WPATH is on one side of that debate and provides guidelines on how to best provide transgender healthcare. Others, such as Dr Hilary Cass, fall on the other side of the debate and disagree with how to, or if one should, provide transgender healthcare to adolescents.”

WPATH’s perhaps surprising position is offered as a defence to the Federal Trade Commission’s allegations of misleading and deceptive conduct. WPATH claims constitutional protection for its right to express its scientific opinions. “That transgender healthcare is an area of intense medical debate does not entitle [the Commission] to prevent individuals and organizations like WPATH from speech aimed at contributing to that debate. To the contrary, participation in such a debate is exactly the type of speech the First Amendment is intended to protect.”

Safe from debate

Australia | “Trans-denial” will not be tolerated in a new special interest group within the Australian Association of Psychologists Inc. The minutes of the August 7 meeting of the Diverse Sexes, Sexualities and Genders—Allies Welcome Group recorded that it was “Not explicitly stated during the meeting but it seemed clear through the discussion that trans-denial and other discourse widely accepted within the queer community as problematic will not be acceptable within this group. The unanimous preference is for affirming practice.”

Resource rich

International | Tavistock clinic whistleblowers Marcus and Susan Evans have launched a website “bringing together our books, articles, lectures and interviews on gender distress, identity and psychological development”. Resources include information and support for parents, and a Family Consultation Service, which “offers parents and families an opportunity to think together about a child’s or young person’s distress, the wider emotional and developmental context in which it has emerged, and the different ways of understanding and responding to it”.

Double standards

America | Dr Karla Solheim, an obstetrician who had performed gender-affirming hysterectomies at an LGBTQ+ clinic in Iowa has recounted for The Free Press her disillusionment with the model promoted by WPATH. “I was floored to discover the research basis into gender medicine both for adolescents and adults was not just poor; it was fraudulent,” she said.

Her public criticism of the WPATH gender-affirming model led to her being forced out as chair of the Iowa section of the American College of Obstetricians and Gynecologists (ACOG), which had endorsed WPATH. “Rather than hear my concerns and take them seriously, my national medical association chose to silence me. They chose to be complicit in a campaign to promote ideology in medicine over evidence-backed science.”

She said she had always thought that medical associations confronted with the truth would change their guidance. “The reality is that these medical associations have now become overrun by a small, loud group of activists. The leaders who we expect to guide us and hold us to the highest standards have succumbed to [the activists] out of cowardice, or even ignorance ... They’re now more interested in silencing critics than they are in standing up for what is best for our patients. I know this because it’s exactly what I witnessed at ACOG.”

“Ordinary people can see quite clearly that this medicine is dangerous. When our greatest medical authorities insist otherwise, it undermines doctors’ credibility and makes people less likely to trust us for their care.”

Wait and see

International | Jason Watson, the New Zealand mental health nurse whose debunking paper on the trans suicide narrative was removed from an Australian journal after activist complaints, has published a new paper on the cautious “watchful waiting” approach to gender distress. In the journal Nurse Education in Practice, he notes the “lack of a robust evidence base” for gender-affirming treatment and the questionable capacity of patients to give informed consent. He suggests instead “a cautious, developmentally informed approach such as watchful waiting may offer a patient-centred framework while the evidence base continues to develop”.

“[Watchful waiting] is defined as a deliberate, evidence-informed approach that considers the individual’s unique needs and circumstances while avoiding unnecessary interventions that may result in long-term or irreversible consequences.

“[It] emphasises allowing sufficient time before planning and implementation to facilitate comprehensive assessment, observation, and, where appropriate, further investigation. This process enables nurses to identify co-existing conditions and associated risks, including psychosocial challenges, co-occurring mental health disorders, neurodevelopmental conditions, and the influence of peer relationships or social contagion.”

Data vacuum

Canada | The influential Globe and Mail newspaper has weighed into the debate over puberty blockers, arguing that treatment “must be based on the best medical advice available, not ideology”. The paper’s editorial board notes the shift away from routine puberty blocking in countries including Finland, Sweden and the UK. “There has been no such re-examination in Canada,” the editorial says.

Meanwhile, Canadian writer Peter Gajdics, a gay man who suffered conversion therapy, has thought better of his past advocacy for the deceptive new generation of conversion bans focused on transgender identity. He says he did not understand at the time that such bans would lead to the medicalisation of gender non-conforming minors. Now, on a Genspect podcast, he says: “Gender affirmative care is the new euphemism for conversion therapy.”

Thumb on the scale

Australia | In the state of Tasmania, the Greens party has released an exposure draft of a law against “conversion practices” involving not only sexual orientation but the ill-defined concept of “gender identity”. The accused could face civil or criminal proceedings, with a maximum prison term of 21 years. In a submission, Emeritus Professor of Law Patrick Parkinson argues that the bill, like its counterparts in other jurisdictions, is “deeply flawed”.

He writes: “There has never been a well-documented issue about therapy concerning ‘gender identity’ that has caused significant harm. The only issue has been debate about the role of psychotherapy in treating gender dysphoria or incongruence. On this issue, medical practitioners differ. That [psychotherapy] treatment, which some call ‘conversion therapy’, is now the mainstream option for gender dysphoric minors in Scandinavia, Britain and elsewhere, following expert medical reviews of the evidence for the efficacy of hormonal treatments in addressing gender dysphoria.

“The Parliament of Tasmania should not put its thumb on the scale on what is an intense debate in the medical and mental health professions internationally.”

Benefit-harm ratio

International | Dr Yuan Zhang, of the Toronto-based Evidence Bridge organisation, has challenged the assumption that the low quality of evidence of benefit for paediatric medical transition entails an equivalent uncertainty about the risk of harm. In a paper based on his July 2026 talk at the recent London conference of the Clinical Advisory Network on Sex and Gender and the Society for Evidence-based Gender Medicine, Dr Zhang argues that “many physiological harms [of medical transition] can be reasonably inferred from established mechanistic evidence in physiology, developmental biology, and pharmacology”.

“Consequently, the current balance of the best available evidence [for paediatric medical transition] suggests that the potential harms may outweigh the anticipated benefits.” Dr Zhang says this has implications for clinical decision-making and equipoise, the ethical principle in research “that requires genuine uncertainty about the relative benefits and harms of competing interventions before a study can be ethically conducted”.

“For example, as for the [UK] PATHWAYS trial, uncertainty may remain regarding the incremental benefits and harms of adding puberty blockers before subsequent cross-sex hormone therapy, compared with initiating cross-sex hormone therapy alone. However, such uncertainty does not imply that either treatment strategy has a favourable benefit–harm profile. “Based on the current best available evidence, both strategies may reasonably be expected to result in net harm. In the absence of evidence demonstrating an overall net clinical benefit, the principle of non-maleficence requires that patients not be exposed to avoidable harm.”

United Kingdom | Writing for Genspect, scientist Dr Zoe Hollowood argues that Dr Hilary Cass’s recent parliamentary briefing on the puberty blocker trial lacks the “intellectual discipline and restraint” of her 2024 final report. The briefing, Dr Hollowood says, “adopts a very different tone, presenting a much stronger and at times unevidenced case for why the trial should proceed (e.g. buying time, harm reduction) whilst minimising potential arguments against the trial (e.g. risks, completion of the data linkage study)”.

International | A 26-country Ipsos survey has tracked a decline in support for teenage “access to gender-affirming care” where parents agree. In 2023, 59 per cent of those polled agreed with such access. That fell to 55 per cent in 2024, then stabilised at 50 per cent in 2025 and 2026.

Singapore | Hormonal treatment of gender dysphoria will continue while health authorities in the Southeast Asian republic of Singapore roll out treatment review panels to make case-by-case decisions. Under recently issued guidelines, puberty blockers are to be banned, while cross-sex hormones will be denied to the 18-21 age group, apart from “exceptional circumstances”. (The age of majority is 21.)

In an August 5 answer to questions from MPs, the Health Minister Ong Ye Kung confirmed the new, psychology-first approach to gender distress. This approach, he said, “gives us greater assurance that each patient receives an appropriate diagnosis and treatment pathway. It enables us to better support young people with [gender dysphoria], while avoiding putting those without [this condition] on a painful and irreversible path.

Mr Ong also appeared to explain the disappearance of the new guidelines from health ministry webpages soon after they were uploaded in early May. He said the guidelines were “not intended for a wider audience” than medical practitioners, who were sent the documents directly.

America | In a Substack post, psychiatrist Kristopher Kaliebe has criticised the lowering of standards in the American Journal of Psychiatry (AJP) when the subject matter is paediatric medical transition. He cites the highly charged language of a January 2026 paper which characterises puberty blockers, cross-sex hormones and surgery as “essential, evidence-based, and lifesaving” and calls for “ethical resistance” to age-limit laws in US states and “medical disobedience”, which “entails deliberate lawbreaking”.

Professor Kaliebe and fellow psychiatrist Dr Kathleen McDeavitt managed to get a letter to the editor published, eliciting a reply from the authors of the paper. “To my knowledge, this exchange is the first time AJP has permitted scholarly exchange on this topic,” Professor Kaliebe says in his post. “It is good that the journal is finally acknowledging the many systematic reviews, the European policy shifts, and the costs of raising concerns inside the field. Most importantly, the gap between inaccurate advocacy language (‘essential, evidence-based, and lifesaving’) and the actual state of the evidence is now on record.”

The Kaliebe-McDeavitt letter to the editor notes the effects of paediatric medical transition as a politicised domain, stating that:

Good in theory

Germany | The new German language S2k guideline for youth gender dysphoria has been scrutinised in a new book chapter by psychiatrists Professor Florian Zepf of Jena University Hospital and Dr Werner Königschulte from Marien Hospital Papenburg Aschendorf. “One of the key innovations of the guideline is the attempt to distinguish between supposedly ‘stable’ gender incongruence and ‘temporary dissatisfaction with one’s own gender’,” they write. “Whilst this approach sounds plausible at first glance, it fails in practice: the guideline does not specify any verifiable criteria by which these two groups could be reliably distinguished from one another in advance. It also remains unclear to what extent such a distinction would even be valid. Without reliable diagnostic markers, this differentiation remains merely a theoretical construct with no immediate practical relevance.

“Whilst the guideline acknowledges that the evidence is limited, particularly regarding puberty blockers and cross-sex hormones, it draws hardly any practical conclusions from this.

“International analyses—including the systematic reviews by the UK’s [National Institute for Health and Care Excellence] and the Cass Review—unanimously conclude that there is a lack of robust evidence of efficacy. The new German-language S2k guideline … deviates significantly from international developments on this issue and is thus adopting an increasingly isolated position.”

No to surgery

Australia | The state of South Australia (SA) has decided not to revive transgender surgery in public health, The Advertiser newspaper reports. Flinders Medical Centre had offered such surgery until 1988. A 2023 SA Statewide Gender-Diversity Model of Care, reportedly co-designed with trans lobby groups, includes taxpayer-funded surgery. In one draft, this model of care proposed trans surgery for minors in the adult services of public health, which would be the most radical step yet in Australia.

Meanwhile, an SA Health review into how 22 minors in 2023-24 were given gender-affirming medical treatment without the mandated psychiatric assessment will not be made public. SA politician Sarah Game, of the Family First party, said a Freedom of Information request lodged last November had resulted in a 27-page, “fully redacted” document, despite the request not seeking any names or private medical records. “We wanted to know what the review identified about how this happened, what recommendations were made, and what changes have been implemented to prevent it happening again,” she said. Ms Game called on the government to release a de-identified copy of the review’s findings. Adelaide, the SA state capital, is hosting a Gender Healthcare Summit on October 9-10.

Money ill-spent

Australia | A grant of AU$10 million to a La Trobe University centre and two trans medicine lobbies, ACON and Thorne Harbour Health, “will exacerbate health and wellbeing risks for young Australians with gender incongruence or dysphoria and channel them towards unproven medical interventions with irreversible effects,” according to Genspect, which advocates for non-invasive responses to youth gender distress. The grant is to enable a voluntary training and accreditation scheme to deliver “safe, inclusive and affirming care for LGBTIQA+ people”. Genspect board member and paediatrician Dr Gary Geelhoed, a former Chief Medical Officer of Western Australia, said that “‘affirming care’ when applied to gender-confused young people is not a synonym for safe care”. He said this treatment model encourages “the use of puberty blockers, cross-sex hormones and surgery, including for minors”.

School to clinic pipeline

America | A new report from the group Do No Harm has documented little-known state funding for transgender ideology. “Taxpayers are not only paying for irreversible and dangerous treatments for children through Medicaid. They are also funding the state-run programs that encourage children down the gender-ideology path in the first place,” James Eller, the group’s director of government accountability, wrote in The Wall Street Journal.

“Through public funding for state education and healthcare programs, taxpayers are unwittingly complicit in physically harming vulnerable children.” His report focuses on the state of Colorado’s “gender-affirming pipeline”. The “I Matter” program delivers “gender-affirming care” therapy sessions to children as young as ages 6-9. “Colorado children currently have access to taxpayer-backed therapy aimed at affirming a ‘gender identity’ that doesn’t match their sex,” Mr Eller said.

“Meantime, at the University of Colorado School of Medicine, taxpayer funding supported the indoctrination of future physicians. Documents show that the ‘LGBTQ+ Health’ curriculum—a mandatory course for all first-year medical students in the 2024-25 class—was heavily influenced by external advocacy groups that support child transgenderism.”

Psychology first

Only 5 per cent of people polled in the Netherlands—home to the puberty blocker-driven Dutch protocol for paediatric medical transition—support the use of these drugs as the primary response to gender-distressed youth.

Of six questions on paediatric medical transition put to 4,179 voters, a preference for psychological treatment (75 per cent) over puberty blockers was the only common ground across political party affiliation, according to pollster and entrepreneur Maurice de Hond. One in five people simply did not know what was best.

“Support for the medical approach [by political allegiance] does not exceed 15 per cent anywhere,” Mr de Hond wrote on his website. That figure of 15 per cent was from loyalists of the progressive-left PRO party.

For this question, respondents were told that minors with gender dysphoria “often face other issues as well”.

“In children with gender dysphoria, other issues often play a role as well, such as autism, depression, or trauma,” Mr de Hond said.

Council vetoed

A representative sample took the survey in late July to early August, after the Health Council of the Netherlands issued its June 30 report. The council acknowledged the weak evidence for the Dutch protocol but claimed there was no reason to restrict puberty blockers or cross-sex hormones because, based on treatment guidelines, their delivery was carefully organised.

A new, revised Dutch guideline for hormonal treatments is to be aligned with the 2022 standards of care (SOC-8) from the World Professional Association of Transgender Health (WPATH). Authors of SOC-8 include prominent Dutch clinicians such as psychiatrist Dr Annelou de Vries and clinical psychologist Dr Thomas Steensma.

Defending itself against US legal action for allegedly false and deceptive conduct, WPATH has argued that its standards are simply one opinion in a contested debate, no longer the gender gospel of the “science is settled” era.

Dutch courage

The new Dutch survey was commissioned by the authors of a June 25 opinion article in the newspaper Trouw calling for the Health Council to inquire deeply into the foundational assumptions of the Dutch protocol. The authors constitute a broad group, with clinicians and ex-politicians including Pieter Omtzigt, founder of the centrist New Social Contract party.

On the survey question whether doctors can predict the stability of a minor’s wish for a gender change, 30 per cent of respondents said No, with 23 per cent Sometimes, 19 per cent Yes, and 11 per cent Don’t know.

The question was dismissed as irrelevant by 17 per cent who insisted that a change of sex is not possible.1

Mr de Hond said the persistence of a cross-sex identity “goes to the heart of the medical debate: can doctors reliably predict whether a child’s desire to change gender is permanent? Only 19 per cent of the Dutch population believe they can.”

Told that “Puberty blockers, hormones and subsequent operations can have lasting physical consequences”, respondents in the de Hond survey were asked what they made of these interventions.

They were pointless, according to 44 per cent, because “No one can truly change their sex.” Just over a quarter of those polled agreed these interventions “can help the body achieve the desired appearance”. Three in ten did not know or did not answer.

For this question, respondents were “presented with the potential physical consequences: effects on bone development, fertility, the cardiovascular system and brain development, and subsequent complications following surgery”.

Respondents with higher education and those under age 35 were more likely to embrace medical interventions as a means to attain “the desired appearance”.

The poll also tested competing values with the question, “The evidence regarding the outcomes of these treatments is uncertain. Which factor should be given the greatest weight?”

Just over a third of respondents opted for “Preventing [minors] from receiving treatment too early that could have lasting consequences”.

The next largest group, 28 per cent, agreed with “Helping [minors] to accept their bodies and their sex”. Next, 24 per cent chose the aim of “Preventing [minors] from waiting too long for help that might be beneficial”. In effect, Mr de Hond said, almost two-thirds had adopted a cautious response.

“A difference between men and women is also evident on this question: women are more likely to opt for preventing premature treatment (41 per cent versus 32 per cent), whilst men are more likely to opt for acceptance (32 per cent versus 26 per cent),” he said.

Publicist Geert-Jan Edelenbosch, one of the authors of the Trouw opinion article and a former coordinator of the youth and education program at the LGBTI organisation COC Nederland, said the de Hond poll was not asking the public to settle a medical question.

“Against the background of the uncertainties acknowledged by the Dutch Health Council itself, the survey shows that a clear majority of Dutch people prefer a more precautionary response than the council does,” Mr Edelenbosch told GCN.

“That matters because the remaining choice is not simply scientific: it is also about how much uncertainty and risk of lasting harm we are prepared to accept when treating children.

On the survey question whether parents should have the right to refuse puberty blockers or cross-sex hormones for their child, agreement was strongest (63 per cent) in the age group (45- to 54-year-olds) most likely to have children still living at home.

Two-thirds of respondents answered Yes to the question “England, Sweden and Finland have become much more cautious about these treatments. Should the Netherlands follow suit?”

Even those who vote for the left-leaning PRO and D66 parties did not constitute majorities opposed to this precautionary, less medicalised posture.

These are significant results because the famous Amsterdam clinic presents itself as more cautious than the overseas adopters of its Dutch protocol for gender medicalisation of minors.

The protocol and its key 2011 and 2014 papers have more recently come under sharp scrutiny, and there have been anecdotal reports that clinical practice in the Netherlands does not live up to the seeming caution of its treatment guidelines.

“Across the six questions [in the poll], two distinct trends emerge,” Mr de Hond wrote. “The first is a sharp political divide, with PRO and D66 on one [left] side and JA21, PVV and FVD on the [right], whilst the CDA and VVD are closer to the right-wing bloc than to the centre.

“The second [trend] runs along the lines of education and age: those with higher levels of education and younger people have greater confidence in the medical approach, whilst those with lower levels of education and older people have considerably less.

“These two lines reinforce each other, but do not dominate everything: when asked what should actually be done, a large majority in virtually every group opts first for psychological support.”

Comment | Professor Christine Kilpatrick, who trained in neurology, occupies two positions that might make any thoughtful person somewhat nervous.

Since 2024, she has chaired the board of the Australian Commission on Safety and Quality in Health Care. And she became chair of the board at the Royal Children’s Hospital (RCH) Melbourne on July 1 last year.

The Commission is a health sector watchdog agency. RCH Melbourne gives minors puberty blockers and cross-sex hormones, and sometimes enables a referral to a private surgeon willing to perform a mastectomy on a teenage girl’s healthy breasts. All this in the name of gender. How can it be reconciled with safety and quality?

Do Professor Kilpatrick’s two hats give rise to a conflict of interest? Asking via RCH’s media handlers produced no answer. The Commission cited its policy on disclosure of interests, and told me that Professor Kilpatrick’s RCH role “has been declared”.

I’m not suggesting any wrongdoing, but there are questions and perceptions that warrant discussion.

On the hospital’s website, you can find a 2018 talk by Dr Telfer on “Legal reform in transgender adolescents”. Hers is a story of children in distress, clinicians championing their cause, the obstacle to reform represented by Prime Minister Tony Abbott and others from the “dominant right faction”, “clever” lawyers nudging the Family Court to wind back its supervision of gender dysphoria treatment for minors, and the ultimate humiliation of those who did not see all this as progress.

At the time, Dr Telfer told her audience of RCH alumni, she “was being targeted personally online”.

The health professional regulator AHPRA had “received a letter from an unnamed group, notifying them that I was a child abuser due to the nature of my work”.

“As instructed by AHPRA I made an appointment with [CEO] Christine Kilpatrick to inform her of the notification. Christine said, ‘Show me that letter’ and then went [on] to say she’d been sent the same one, but had thrown it in the bin. Fortunately, the Medical Board also dismissed it as being politically motivated.”2

More reason to fear a conflict of interest for Professor Kilpatrick? I cannot know if that letter of complaint was accurately characterised by RCH, but it’s a hallmark of the “gender-affirming” worldview to dismiss even evidence-based criticism as right-wing politics or religious conservatism.

Not our problem

The gender-affirming treatment model has been the subject of heightened scrutiny for several years now. Citing weak evidence and the risk of harm, health authorities in the UK, Finland, Sweden, New Zealand and Australia’s state of Queensland have adopted policies to restrict the hormonal interventions still given as routine at most public children’s hospitals in Australia.

Any role in this for Professor Kilpatrick’s Commission? I was told it “has not undertaken work, or been asked to conduct any work, on the issue of youth gender dysphoria”.

The response: “The Commission is a national co-ordinating body for improvements in the delivery of safe and high-quality health care. It is not a regulatory agency or complaints body, and does not directly regulate healthcare facilities.

“The Commission’s planned activities are shaped by our strategic priorities and align with the functions of the Commission set out in the National Health Reform Act (2011).”

One of its four key priorities is “Strong outcome-focused clinical governance, [because] clinical governance, integrated standards and accreditation drive better patient outcomes.”

A recent letter to Australia’s federal Health Minister Mark Butler disputes the Commission’s self-characterisation as simply a co-ordinator with no obvious role in the gender clinic controversy.

“A body that approves agencies to accredit health service organisations on its behalf, the accreditations of which it is responsible for then authorising and listing on its website, is not merely a coordinator,” says the June 1 letter from Emeritus Professor Bronwyn Winter as Co-Convenor of Australian Feminists for Women’s Rights.

The letter alerts Minister Butler to the statutory functions of the Commission under the 2011 Act, including its role in “the formulation of model national schemes to accredit health service organisations”.

Professor Winter’s letter invokes a string of health scandals—Chelmsford, Ward 10B, Newhaven, Bundaberg, Campbelltown, Oakden, and Djerriwarrh—as the founding rationale for the Commission’s creation.

“The Commission appears to have lost sight of its regulatory mandate to prevent avoidable harm by doctors,” the letter says.

“The administration of puberty-suppressing and cross-sex hormonal agents to alter the bodies of children without a valid evidence base allowing for informed consent repeats the above-mentioned pattern [of past scandals].

“This pattern is to ignore significant concerns being raised and instead to assume that a patient safety accreditation system is working. The medical profession’s own repeated failure to recognise this pattern is precisely why the Commission was established as an independent statutory body tasked with external clinical governance of health services.”3

Detransition: Keira Bell, a former patient at the London-based Tavistock gender clinic, and other detransitioners tell their stories at a 2026 Genspect conference in Washington, DC

Strictly feedback

I asked the Commission whether it had any role in the development of new national treatment guidelines by the National Health and Medical Research Council, a project assigned by Mr Butler in January 2025. The Minister also asked the NHMRC to undertake “a comprehensive review” of the de facto national guidelines for youth gender dysphoria first issued by RCH in 2018.

“The Commission is registered to receive updates [on the NHMRC guideline project] and will contribute feedback during the public consultation,” a spokeswoman said.

Intriguingly, it seems there might have been an opportunity to run such an NHMRC review “a few years ago” on the recommendation of the Commission, according to internal documents obtained under Freedom of Information (FOI) law.

An outsider, whose identity was redacted from the FOI documents issued to GCN, had asked in May 2025 if the Commission had “ever reviewed or endorsed” the RCH gender clinic’s treatment guidelines, which have been promoted as “Australian Standards of Care”.

This led to an email exchange within the Commission, touching on the new NHMRC guideline project, with one Commission staffer saying: “… I saw there was discussion around this a few years ago with a recommendation from the Commission that the NHMRC undertake a review—which has now commenced [following Minister Butler’s intervention]”.

I asked the Commission to confirm the fact of an earlier opportunity to scrutinise gender clinics, but received no reply.

In August 2025, the month following Professor Kilpatrick’s arrival as chair of the RCH board, the hospital underwent a “short-notice assessment” for accreditation.

The benchmark is the Commission’s National Safety and Quality Health Service Standards. The assessment is undertaken not by the Commission directly but by an accrediting agency, such as the Australian Council on Healthcare Standards, in a system overseen by the Commission.

Under the rubric of clinical governance, RCH was assessed on 33 safety and quality aspects, known as “actions”. The hospital met requirements on 31 with no changes needed, and satisfied another two after necessary or recommended “improvements”.

“The Clinical Governance Standard aims to ensure that a clinical governance framework is implemented so patients and consumers receive safe and high-quality care,” the Commission website says.

Action 1.01 states that the hospital board “Endorses the organisation’s clinical governance framework”. Action 1.27 requires the hospital to provide clinicians with “ready access to best-practice guidelines”.

Under the heading “Partnering with Consumers”, Action 2.04 has the hospital ensuring “that its informed consent processes comply with legislation and best practice”.

Unreliable guide

To be sure, the gender clinic is just one centre within a large children’s hospital. But nothing at RCH rivals the gender clinic as a subject of considerable public disquiet and a potential threat to the reputation of the hospital.

In her 2024 final report, Dr Cass noted that the evidence for puberty blockers and cross-sex hormones—confidently recommended by the RCH guideline—was “remarkably weak”. As a consequence, clinicians, minors and their parents who rely on this RCH document cannot know whether the treatments promoted have a favourable benefit:risk ratio.

Yet this guideline, with no published expert authors outside the RCH clinic, was adopted by children’s hospitals across Australia as if it were a national standard. Clinicians using the RCH guideline were advised that not even a diagnosis of psychosis or depression was a necessary obstacle to the medical transition of a gender-distressed minor.

In March 2023, the RCH document was declared untrustworthy by a pioneer of evidence-based medicine, Professor Gordon Guyatt.

The RCH guideline and its contradictions figured in an important 2025 Family Court case known as “re Devin”, involving disagreement about the care of a gender non-conforming boy aged 12 who had been a patient at the RCH gender clinic for almost four years. The clinic and Devin’s mother favoured puberty blockers; Justice Andrew Strum agreed with the father that the child should be protected from blockers and the clinic.

During the hearing, Dr Telfer, who served as the clinic’s director from 2012 to 2022, gave evidence that the RCH treatment guideline was “best practice”. She was the lead author of the document.

In cross-examination, Dr Telfer conceded that her rating the document as best practice “was essentially tantamount to her agreeing with herself,” Justice Strum said in his April 2025 decision. He regarded the guideline as “oddly binary” in its advice “to affirm unreservedly those who present with concerns regarding their gender, brooking no questioning thereof”.

The judge was critical of Dr Telfer for failing in her duty to give impartial evidence as an expert witness in the case; instead, she presented herself as an “advocate for trans rights”.

He also rebuked the RCH gender clinic for persisting in its over-confident claim that puberty blockers are “fully reversible and relatively risk-free” when, in court, Dr Telfer and Devin’s treating psychologist, Dr N, had “to concede the lack of evidence to support that position”. Justice Strum found Dr Telfer unable to cogently defend her belief that very young children had an “immutable” gender identity, without which medical intervention would be hard to justify.

Professor Kilpatrick’s Commission has launched a new National Model for Clinical Governance. She is quoted as declaring: “When board members, executives and clinical leaders champion clinical governance as fundamental to achieving high-quality care, it sets the tone for the rest of the organisation.”

The new model document says: “Public inquiries into suboptimal care show that weak clinical governance can result in normalisation of poor care, ignored patient concerns, a culture of blame, a disengaged workforce, and overemphasis on legal and financial matters at the expense of care quality and patient outcomes.”

What of the accreditation tick given RCH for informed consent? In re Devin, Justice Strum noted the opinion of a consultant psychiatrist, Dr O, that the boy and his parents were not likely to get from RCH gender clinic staff the “accurate and comprehensive” answers “necessary for true informed consent”. The judge found Dr O to be an “impressive, considered and unbiased expert”.

Is the Commission satisfied that the accreditation of RCH was thorough and rigorous? Does a hospital with such a gender clinic truly meet the National Safety and Quality Health Service Standards of the Commission? Is it in line with the new National Model for Clinical Governance?

No surrender

On 5 June 2025, Justice Strum allowed the identification of Dr Telfer and the RCH gender clinic in the otherwise anonymised case of re Devin. In response, the hospital issued a defiant statement, saying it was “proud to lead a gender service that delivers a world-leading, multi-disciplinary model of care with a strong emphasis on supporting the mental health and wellbeing of the children and young people referred to our service. Our gender service is underpinned by both national and international research methodology.”

On July 1 last year, when Professor Kilpatrick began her term as chair of the RCH board, did she bring some much-needed realism to the analysis of the gender clinic’s record and its clinical governance? There is no outward sign of it.

In reply, Professor Kilpatrick acknowledged that “the board has overall responsibility for ensuring the clinical governance”. Within this clinical governance framework, she said, “there are many elements of the treatment which are carefully thought about to make sure there is evidence for that treatment, that they’re monitored carefully, that the staff are educated and trained in that particular area”.

She said clinical governance ensured “that the quality of care is appropriate at this hospital, and we monitor it very carefully through our quality committee and also through the board itself and also within my meetings with the CEO as well”.

One mother pressed her, saying: “To put children on puberty blockers, [when] almost invariably they will go on to cross-sex hormones, [means] they will be sterile, they will have no sexual function. A child cannot give informed consent for that and yet the hospital still seems to defend your position on this [treatment] and I think that is absolutely untenable.”

In a more accommodating tone, Professor Kilpatrick replied: “I’m not a paediatrician, and I’m certainly not an expert in gender dysphoria. And I can understand that the treatment of this condition is for some—for many people, I’m sure, challenging. And the concept of the condition is challenging.”

She mentioned the NHMRC guidelines project, itself a study in conflicts of interest, and said: “I certainly welcome that [project], and I’m sure we all welcome that.”

The Cairns connection

As for the role of her Commission, the recent investigation of a paediatric gender service in the regional city of Cairns suggests some awkward parallels with the RCH clinic. There are 34 references to the Commission in the Cairns report issued in January 2026. The inquiry was triggered by concerns about “treatment adherence with clinical standards”.

The Cairns service had been operating for 20-plus years, but it was “never formally established” and its clinical risks were not monitored or controlled at an executive or board level, according to the report from the investigation.

Although it was supposed to be following the (low-quality) RCH guidelines, the Cairns service showed a “high level of variability with respect to initial assessment, and the documentation of a client’s decision-making capacity”.

There were “deficiencies in the quality of care”. The clinical setup was “not reliably safe for paediatric clients, with mixed adult-child settings, unsecured medications, and incomplete risk assessment for high-risk adolescents”.

In a significant number of cases, there were “gaps in timely and clinically appropriate assessment, treatment, follow up, referral and escalation”. Informed consent was “not consistent with best practice”. The service “did not have adequate clinical governance systems in place” and failed to align with the Commission’s (now superseded) National Model Clinical Governance Framework.

A recently improved system for the Cairns health area, the report noted, was “broadly in line” with the Commission’s guidance document “Introduction of New Interventional Procedures and Clinical Practice Innovations”.

That guidance, the Cairns report said, “calls for a structured governance process, including a dedicated New Interventional Procedures Committee reporting to the organisation’s clinical governance body, to assess proposals, monitor implementation, and determine when innovations can transition to routine care”.

Which brings us back to the RCH gender clinic. There are serious questions about clinical governance at the hospital and how the gender-affirming innovation—as represented in the clinic’s 2018 treatment guideline—became routine.

It is now public knowledge that in September 2019 the RCH gender clinic applied within the hospital for retrospective approval of the new treatment approach it was already using as routine.

The accompanying letter from the gender clinic to the chair of the RCH New Technology and Clinical Practice Committee (NTCP) said: “It is important to highlight that controversy surrounds the management of gender dysphoria, which has recently been replayed in the public media.”4

The letter attributed the controversy to “religious beliefs about sexuality”, potentially irreversible effects of the medical interventions, and the “paucity” of evidence on treatment outcomes.

The gender clinic’s application relied on low-quality evidence to claim a high risk of attempted suicide in untreated minors, a doubtful “reversible” status for puberty blockers given to children as young as 10 to 12 years old, and a supposedly low incidence of regret after treatment.

The application was refused in October 2019 by the majority on the hospital’s NTCP committee, whose job is to scrutinise new treatment proposals or medical devices to ensure they are safe and effective.

The committee, which reportedly felt it lacked authority to review an established clinical service, referred the matter to the hospital’s executive team, with the result not captured in FOI documents obtained in 2025.

Psychiatrist and researcher Dr Alison Clayton, who had submitted the FOI request, asked: “Was the RCH treatment protocol approved by the executive? And if so, what was the official and legal basis of this clinical governance process, which appears to have bypassed usual channels?”

I reported Dr Clayton’s analysis for The Australian newspaper on 3 May 2025, two months before Professor Kilpatrick became board chair. We know the Commission is aware of this clinical governance issue. On 28 May 2025, an internal email, obtained under FOI law, cited my news report. The Commission staffer also referred to my commentary on the re Devin case for The Australian on 10 April 2025.

Agents of influence

Professor Kilpatrick is not the only link between the Commission and the RCH gender clinic. Both have ties to radical trans organisations.

The gender clinic website links to MINUS18. Its website tells minors: “Puberty blockers can stop your body developing things like breasts or an ‘Adam’s apple’, and basically give you a bit more time to figure things out. It’s also a reversible treatment.” No mention of international data showing the vast majority of minors begun on blockers proceed to cross-sex hormones, meant to be taken lifelong.

In its 2024-25 annual report, the Commission proudly declared the renewal of its membership with the Pride in Health + Wellbeing program of ACON, the former AIDS council which is now a national trans activist lobby as well as a provider of paediatric medical transition at its Sydney Kaleido clinic.

ACON’s influence in the health sector seems so pervasive that it would be more newsworthy to find an agency not affiliated with it.

Take the Australian Council on Healthcare Standards, which assesses hospitals such as RCH for accreditation within the Commission’s system. It promotes Pride Month with alarming but low-quality suicide statistics.

When an accrediting agency engages in fast-and-loose “LGBTQI+” activism, its capacity to rigorously assess a hospital with a high-profile gender clinic must be in doubt.

Would the public have confidence in the Commission exerting a corrective influence from above?

At the recent Australian Pride in Health + Wellbeing Awards—a lavish event staged by ACON—Anna Flynn, Director for Partnering with Consumers at the Commission, delivered a keynote address titled “Person-centred care in practice: Every experience matters”.

I asked the Commission if this created a conflict of interest. No direct answer, but a spokeswoman said Ms Flynn’s “presentation focused on the importance of empowering patients, carers and communities through strong and representative clinical governance and a person-centred approach to care”.

When lobby groups are dignified as “communities” and “consumers”, when they exert gender ideological influence, who protects the public interest for Australians?

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

GCN global briefs

Renunciation

United Kingdom | The puberty blocker trial recommended by the Cass Review can go ahead following the failure of a legal challenge to ethical and regulatory approval of the trial. Some 226 minors with “gender incongruence” and under the age of 16 are to be recruited, and randomly assigned to two groups: the first receiving blockers straight away, the second after 12 months.

The legal challenge was brought by the parents’ organisation Bayswater Support Group, detransitioner Keira Bell and therapist James Esses. Their request for a full judicial review was rejected on Friday by Justice Chamberlain of the High Court, who said whether to approve the trial was “quintessentially a question of judgment” for the Health Research Authority (the HRA gave ethical approval) and the Medicines and Healthcare products Regulatory Agency (the MHRA conferred regulatory approval).

The judge said: “The court’s function is not to say whether it agrees with the decision under challenge, but rather to examine whether the defendant [the HRA and the Health Secretary on behalf of the MHRA] has exercised their function contrary to the legislative scheme or otherwise unlawfully.”

Bayswater Support Group said it still believed the trial “does not meet the legal and ethical thresholds required for research on children”. It said the Declaration of Helsinki on clinical trials was “not intended to permit experimental interventions on highly vulnerable children simply in order to discover whether benefit exists”. Ms Bell said: “The push for this trial represents one aspect of a profound descent into the desecration of our humanity. The protection of children should be an inviolate principle, but this clinical trial tells a different story … We will be consulting as a team regarding the possibility of an appeal”. For news reporting of the case, see Nick Wallis. For commentary, see Transgender Trend.

In a parliamentary briefing paper, Baroness Cass, the paediatrician who led the 2020-24 review of youth gender dysphoria care, has presented a detailed argument for going ahead with the blockers trial. On the phenomenon of self-medication, she says up to 20 per cent of young patients at the new National Health Service gender clinics admit to taking a range of medications, including drugs as substitutes for puberty blockers. She says oestrogen and testosterone are being used as cross-sex hormones as young as 11-12 years old, “some on very high doses, resulting in biological females developing facial hair by 13. In most cases there has been a lack of any monitoring, and of any evidence of consent.”

“In summary, taking the young people we know about, and the much larger number that we only have an inkling of from anecdotal reports and comments from Dr Helen Webberley about the GenderGP [online clinic] caseload, the relatively small numbers who might be enrolled and closely monitored and supported in a trial are dwarfed by the hundreds who are currently on cocktails of drugs from elsewhere with no support or monitoring. These risks are immediate and deeply worrying.

“It was suggested in parliamentary debate that this is the same as taking cocaine, and we would not prescribe it just because children were getting it on the street. However, we have to take responsibility for the fact that we have given unevidenced messages about treatment options, failed to address unacceptable waiting lists for this very vulnerable group, banned the drugs that we told them were essential and not yet followed through on commitments that were made for a safe prescribing environment.”

Dubious diagnosis

The Netherlands | The Dutch protocol for paediatric medical transition is afflicted by unclear diagnosis and tendentious language, according to Dr Armand Girbes, the former head of the intensive care unit at the university hospital VUmc, which is home to the famous Amsterdam gender clinic.

Dr Girbes, a consultant in internal medicine and a clinical pharmacologist, has written a sharp criticism of the Dutch model and its defence by the independent Health Council of the Netherlands. (He was a signatory to the June 25 opinion article in the newspaper Trouw, which argued that the Dutch could no longer ignore the international shift towards a more cautious, less invasive response to gender-distressed youth.)

Writing for the publication Wynia’s Week, Dr Girbes says: “An accurate diagnosis is not only necessary to choose the right treatment, but also to prevent an incorrect treatment from masking or even exacerbating the actual condition. In children and young people who present with feelings of gender dysphoria, that diagnosis is often far from clear. This is all the more important now that this group is much more likely to also have other symptoms such as autism, depression or ADHD.”

“The resulting question is therefore: is gender dysphoria the primary diagnosis here, or is it a symptom of something else? That question must be addressed before any irreversible medical intervention is undertaken.

“All of this is of the utmost importance in order to comply with one of the most fundamental principles of medicine: primum non nocere—first, do no harm. Hormone treatments and surgery in children and adolescents cause irreversible damage, including infertility, sexual dysfunction, bone problems, an increased risk of cardiovascular disease, lifelong dependence on medical care and, not least, a risk of death. Anyone proposing such interventions bears a heavy burden of proof.

“After thirty years of the Dutch Protocol, that burden of proof has still not been met. The uncertainty surrounding the diagnosis itself is systematically underestimated. Is gender dysphoria in a teenager a primary, stable identity disorder that needs to be confirmed? Or is it a symptom of something else: autism, trauma, depression, ADHD, social influence via peers and the media, or the normal confusion of puberty?”

Dr Girbes contrasts the seeming confidence of the Dutch gender clinicians with the international scrutiny of their foundational studies. The Health Council, which confirmed the weak evidence base, found no reason to cease these hormonal treatments, affirming them as well organised.

Dr Girbes says the council’s report “acknowledges that the level of evidence is low and refers to international developments, but then concludes that the Dutch approach is ‘careful’ enough to be largely continued. That is precisely the disdain of a ‘leading’ nation: foreign systematic reviews and thorough peer-reviewed analyses are noted, but not deemed decisive. After all, we do it more carefully.”

“It is striking in this context that the manifesto of D66—the [centre-left] political party that seems most committed to the Netherlands’ role as a leading nation in areas such as transgender care (for young people)—states that care whose effectiveness has not been proven must be scrapped. The CDA and VVD [centre-right parties] also support this.

“Logically, this means there is no credible reason to maintain the current medical gender care for minors. After all, high-quality systematic reviews conclude that the evidence for puberty blockers and cross-sex hormones in young people is low to very low: there is no convincing evidence of lasting improvement in mental health, suicidal tendencies or quality of life, whilst the risks of infertility, sexual dysfunction and impaired bone development are real and largely irreversible.”

Dr Girbes suggests that the Health Council has compromised its independence and allowed “ideological convictions” to trump the scientific evidence. He highlights the role of biased language—for example, teenagers are said to be “assigned male at birth”.

“It suggests that sex is arbitrarily ‘assigned’ at birth rather than biologically observed, and that the medical interventions are, by definition, ‘affirming’ and therefore positive. This choice of words is not scientific progress, but an ideological shift that frames the entire treatment model as self-evident and harmless. After all, anyone who criticises ‘gender-affirming care’ appears to be against care. Referring to androgens and/or oestrogens as ‘gender-affirming hormones’ also falls into this category.”

Trans spectrum: “What I found was that the transsexual males, the ones who were certain that they wanted to be women, were all autistic”—psychiatrist Dr Az Hakeem

Whose theory?

America | In an essay for Skeptic magazine, author Lisa Selin Davis highlights an overlooked conundrum of gender transition. She writes: “Among the most important issues with pediatric gender medicine is what is being treated. If originally transition was to alleviate distress, and make it easier to pass, those goals have largely been discarded in the face of a revolutionary approach to gender identity—not just male and female, but dozens of neo-identities and pronouns like xi and xir to match.”

“Few proponents have stopped to ask what gender identity is, and to question whether everyone has one. In fact, there are several theories of gender identity. One is that it’s simply an awareness of one’s sex—and one would need such an awareness in order to be distressed about it.

“Another is that it’s a cognitive phase, when toddlers become aware that there are two sex categories, and that they belong to one or the other. They base their sense of what category they belong to on their adherence to gender norms. By around age six or seven, that phase cedes to another: gender constancy, when kids realize their category is based on bodies, not stereotypes.

“The third theory is that gender identity is a sense of oneself as man, woman, both, neither, or some other category, completely independent of the body. This theory has prevailed, and remained largely unquestioned—but it needs to be. That is a subjective belief—one anyone is entitled to. But it is not an objective fact, as biological sex is.

“Still, many young people, including those who’ve gone to medical school, were reared with this version of gender identity as an indisputable reality, and do not understand that it is a political category, not a biological one. Clinicians, teachers, parents, and patients should be informed of these various competing theories, and not simply taught one of them as a fact.”

Rhetoric v reality

The Netherlands1 | A former clinician at the Amsterdam VUmc gender service, clinical psychologist Dorine Sellenraad, says she doubts the Dutch claim to greater caution than their overseas colleagues when it comes to gender dysphoria diagnosis and treatment. She worked in the clinic from 2000 to 2001 with adult patients. “Leading clinics such as the VUmc should advocate for psychological transgender care, but they do not,” she told GCN.

“What I hear is that the regular gender therapists are inclined to conduct young adults into the somatic pathway [of hormones and surgery] when these young adults ask for exploration.

“What we practitioners in [specialist mental health care]—who work with young adults (18-25)—see more and more is that these young adults who are referred to us with a possible autistic disorder, trauma complaints, anxiety, sadness and personality problems, also have a somatic treatment process going on for gender dysphoric complaints, whether or not at the VUmc.

“These young adults themselves make no connection between the various problems and their gender dysphoria and most of the time we are not being approached for consultation by the gender therapists. Now it may be the case that patients themselves do not say anything about other problems to the gender practitioners. This is one of the reasons why a good diagnostic procedure [that includes taking a patient’s history from sources other than the patient] is required.”

Also a signatory to the Trouw opinion article, Dr Sellenraad said she attended a 2024 meeting at the VUmc where the case of a patient with gender dysphoria and several other problems was discussed. She said she was struck by the ease with which a VUmc clinician had recommended hormones.

“I fear that the Health Council [in its recent report on paediatric medical transition] relies too much on what is said and written, and has not investigated enough how it works in practice.” GCN sought comment from the VUmc clinic’s senior psychiatrist, Dr Annelou de Vries.

Genspect’s Inspecting Gender has published a critical profile of medical psychologist Dr Peggy Cohen-Kettenis, a pivotal figure in the development of the puberty blocker-driven Dutch Protocol. In January 2024, Dr Cohen-Kettenis said that funding from Ferring Pharmaceuticals did not influence Dutch research on puberty blockers. “In case of any signs of negative effects [from blockers] we would have ended the protocol,” she told GCN.

Third degree

Brazil | Celina Lazzari, co-founder of MATRIA Brazil, a sex-realist women’s group, had to fight in the courts to secure her PhD after she was targeted by activists over her opposition to paediatric medical transition, Reduxx magazine reports.

MATRIA’s other co-founder, Clarice Saadi, says this is not an isolated case, with her group supporting “many researchers who have been silenced, pressured, or discouraged from conducting studies that critically examine issues related to the sex-based rights or trans ideology”. Ms Lazzari’s doctoral research found that social workers “had a tendency to identify children as transgender prematurely” and that “affirmative gender theories exert a strong influence on this process”.

Meanwhile, Genspect has begun to offer its Beyond Trans online support groups in South America.

Tomboys at risk

The Netherlands | In the newspaper De Volkskrant, sociologist Jolande Withuis deplores the illogical nature of the Dutch Health Council’s findings and advice on the gender medicalisation of minors. “It states, in fact, that whilst there is admittedly no scientific evidence for the current treatment of children with gender dysphoria, and whilst we still know very little about key issues (such as the long-term consequences of hormone use and regret), we must, above all, carry on with it. This appears to be a political compromise—not least regarding a medical treatment with far-reaching consequences.”

She also laments the failure of the council to explain the switch in patient profile to chiefly female teenagers. “My feminist heart breaks when I think of a ‘tomboy’—a boyish girl—who is in love with a female friend and is bullied at school by ultra-feminine little bitches who get up at six o’clock to apply thick layers of make-up, as dictated by influencers. Such a girl—who may well be a lesbian—can now easily conclude that she needs to ‘transition’ because she was ‘born in the wrong body’. After all, that fashionable slogan is being thrust upon her from all sides.”

Defiant gender clinics

Sweden | Dutch-style early transition of minors became routine without any study comparing this invasive model with the previous, more cautious “wait and see” approach, according to Agnes Wold, who is a senior physician, commentator on health, and professor of clinical bacteriology at Sweden’s University of Gothenburg. In an article published by the newspaper Expressen, Professor Wold surveys the history and ethics of the widely adopted Dutch Protocol for paediatric medical transition.

She writes: “This large-scale experiment has been ongoing for a quarter of a century in Sweden and the Western world. It was launched without any evidence of its effectiveness or safety. Once the clinics had opened, they attracted various groups of confused young people who believed their problems could be cured by gender reassignment.”

“At a group level, no benefit from the treatment can be demonstrated, whilst there are numerous side effects; at an individual level, it is impossible to identify who might actually be helped. The treatment is therefore ethically indefensible. It is high time to bring the experiment to an end.”

Professor Wold questions the effect of the new, more cautious treatment advice issued by the National Board of Health and Welfare in 2022. She says “clinics have not heeded this advice: more children are being given sex hormones now than before the advisory was issued. For although fewer girls are receiving testosterone, a greater number of boys are receiving oestrogen. And more boys than ever are now being given puberty blockers, contrary to the recommendations.”

It’s cosmetic

America | In a journal article, evolutionary biologist Dr Carole Hooven and philosopher Professor Alex Byrne document the effects of trans identity politics on understanding of the sex binary with its male and female gametes.

On gender medicine, they say: “Patients are poorly served by confusions about fundamental aspects of biology; in particular, they deserve to be told that ‘gender-affirming’ medical treatments are cosmetic, rather than being allowed to think that sex is ‘mutable’. That alone does not restrict treatment options, but honest communication with patients is a standard precept of medical ethics.”

Language games

The Netherlands | In the OpinieZ magazine, Johan Bolhuis, Affiliated Professor at the University of Cambridge and Professor Emeritus of Cognitive Neurobiology at Utrecht University, suggests that conflicts of interest have impaired the independence of the Dutch Health Council committee tasked to give advice on paediatric medical transition. “Although the committee consists solely of academics, its report is rife with unscientific terms such as ‘gender identity’, ‘cisgender’ and ‘sex assigned at birth’,” he writes. “By consistently using this terminology, the impression is given that these are factual scientific concepts.”

“The [council’s] report seeks to paint a picture that transgender care in the Netherlands—the birthplace of the Dutch Protocol—is in excellent order, in contrast to neighbouring countries. In our country, puberty blockers and hormones are said to be a last resort, used only when long-term therapy proves insufficient.

“The reality is quite different. A recent study by the Amsterdam UMC [gender clinic] shows that 82 per cent of adolescents who registered at the gender clinic between 2009 and 2019 went on to undergo medical transition. Apparently, the ‘(…) carefully structured process, with an extensive exploratory and diagnostic phase, careful assessment of indications and support from multidisciplinary teams’ has little effect on the vast majority of adolescents.”

Apologies then, regrets now

Australia’s nursing federation has published a “clarification” following its decision to apologise and retract a journal article by mental health nurse Jason Watson, who had cited peer-reviewed studies to challenge the alarmist “trans youth suicide narrative”.

On Thursday, following intervention by the Free Speech Union of Australia, the Australian Nursing and Midwifery Federation (ANMF) said that its two apologies for publishing Mr Watson’s article were “not intended to state or imply any finding that the author engaged in scientific or professional misconduct, or as to the author’s character, motives or professional competence”.

“The ANMF has made no such findings and regrets any contrary impression created by the wording of the statement.”

However, Mr Watson’s article—“What are the facts regarding trans youth and suicide? Taking a second look at the trans youth suicide narrative”—has not been republished by the Australian Nursing and Midwifery Journal and the apologies are still online.

The retraction and apologies were reportedly triggered by the Victorian branch’s “LGBTQIA+ reference group”.

The July 30 statement of clarification—posted online above each apology—says the ANMF, the country’s largest trade union, “is reviewing its editorial processes, including the processes applying to articles dealing with suicide and other sensitive clinical and public health matters”.

“The ANMF remains committed to supporting all of its members, including its LGBTQIA+ members.”

Dr Reuben Kirkham, a director of the Free Speech Union of Australia (FSU) assisting Mr Watson, said the ANMF clarification was “wholly unsatisfactory”.

“It does not correct the scientific record. It does not apologise for retracting the article. They still have the article retracted,” Dr Kirkham told GCN.

“So, until they reverse the retraction and correct the scientific record, then there is some unfinished business here, to put it mildly.

“Once [the Watson article has] been taken off the scientific record, you have the defamatory sting of a retraction.”

In a July 29 letter to the ANMF, Dr Kirkham asked for the retraction to be reversed; a statement explaining how the serious error of such a retraction would not be repeated; and an apology to Mr Watson including compensation. The FSU set an August 6 deadline for a reply.

The FSU letter to the ANMF federal secretary Annie Butler said—

“Scientific censorship has no place in a modern democratic society, let alone in an indexed medical journal,” Dr Kirkham wrote.

“The LGBTQIA+ activists, if they have something of genuine scientific merit to say, may of course submit their own articles and reply [to Mr Watson’s article], under the usual protections for a peer reviewed publication.”

GCN has sought comment from the ANMF.

Transition for toddlers

Italy | An affirmation-only guide, which offers a case study of social transition for a three-year-old Italian boy and advises paediatricians to refer teenagers to gender clinics “without judging” their requests, has had an unexpected effect.

It has driven a fast-growing online petition that stresses the lack of evidence for the gender-affirming treatment model and proposes careful diagnostic exploration when a young person declares an identity at odds with biological sex. It is the first time that a substantial number of Italian health practitioners have openly challenged the affirmative treatment model, according to the parents’ group GenerAzioneD.

The authors of the gender-affirming guide—issued by the Italian Paediatric Society and the Cultural Association of Paediatricians under the title Beyond the Gaze: A Practical Guide to Gender Variance, Sexual Orientations and Same-Sex Parenting for a Welcoming Paediatric Clinic—have felt the need to publish a Q&A “technical document” in response to the critique of the petition.

At the time of writing, more than 500 practitioners have signed the July 22 petition, calling on the Paediatric Society to rethink its activist guide1. The petition, with the title First, Do No Harm: Science Beyond the Gaze, will also be sent to Italy’s Health Minister, Professor Orazio Schillaci.

Signatories include child neuropsychiatrists, physicians, bioethicists, nurses, midwives, psychiatrists, psychologists, psychotherapists and paediatricians. An additional 500-plus signatories come from the general public.

It began in Berlin: Zhenya Abbruzzese traverses the history of transgender medicine

Breaking the silence

A Meloni government draft law to impose stricter controls over puberty blockers and cross-sex hormones for minors has yet to be discussed in Parliament, and health professional societies who issued an endorsement of pubertal suppression in February 2024 have ignored analysis of the flaws in their case.

“Against this backdrop of substantial institutional inaction, we believe this [petition] sends an important signal, as it breaks a long silence and draws the attention of the Italian medical community to the need to engage with the most up-to-date scientific evidence and the evolving international debate,” a member of GenerAzioneD told GCN.

Point of no return

The affirmation of a three-year-old is “unthinkable” and “would merit attention from the Italian health authorities,” according to the Head of the Independent Authority for Children and Adolescents, Marina Terragni, who is also a feminist and former journalist.

“Social transition, as a response to a possible period of uncertainty—an extremely common experience in the lives of children and adolescents—has all too often proved to be a point of no return, the starting point for so-called ‘affirmative therapy’, which progresses from puberty blockers to cross-sex hormones and surgery by the age of 16,” Ms Terragni said.

She noted the rise of “critical reflection” on the affirmative approach internationally and the shift to caution elsewhere in Europe, with the current advice to prioritise “a holistic approach and a thorough psychological assessment to rule out any psychiatric co-morbidities”.

“The hope is that the guide published by [the Paediatric Society] may provide an opportunity to launch a wide-ranging scientific debate in Italy too, led by the highest health authorities, which takes into account the latest international scientific findings on the subject of dysphoria in children and young people, whilst keeping the best interests of the child firmly at the centre.”

The Society’s guide claims that “social affirmation” of children “is reversible and has no medical implications; it is the only intervention recommended for the prepubertal period”. Although the guide does not mention puberty blockers or cross-sex hormones, the designated role for paediatricians includes the referral of adolescents to specialist gender clinics.

The Society’s technical document says paediatricians are not expected to “make specialist diagnoses or to determine treatment pathways” but to “refer without judging, exaggerating or downplaying requests for help”.

The guide itself notes that the “depathologised” term “gender incongruence” remains in the ICD-11 diagnostic system in order “to ensure access to healthcare pathways for gender affirmation, if desired”. Gender incongruence does not require the distress that went with “gender dysphoria”.

The anonymised case study of “Anna”, a boy who has been trans-identified since the age of 3, poses a dilemma when school starts: there is “an inappropriate request for diagnostic certificates to allow the child to wear the white school smock for girls”.

“The paediatrician intervenes, clarifying that the child does not present with clinical distress (gender dysphoria), but rather a gender variance … An alias is therefore established to address the issues relating to the use of her registered name, the school uniform and the use of school toilets.”

In the case study of “Liam”, a 15-year-old girl who binds her chest, the paediatrician stresses the importance of the mother “accepting her son’s identity” and offers her information about “multidisciplinary care at specialist centres dedicated to gender incongruence”, namely gender clinics. The father, who does not go along with his daughter’s male role, is blamed for “contributing to a conflictual family atmosphere”.

An introduction to the guide says: “Expressions such as ‘It’s just a phase’, ‘You’re too young to know’ or ‘You’ll see, it’ll pass’ … risk conveying a sense of devaluation or inadequacy at a stage of development when being listened to and feeling trusted are fundamental.”

Critical mass

The July 22 petition, which began with 300 signatures and took off by word of mouth, is unprecedented, according to the parents’ group GenerAzioneD, which played a co-ordinating role.

“To date, in Italy, critical stances towards the affirmative approach to gender dysphoria in children and adolescents have been largely isolated and individual,” a member of the group said.

“This is the first document signed by such a significant number of healthcare professionals who, by giving their full names, are taking a public stand.

“The signatories are calling on the Italian Paediatric Society to reconsider the guidance in the light of the most recent systematic reviews of the international literature and the shift in approach currently being observed in a growing number of European countries.”

The petition echoes the guide’s wish to reduce stigma and discrimination but warns that a single-minded focus on gender identity means “losing sight of the overall clinical picture”.

“[This] must not result in protocols that, in effect, curtail the paediatrician’s clinical freedom, thereby discouraging diagnostic exploration, the assessment of co-morbidities and the adoption of a differentiated, case-by-case approach,” the petition says.

The petition notes that psychiatric problems, personality disorders, autism and ADHD often predate or accompany gender dysphoria, making it hard to discern the direction of causality.

“There is a real risk of diagnostic overshadowing, that is, of reducing the young person’s entire suffering to the sole dimension of gender, whilst neglecting other primary diagnoses that warrant treatment.”

The petition argues that neurodiverse conditions cannot be attributed to “minority stress”, a concept used by gender-affirming clinicians to explain psychiatric conditions in trans-identified patients as the internalised product of an intolerant and bigoted society.

“In the light of current scientific knowledge, empathetic and non-judgemental care means, for the paediatrician, not to recommend affirmative approaches at an early stage, [because the] outcomes in terms of safety and efficacy are unclear,” the petition says.

Instead, the role of the paediatrician should be “to create a context of pause and reflection, providing appropriate information, highlighting the necessary precautions and the potential risks associated with such approaches, as well as the important role of co-morbidities in this context.

“An approach that is truly centred on the child’s wellbeing protects their dignity and their right to be included in a multidisciplinary assessment, without, however, rushing the process of cognitive maturation or promoting premature social or medical interventions in the absence of solid and widely accepted evidence.”

Sandra Pertot

Out in the open

Now we know that Australia’s public broadcaster, the ABC, refused to publish an opinion article by Sall Grover, who is fighting for the rights of women and girls in the Giggle for Girls v Tickle case. As disturbing as the Grover-ABC debacle is, the fact that it has played out in public provides an insight into the way the transgender ideology power dynamic works.

The story begins in 2013 when the Gillard Labor government amended the Sex Discrimination Act by removing the biological definition of sex and introducing “gender identity” as a protected ground against discrimination.

These changes created the legal fiction that a man can be a woman if he says he is.

As a result, in 2026 all three justices in the latest round of the Giggle v Tickle case rejected Ms Grover’s assertion that she was excluding a man from her female-only social media platform, rather than discriminating against a trans woman. The judges expressed their view that in Australia “ordinary usage” of language accepts that a man who presents as female, with or without surgery, has become a woman.

This claim is, in my view, extremely shaky. To start with, the voices of ordinary women who disagree with this belief are suppressed by the type of action being dealt with by the court: ordinary women are punished if they assert in any public place that a woman is an adult female human. Ms Grover is just one example. Others include Kirralie Smith, who is being sued for correctly identifying the sex of male football players competing against females, and Jasmine Sussex, who made the public comment that men can’t breastfeed.

This alone distorts any assessment of “ordinary usage”, which becomes heavily skewed by the loud voices of trans activists.

There is evidence to support the view that ordinary people know a man cannot be a woman. A 2023 survey by the media website news.com.au asked 50,000 Australians 50 questions about a range of controversial topics.

Question 18: Should transgender athletes be allowed to compete in women’s sport?

No: 82.6 per cent

It depends on the sport: 8.2 per cent

I don’t know: 4.9 per cent

Trans women are women: 4.2 per cent

This undermines the view that the general community accepts that a trans woman is a woman.

Further, many trans people do not believe they change sex. Public advocates for trans rights like Caitlyn Jenner, Buck Angel and Chaz Bono openly acknowledge that they have not literally changed their biological sex. Caitlyn Jenner goes so far as to state that trans women are not “real women”.

Binary: evolutionary biologist Dr Colin Wright explains the nature and importance of reproductive sex

It’s more than academic

One would think that a female Australian university academic with a special interest in sex and gender would have a good grasp of the basics of biological sex and the history of feminism in Australia.

Yet Professor Paula Gerber, an academic lawyer at Monash University in Melbourne, decided to share her wisdom in an article published on the ABC site with the provocative title: “Why the Giggle for Girls v Tickle judgement is good for trans rights and women’s rights”.

In her view, “the judgement is also a victory for women’s rights. Feminists have long been fighting against the patriarchy that perpetuates gender stereotypes around how we should look and behave. We know that that sort of scrutiny makes every woman more vulnerable to the policing of our bodies.”

This claim is so wrong, so bizarre, especially coming from a lawyer who claims to be a champion of female rights, that it cannot, in my view, simply be a matter of opinion but a misrepresentation of historical facts. Professor Gerber wants us all to ignore the gains of second-wave feminism in the 1960s–1980s, which fundamentally reshaped society by challenging traditional gender roles and pushing for women’s autonomy from the wants and demands of men. Among other major gains, this women’s movement shattered the traditional bio-essentialism views that women are the “weaker sex” and are more emotional, less competent and intelligent than men.

Both sexes benefited from the breakdown of rigid boundaries for female and male appearance, clothing, workplace roles, and so on. Many women abandoned the uncomfortable nylon stockings in favour of bare legs (not the trivial revolt it may seem now). They stopped wearing makeup, began wearing more comfortable loose clothes in place of fitted dresses. Females were given access to education for a range of occupations, previously seen as unnecessary since women were destined to be full-time wives and mothers. And it became more acceptable for women to enter traditionally male work roles such as truck driving, the trades, engineering, and so much more.

The accepted way for men to dress became more relaxed, and my recollection is that males faced far more negativity when they started breaking rules. The drama created by the Beatles hairstyle and the new trend for men to wear coloured shirts seems unbelievable now, but it was intense; I was there. Entertainers like Boy George and David Bowie drew significant criticism but were instrumental in challenging male stereotypes at several levels beyond clothing. It became acceptable for men to enter traditionally female roles such as nursing, childcare, and flight attendants.

One outcome of this liberation of women was that the academic discipline of “gender studies” became rather superfluous. The obvious question is whether academics like Professor Gerber had to find new areas of debate and controversy to justify their ongoing relevance: the “men can be women” movement, which fortuitously emerged at just the right time, the 1980s, opened up a whole new area of controversy and research.

The ABC of censorship

The real champion of female rights, Sall Grover, approached the ABC to respond to these disputed issues asserted by Professor Gerber. In Ms Grover’s initial draft article, she argued that expanding trans women’s rights infringes upon women’s sex-based rights and fails to acknowledge the biological reality of trans women as male. Ms Grover criticised legal developments, specifically in the Giggle v Tickle case, for favouring gender identity over the material rights of biological women to single-sex spaces. Her full article was subsequently published in The Australian newspaper.

Significantly, a senior editor at the ABC had described Ms Grover’s original draft as “very, very good”. Despite that, and after many revisions, the ABC’s Editor of the Religion and Ethics website canned the article on the following grounds: “pervasive inaccuracies” in Ms Grover’s presentation of the Sex Discrimination Act and Giggle v Tickle, as well as “overstatement” about the extent to which changes to the Act present a threat or danger to women and single-sex spaces.

Ms Grover’s use of language such as “biological fact”, “truth” and “material reality” was a “problem”, according to the ABC editor, because of the “high likelihood of alienating and offending the very people I would imagine you are hoping to convince”.

Ms Grover asked for clarification of these claims, but none was forthcoming, which I interpret to mean the editor had no grasp of the issues that Ms Grover was describing and no factual evidence to justify why the article was rejected. I also note that while offending trans people is not acceptable, offending women is perfectly fine.

It seems females having their rights limited to suit a group of males who can claim to be women is insignificant. Talk about a return of the power of the patriarchy!

The fact that there is zero evidence for Professor Gerber’s claims brings me to a very sobering point: if supporters of trans ideology will manipulate history to this extent to suit their narrative, what other “truths” are they consciously and deliberately creating? Indeed, the defining characteristic of any attempt to obtain clarity and evidence for many of the claims made by trans advocates is name calling and punishment in place of hard evidence.

Extraordinary claims

When did it become possible for a man to be a lesbian?

Throughout human history, sex with someone of the same sex (homosexuality) rather than heterosexual sex has been known and was certainly not rare.

Anthropological, historical, and biological evidence indicates that no culture in human history has been entirely without members who experience same-sex attraction. While societies have vastly different ways of defining, accepting, or regulating these behaviours, same-sex desire and relationships are a recognised part of the human experience across all populations.

Suddenly, in the 1980s, a small group of people in the Western world decided not only that a man can be a woman, but that being gay, homosexual, is not same-sex attraction but same-gender attraction. This was part of the agenda of the queer theory movement to break down what they regarded as the heteronormative, male/female binary stranglehold on sex, sexuality and gender.

I say “suddenly”, because in 2024 when I was writing an article on the Australian Human Rights Commission there were two definitions of lesbian on their website, which indicates just how recent and sudden the change was—

Back then, according to the commission sexual orientation “refers to a person’s romantic or sexual attraction to another person, including, amongst others, the following: heterosexual, gay, lesbian, bisexual, pansexual, asexual or same-sex attracted [Emphasis added].”

Now the commission claims that sexual orientation “is understood to refer to each person’s capacity for profound emotional, affectional and sexual attraction to, and intimate and sexual relations with, individuals of a different gender or the same gender or more than one gender [Emphasis added]”.

In the same way that any opposition to the “men can be women” claim is punished, any disagreement with this new definition of sexual orientation leads to punishment.

How did they gain this power? They traded, and continue to trade, on the image of the poor gender-confused, sexuality-confused young people who will self-harm if they aren’t “affirmed”.

More significantly, over time, trans advocates have gained positions of power. The current Sex Discrimination Commissioner Dr Anna Cody is a true believer that a male/man can be a woman and a lesbian. As well as Ms Grover’s case, Dr Cody intervened in the case involving the Lesbian Action Group when they wanted to hold public lesbian events in Victoria that exclude males who claim to be a lesbian.

Intellectual malpractice

There is the same pattern of manufactured claims in the health professions. Where is the evidence that a child “knows” they are the other gender/sex (these terms continue to be conflated when it suits)? Where is the body of research that reveals this? Claiming that affirmed children are happier doesn’t meet the criteria of rigorous research.

A man can be a woman? How and by what criteria?

Health professionals should be on the front line of the fight to restore biological reality across our society, safeguarding children from irreversible changes to their bodies and supporting female sex-based rights.

Instead, these ideological claims are forced onto health professionals by the same pattern of bullying and punishment noted above, as the cases of Dr Jillian Spencer1 and Dr Andrew Amos demonstrate. It is time to change the dynamic and make the health associations accountable for their claims and demands.

It came as a shock to me to find that many if not all health professional associations embrace trans ideology and will not accept any comments that challenge their position. My disillusionment came about some years ago when I noticed the Royal Australian College of General Practitioners (RACGP) had this definition of sex on the website—

“A person’s assigned sex at birth, determined by sex characteristics observed at birth or infancy. A person’s sex can change over the course of their lifetime and may differ from their assigned sex at birth.”

Naively I contacted the RACGP to suggest they add the explanation that only individuals with specific Disorders of Sexual Development (DSDs) can appear to change sex, because as the college’s definition stood, it implied anyone could change sex. It stunned me that after a few email exchanges they told me to stop contacting them; they were confident in their definition.

The following quote from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) gives a good summary of the position that health profession associations promote—

“[This New Zealand draft law] would define ‘woman’ in law as ‘an adult human biological female’ and ‘man’ as ‘an adult human biological male’. RANZCOG’s submission explains that this is not a scientifically or clinically accurate description of human sex, which is a complex product of chromosomes, genes, hormones and other factors that exists on a spectrum rather than as a strict binary. Around 1–2 per cent of people have intersex variations or differences of sexual development that this definition fails to account for.”

These irrational beliefs are also taught in some tertiary education departments of health and, worryingly, in the biological sciences. How can any health profession, but especially one whose area of expertise depends on knowing the difference between a woman and a man, possibly justify this position? Further, disorders of sexual form and function are not natural variations any more than a child born deaf or blind has a natural variation in hearing or sight.

This is the brick wall facing health professionals who know that a woman is an adult human biological female. Denial of biological reality underpins all of these gender ideology claims, including their justification for “gender-affirming” interventions for children and adolescents.

Call to action

Those of us who know that biology is what makes us human and determines our sex need an action plan. Professional associations and university departments that promote the dogma that biology doesn’t matter must be held accountable, despite any determined efforts to silence dissent.

I propose that these associations and education bodies are flooded with demands that they answer the following questions—

1. Why is there a human characteristic called sex? What is its form and function?

2. If sex isn’t binary, what are the other sexes?

3. What role do these other sexes play in reproduction?

4. If a person with a DSD is fertile, do they produce gametes that are neither sperm nor ova?

5. If sex is a spectrum, how does sex change across the sex dimension from XX to XY?

6. Setting aside individuals born with a DSD, outline the process by which a man (a human born male) becomes a woman (a person born female)? What biological parts and functions change?

7. Women know they are women because they are adult female humans – what criteria does a man use to decide he is a woman?

8. Do all trans women use the same criteria?

9. Can a person with a penis be a woman? A lesbian?

10. How would you explain to a child how babies are made?

I encourage anyone—health professionals, concerned parents, schoolteachers, anyone—concerned that some health professionals deny biological reality, to contact the relevant health association or state health service. The various associations and health departments are easily found on the internet and usually have a position statement that outlines their opinion of biological reality, as well as contact details.

For example, the emails for RANZCOG are ranzcog@ranzcog.edu.au and ranzcog@ranzcog.org.nz.

We must dispel the illusion that only a silent minority acknowledges the reality that sex is binary and immutable.