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.

The gay and lesbian critique

There is no recognized body of “gender-critical” gay and lesbian writing analogous to gender-critical feminism. Like gender-critical feminism within the broader feminist sphere, the gender-critical stance is a minority view among gay men and lesbians, and one that tends to be held by an older generation. But several elements of a critique articulated by some gay men and lesbians have coalesced in recent years, and there are signs that the critique is gathering momentum.

The critique emerged in the context of a sharp pivot toward emphasizing trans rights by major LGBT organizations—GLAAD and HRC in the US and Stonewall in the UK—after marriage equality was achieved.1 The pivot was not just toward trans rights, but toward a specific version of trans rights, premised on the primacy of gender identity over sex.2 This move left some gay men and lesbians feeling unrepresented by these organizations;3 in the UK, it led to the establishment of a competing organization, the LGB Alliance.

Like the feminist critique, the critique developed by gay men and lesbians insists on the importance of sex. But its concern with sex is focused on the connection between sex and sexuality. Homosexuality, on this account, is defined by sex: it is a matter of same-sex attraction, not same-gender attraction. These critics therefore strongly reject claims that lesbians, for example, are transphobic if they are not sexually attracted to trans women with male genitalia. More fundamentally, they argue that the displacement of sex by gender identity—what Allan Stratton has called “gender supremacism”—threatens the foundations of homosexuality as a social practice, since the very existence of homosexuality (or bisexuality) as an intelligible category depends on people identifying themselves and their potential sexual partners by sex.4

The insistence on the importance of sex has led some gay and lesbian critics to challenge the widely held assumption, encoded in the LGBT acronym and its more elaborate offshoots, that all forms of sexual and gender diversity belong together and form the basis for a shared politics. They suggest that sexual orientation and gender identity are not always complementary modes of diversity that coexist happily under the rainbow flag; they may instead be competing ways of interpreting difference and defining social reality.5

More specifically, these critics argue that the focus on gender identity and the devaluation of sex may lead some gay people to redefine themselves as trans or nonbinary. Long-standing fears of “butch flight” to the newly available identity of trans man, going back to the 1990s, have nourished a broader concern about the undermining of “lesbian” itself as a category in a context in which many young people, particularly natal females, are exploring and adopting gender identities other than “woman.”6

But the critics’ main concern is with children and adolescents. They argue that instruction in gender identity, formal and informal, may contribute to producing the felt incongruence between gender identity and natal sex that it claims simply to be describing and recognizing. The hyper-available language of gender identity, that is, may transform rather than simply reveal the self-understandings of children and adolescents.

By demoting sex to “sex assigned at birth,” positing the existence of an internal gender identity to which only the individual concerned has access, investing this posited gender identity with the dignity of authenticity and true selfhood, and inviting young people to consult their feelings to determine whether their gender identity is or is not congruent with their “sex assigned at birth,” instruction in gender identity offers gender-nonconforming young people a potent new schema of sense-making that may alter the way they understand themselves and their predicaments.

It may lead some gender-atypical children who would have grown up to be gay adults—as research shows is often the case7 with gender-nonconforming children—to instead interpret their gender-atypical behavior or preferences as a sign of a gender identity that is not aligned with their sex, and in some cases to be placed on a pathway toward social and medical transition. Many older gay observers have noted that, had they grown up in today’s environment, they might well have been diagnosed with gender dysphoria, taken puberty blockers, and gone on to transition.8

Central to the critique is the concern that homophobia—in young people themselves, in their familial and social milieus, and in the wider cultural or political environment—may encourage adolescents troubled by their same-sex attractions to consider the possibility that their gender identity might differ from their natal sex.9

Seizing on this possibility, which has become much more culturally available and socially legitimate for adolescents in the last decade or so, especially in certain milieus, allows them to reinterpret their same-sex desires as heterosexual.10 Yet as Andrew Sullivan has argued, with respect to boys with same-sex attractions, this interpretive reframing is troublingly akin to “the deepest, oldest homophobic trope: that gay boys aren’t really boys.”11 That homophobia plays a part in such reinterpretations is no mere theoretical possibility. Most adolescents referred to gender identity clinics report same-sex desires.12 And one clinician who resigned from the Gender Identity Development Service of the London Tavistock clinic reported that “it feels like conversion therapy for gay children” and that children frequently “started identifying as trans after months of horrendous bullying for being gay.”13

The transgender critique

Perhaps more surprisingly, the institutionalization of gender identity has also been criticized by some transgender people. Just as some feminists deny that gender identity alone makes one a woman, some transgender critics deny that gender identity alone makes one transgender. They suggest that defining transgender solely or primarily in terms of how one identifies, without any reference to dysphoria or to transition, has stretched the category to the point of meaninglessness. Debbie Hayton, for example, has criticized the focus on gender identity as a shift from observable forms of doing—specifically, transitioning—to an unobservable state of being.14

Writing from a very different perspective, Kadji Amin has similarly challenged the definition of transgender “as a matter of ‘personal identity’ alone.” In the context of a sharp critique of “nonbinary” as a socially empty category that, for some, serves primarily as a political signifier, Amin argues that “what is socially relevant is transition, ... not identification.”15 Robin Dembroff, too, defines transgender in terms of “costly and willful gender deviance,” and rejects as overinclusive definitions that appeal simply to gender identity or gender nonconformity.16

Some are concerned, moreover, that the focus on gender identity may threaten the broad public recognition and rights gained in recent decades by transgender people. On this view, that recognition and those rights rest implicitly on an understanding that transgender is a relatively rare phenomenon, grounded in gender dysphoria so severe that it impels a small minority to embark on risky and costly projects of transition. Some transgender people therefore oppose the teaching of gender identity in schools. As Brianna Wu put it, “no one needed to tell me I wanted to be a girl when I was five years old. It’s all I could think about. So, why ... are we trying to inculcate these children into this?” Doing so “is tailor-made to turn parents against us.”17

Divorcing gender identity from dysphoria and transition, and understanding it as a mere subjective feeling, likewise risks undermining the rationale for public recognition and rights. Some transgender people therefore join the feminist and gay and lesbian critiques in opposing self-identification as the sole criterion of access to sex-segregated spaces.18 As Debbie Hayton has argued, “there was widespread acceptance of transsexuals in women’s spaces when I transitioned in 2012. But the assumption was that you’d changed your body or were going to, and this was a response to a medical condition. Moving it from a medical to a social issue has damaged our acceptance.”19 Others, however, see this kind of argument as seeking to uphold exclusionary “transnormative” criteria about the “right way” to be trans.20

Like feminist and gay and lesbian critics of gender identity, a number of transgender critics also insist on the reality and importance of biological sex. They do so because they understand themselves and their transgender (or as some prefer to say: transsexual) trajectories in relation to their sex. Not in relation to their “sex assigned at birth,” but to their sex, full stop.21 They take the material and biological reality of sex seriously precisely because they have had to struggle with it all their lives.22

The distinction between sex and gender may have been famously pronounced illusory by Judith Butler, for whom sex is “as culturally constructed as gender” and “will be shown to have been gender all along.”23 But that distinction—and the material reality of sex—remains indispensable to the self-understanding of many transgender people, especially those who consider themselves transsexuals. The insistence on the material biological reality of sex recalls arguments of the 1990s and 2000s between transsexuals, who did not “seek to queer or destabilize categories of gender but to successfully embody them,” and queer theorists, who celebrated transgression, fluidity, the destabilization of categories, and the proliferation of gender identities between and beyond the binary pair.24

Most transgender critics do not reject the idea of gender identity per se; that idea remains central to their self-understanding. What they challenge is a fully disembodied understanding of gender identity, defined without relation to the material reality of sex, the suffering of dysphoria, or the experience of transition. They fear that such a free-floating understanding of gender identity, unmoored from the coordinates of binary sex and the narratives of dysphoria-driven transition that made the transgender phenomenon intelligible to a broad public and built remarkable public support for transgender people, may now be weakening that understanding and support.

Some transgender critics, however, have directly challenged the category “gender identity” itself; they see it as detrimental to trans politics. For Andrea Long Chu, “transition expresses not the truth of an identity but the force of a desire ... [It is] a matter not of who one is, but of what one wants.”25 She argues that the “freedom of sex”—the right to alter aspects of one’s sexual biology—should not depend on gender identity, a concept “clumsily adapted from psychiatry.”26 And Amin has scathingly criticized the centrality of “provincially Western” understandings of gender identity to trans politics—as well as the “neoliberal universalization of identity as the basis of all politics.”27

***

These critiques [including the more familiar feminist critique, not included in this extract] differ in emphasis and argument, but they converge in challenging four main ideas about gender identity. These ideas—that it should always be affirmed; that it should govern access to sex-segregated spaces and activities; that it is more fundamental than sex; and that it is universal and foundational for selfhood—comprise the core presuppositions of the institutionalization of gender identity in medicine, law, data-gathering, and education. The fact that these ideas have come under critique from some feminists, some gay men and lesbians, and even some transgender people makes clear that the controversies analyzed in this chapter, notwithstanding their blatant instrumentalization by the right, cannot be adequately understood solely through a left–right lens.

This is an extract from Rogers Brubaker’s new book, Gender Identity: The Career of a Category, published by Polity.

The gist

Child and adolescent psychiatrist Dr Jillian Spencer hopes that the end of disciplinary proceedings against her will encourage other Australian health practitioners to speak up about the harm to children of the gender-affirming treatment model.

Earlier today, her former employer issued a statement acknowledging that Dr Spencer’s concerns about the Brisbane-based Queensland Children’s Gender Service “were grounded in her training and background as an experienced child and adolescent psychiatrist”. (Critics of the gender-affirming model are often assailed as hateful bigots by transgender rights activists and gender clinicians.)

As part of a settlement of her litigation as well as disciplinary action against her, Dr Spencer’s former hospital accepted that her opposition to the medicalised gender-affirming model was part of “legitimate professional and public debate”. The hospital’s statement also recognises “that clinicians play an important role in raising concerns about patient safety and clinical practice”.

Dr Spencer had launched legal actions to fight disciplinary proceedings for “transphobia” and dismissal for criticising the gender-affirming clinic run by the Queensland Children’s Hospital. Her conflict with her employer, as she raised concerns internally at first and then in public forums, dated back to 2022, when she became familiar with the operations of the gender clinic as a senior clinician at the hospital.1

Today’s statement—which describes Dr Spencer as “a strong advocate for change in Queensland in the model of care for children and adolescents experiencing gender dysphoria”—marks an end to the dispute between her and the hospital.

“All matters between the parties have been resolved by mutual agreement,” the statement says. “All disciplinary proceedings against Dr Spencer have been discontinued. The terms of the resolution are confidential.”

Speaking out: “I could not hold my head up if I didn’t speak about this”—Dr Spencer was interviewed for Channel Seven’s Spotlight program in 2023.

The detail

Dr Spencer said today’s statement by the Children’s Health Queensland Hospital and Health Service, which is responsible for the gender clinic, set a precedent for other tertiary hospitals across the nation.

The statement says the health service “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.”

In an interview with GCN, Dr Spencer said: “It’s really important that a tertiary hospital within Australia has publicly acknowledged that the affirmation model is not the right model, that the model needs to be changed.”

“We need those other hospitals [outside the state of Queensland] that are harbouring a gender clinic using the affirmation model to be called to account as to why they’re not changing their model,” she said, citing recent Finnish research showing an increase in the need for specialist psychiatric care after young people undergo hormonal or surgical affirmation.

“In [today’s] statement, the hospital is acknowledging that hormonal interventions are ‘serious decisions for children regarding their body and long-term health’.

“We all just know, as human beings, that adolescents can’t understand the long-term implications of infertility and lack of sexual function and physical health problems [from hormonal treatment] and the risk of regret,” she said.

Dr Spencer said affirmative gender clinics did not live up to their public claim that they practise multidisciplinary care following a comprehensive assessment and consideration of a range of potential underlying causes of what is presented by minors as gender distress.

“When you work alongside these clinics, you see exactly how much kids are put on a pre-determined pathway,” she said.

“You see the model of care failing to acknowledge the co-morbidities and mental health problems and family issues and trauma of these children, and instead celebrating these children as being trans and encouraging them along a pathway of changing their body as a strategy to manage their distress.

“The gender clinics do claim that distress in children is related to the stigma and difficulties of being a trans person in a ‘cis-heteronormative’ world. They say that in order to justify delivering this cookie-cutter approach of affirmation, but it’s simply not true.

“Anyone who works with these children can see that these children are very troubled and confused and traumatised. It’s intuitively obvious, and when you’ve had training in child and adolescent psychiatry … it’s barn-door obvious.”

Today’s statement includes a reference to the Queensland government’s moratorium on any new treatment of gender-distressed minors with puberty blockers and cross-sex hormones in the public health sector following an independent review. Queensland is the only Australian state with such a policy. Private prescription of these hormonal drugs is unaffected.

Back in Queensland, the gender clinic continues to treat existing under-18 patients with poorly evidenced hormonal interventions.

The clinic states that its healthcare is “informed by” two low-quality affirmative guidelines, one from the Royal Children’s Hospital Melbourne, the other from the scandal-plagued World Professional Association for Transgender Health.

A 2021 work instruction for the Queensland Children’s Hospital mandated the affirmative policy and cited two court rulings that 15-year-old girls had the capacity to consent to trans mastectomies.

On its website, the Queensland gender clinic says it “is currently reviewing and updating its fact sheets and other resources. While this important work is under way, please email us if you need any information or questions”.

The website still hosts a 2019 podcast titled “My Amazing Body”, in which a female psychiatry registrar explains a child’s distress at the onset of a normal puberty by imagining that she herself was transformed into a male.

The podcast comes with a caveat that “Information contained within it should be taken as accurate at the time of recording”.

The website of Children’s Health Queensland includes an article on “Helping trans, non-binary and gender-diverse kids thrive” by child and adolescent psychiatrist Dr Stephen Stathis, who founded the gender clinic.

“Research tells us that with the right support these kids can grow up to be trans adults with similar health, social and educational outcomes as same-aged peers. Gender-affirming specialist care is associated with decreases in psychological distress and improvement in quality of life for trans youth,” Dr Stathis wrote.

The article does not comment on the quality of that research and does not use footnotes, making it difficult to know which studies are cited to support which claims.

The reference list includes 17 studies, but there is no mention of the “gold standard” systematic reviews undertaken since 2020 in jurisdictions such as Finland, Sweden and England. Those reviews have confirmed that the evidence base for hormonal treatment of gender-distressed minors is weak and uncertain.

(GCN is not suggesting any wrongdoing by Dr Stathis; gender clinicians may be confronted with complex cases and very distressed young people.)

In a 2023 talk to a conference, Dr Stathis acknowledged the low-quality nature of the evidence for hormonal treatments, a weakness which he said was the norm for paediatric psychiatry.2

He conceded there were “questions about the reversibility” of puberty blockers, which suppress natural sex hormones. He noted that suppression of sex hormones in sheep affected their cognitive function and he also mentioned data showing cognitive decline in men under hormone suppression for advanced prostate cancer.

He told the psychiatry conference that he was unaware of any evidence—“at this point in time… it might change”—that puberty blockers could harm cognitive development or executive function in children being treated for the distress of gender dysphoria. (There is a lack of robust data on the effects of puberty blockers on today’s gender clinic caseload.)

Although the Stathis article on the website of Children’s Health Queensland is dated 7 May 2026, internet archives suggest it was first published in 2022 or earlier.

An earlier version of the article made a claim that does not seem to be supported by high-quality evidence: “Trans youth have a 20 times increased risk of suicide compared with same-aged peers in Australia and 7 times higher rate of self-harm.”3

The current version of the article says: “Trans youth have substantially elevated risks of suicide attempts and self-harm compared with same-aged peers in Australia.” This claim appears to rely on a low-quality anonymous online survey promoted through social media and other avenues, including “queer departments at universities, trans and LGBTIQ support groups”. Such surveys are considered unlikely to be representative and may overstate suicide risk.

And the current version has also lost a paragraph—

“While gender-diverse children and young people are thankfully seeking help, the referrals are exponentially greater than a decade ago. European gender clinics that have been providing care for 40 years tell us today’s gender clinic youth have no greater rates of mental health distress nor are they less likely to be transgender than the smaller numbers that sought help a decade ago. The good news is that more of these kids are reaching out for support and that specialist gender services are now established.”

Since the mid-to-late 2010s gender clinics around the world have reported the rise of atypical teenage female patients often with complex mental health problems. This has been documented in research, particularly studies using Finland’s comprehensive health registry data.4

GCN has sought comment from Children’s Health Queensland, the gender clinic and Dr Stathis. GCN does not dispute that gender-affirming clinicians believe their interventions help vulnerable minors.

Unpublish

Australia’s nursing federation, the country’s largest trade union, has issued two apologies and taken down a journal article that questioned the alarmist “transition or suicide” narrative relied on by activists.

The article—titled “What are the facts regarding trans youth and suicide? Taking a second look at the trans youth suicide narrative”—was written by mental health nurse Jason Watson and published in the current edition of the journal of the Australian Nursing and Midwifery Federation (ANMF).

The 1,400-word article cites England’s Cass Review, relevant Dutch and Finnish studies, as well as research by UK suicide prevention expert Professor Louis Appleby, who debunked activist claims of a “surge” in youth suicide after 2020 when access to puberty blockers at the London-based Tavistock gender clinic was restricted.1

The tone of Mr Watson’s article is scholarly, and he analyses the methodology of various studies, including one that reports a decrease in suicide risk over time for some patients.2

However, his article suggests that the balance of the research does not support the “trans kid or dead kid?” choice put to some parents hesitating about puberty blockers or cross-sex hormones for their child.

“I think it is safe to state that the pro-trans suicide narrative is at least tenuous and at most simply incorrect,” Mr Watson writes.

“This seems to fit with the Cass Review’s narrative that the significant majority of current transgender research is of a disappointingly poor quality and is ideologically rather than scientifically based.”

The article was swiftly taken down from the ANMF journal’s online edition, which now jumps from page 39 to page 42 without explanation that a two-page article has been excised from the Focus section on mental health. The Watson article remains, however, in the print edition posted out to members of the nursing union.

Sorry, again

On July 3, the ANMF Victorian branch published an online apology, followed a week later by another apology, this time from the federal office of the union, which promotes itself as the “collective voice of more than 356,000 nurses, midwives and care workers”.

Neither apology discusses or analyses the content of the Watson article, apart from a reference to its title and subject matter—“gender-affirming healthcare and outcomes of suicide in the transgender community”.

The Victorian apology, signed by acting secretary Nicole Allan, says the branch was alerted to the article by its “LGBTQIA+ reference group”.

“Negativity and hatred have no place in our movement,” says the apology, which also implies that the article is in some way discriminatory and creates an “unsafe environment for those seeking support”.

The unsigned federal apology invokes a duty to exclude “damaging and harmful opinions” from the journal.

“The ANMF acknowledges that publication of this opinion piece has caused immediate and significant distress to the transgender community, the LGBTQIA+ community, and the wider community. We sincerely regret the harm this has caused and deeply apologise for this.”

The apologies do not cite any material from the article in support of their claims. It was not explained how discussion of the evidence base could be harmful.

“No one can critique them on their apology or their position because they don’t really provide any information to be critiqued,” Mr Watson told GCN.

“One of [my supportive bosses] said, along the lines of, ‘They don’t even know who you are, and this [apology] makes you look like somebody who you’re not’.”

Mr Watson said nobody from the ANMF or its journal had taken the trouble to tell him his article had been suppressed.

“I think it’s a shame because [trans and suicidality is] a topic that needs discussion, and I would quite happily have a discussion with someone who totally disagrees and thinks [my article is] a bunch of rot,” he said.

“It’s really unhelpful for the profession as a whole, because the message is that there’s nothing [in trans healthcare] that needs to change here. You can’t put any other part of healthcare in that category of ‘don’t discuss it’.”

As a mental health nurse, Mr Watson said he has to help steer children and adolescents through crisis towards treatments for conditions such as severe depression or anxiety.

For those treatments, he said, “there’s generally a very sound research base, and it’s nice and concrete and easy to follow”.

“And this [gender distress] seems to be the only ‘mental health’ condition where the data base is shaky at the very least, and perhaps even made up at the very worst.”

He said there was a sensible guide to handling the risks of suicidal thoughts and suicide attempts in young people—unless they were trans-identifying, where the pathway was poorly evidenced transition.

Self-fulfilling prophecy

The Watson paper itself highlights the risk that “exposure to media messages suggesting [trans youth] would or should experience suicidal thoughts or behaviours [contributes] to them developing such thoughts or behaviours.”

The research cited in Mr Watson’s journal article includes the studies below. The quoted summaries are his. Links go to the published studies.

Dhejne 2011: “The most at-risk stage for these trans clients was post transgendered surgeries where the completed suicide rate was 19 times higher than non-trans peers.”

Wiepjes 2020: “[O]ver the period of the study there had been eight transgendered men (TGM) complete suicide and 41 transgendered women (TGW). The study suggested that the frequency of suicide for TGM was constant over time—meaning that the rate of suicide did not improve once transgendered healthcare began and was completed. [The study] also stated that the rate of suicide for TGW did decrease over time, and that it decreased once transgendered healthcare began and was completed.”

de Blok 2021: “[The TGW] client group, post receiving transgendered healthcare demonstrated significantly higher rates of mortality by heart disease, lung cancer, HIV-related death and by completed suicide compared to expected mortality rates in the general Dutch population.”

Erlangsen 2023: “[This] study of 3,759 trans clients over 41 years found there were 92 post-treatment TGW suicide attempts and 12 completed suicides. These rates for suicide attempts and completed suicide were described as ‘significantly higher’ compared to the expected rates of the general population.”

Ruuska 2024: “This was the only study with a control group of cis young adults of similar age, stage and from similar location [to the trans group]. The study found there were 55 deaths in the [trans] study group over this 23-year span. Of those deaths, 20 were by completed suicide (36 per cent). This indicated that compared to the [non-trans] control group, general mortality was 66 per cent higher [in the trans group] and death by suicide was 300 per cent higher.”

Going global

A complaint that Australia’s college of psychiatrists has tried to shut down critical debate about “gender-affirming care” has been referred to the ethics committee of the World Psychiatry Association (WPA).

A group of 13 psychiatrists claims that “punitive action” by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) against critics of the puberty blocker-driven, gender-affirming treatment model is “unprecedented”.

The group’s letter to the Switzerland-based WPA cites the college’s suspension of psychiatrist Dr Andrew Amos, a sceptic of the hormonal treatment of gender-distressed minors who has been silenced on social media by the regulator AHPRA, which shows signs of influence by gender identity ideology.

Also raised in the letter is the forced removal of child and adolescent psychiatrist Dr Jillian Spencer from the college’s 2026 congress earlier this year after she brandished a sign reading “RANZCP kicked out Dr Amos. Why?”

On the agenda

In reply to the group letter, WPA director of administration Atina Ivanovski said the association’s executive committee would “give the matter due consideration in the coming weeks”.

The letter, which has also been referred to the WPA ethics committee, was signed by 13 fellows of the Australian college including psychiatrists—Professor Philip Morris, Dr Roberto D’Angelo and Dr Catherine Llewellyn, for example—who have been public critics of youth gender medicine.1

“In recent months, the RANZCP has effectively moved to shut down debate about the safety and effectiveness of medical gender‑affirming interventions, targeting [college] fellows who raise concerns about the limited evidence base and potential harms,” says the letter addressed to WPA president Professor Danuta Wasserman and the ethics committee.

“The steps taken by the RANZCP are unprecedented in terms of their punitive nature and serious implications. This sends a clear warning to all members: speaking openly about risks and uncertainties in this area may now carry career‑threatening consequences.

“These actions are occurring precisely as a growing number of progressive jurisdictions [in Finland, Sweden and the UK, for example] are limiting or curtailing medical gender‑affirming treatments for minors, in response to mounting concerns about their harm-benefit ratio.

“Rather than engaging with these developments, the RANZCP has adopted a stance that silences attempts to question the applicability of the ‘gender‑affirming’ model to a new cohort of youth whose presentations differ markedly from earlier patient groups.

“Two recent cases illustrate our concern. Dr Andrew Amos, an academic psychiatrist who has published and spoken about limitations and potential harms of the gender‑affirming model, was suspended from the RANZCP after complaints about his public statements [questioning] gender-affirming care.

“Dr Jillian Spencer, a child psychiatrist, was removed from the RANZCP congress and had her [congress] registration cancelled after attempting to draw attention to [Dr Amos’s] case through a peaceful protest.”

Dr Spencer was suspended from her role as a senior clinician at the Queensland Children’s Hospital—home to a gender clinic—after she went public with her concerns about the lack of safety and evidence for gender-affirming treatment.

“Whatever one’s views on gender‑affirming care, many RANZCP members find these events [involving Drs Amos and Spencer] deeply troubling,” the group letter to the WPA says.

“Suspending a fellow for expressing a clinical perspective that diverges from the college’s promoted position, and ejecting a silent protester from a conference, set a dangerous precedent that chills scientific debate and professional dissent.”

In a statement to The Australian newspaper, a spokesperson for the RANZCP said the board had suspended Dr Amos’s membership earlier this year “in response to significant restrictions placed on his right to practise by the [regulator] AHPRA”. Dr Amos had been targeted by transgender rights complaints to AHPRA (the Australian Health Practitioner Regulation Agency).

Dr Amos told GCN that nobody from the college had given him notice of the decision, nor any explanation why it had chosen to suspend him— “no notice, no ability to present my case, no ability to appeal the decision,” he said.

Dr Spencer says she was pushed over by security and dragged out of the RANZCP’s May congress in Melbourne. Her protest sign was supposedly prohibited as “advertising”.

She told GCN she had invoked the RANZCP complaints policy, asking that the college contact attendees who might have witnessed her treatment. A college official had said the incident would be “formally investigated” but Dr Spencer was given no details about this process.

Natural justice

In April, RANZCP president Dr Astha Tomar was challenged by a group of 22 fellows and members—among them Professor Morris and Dr D’Angelo—about the suspension of Dr Amos in circumstances where the regulator AHPRA had taken “immediate action” against him without formal investigation or findings of fact.

In her reply to the group of 22, Dr Tomar said the college board had a duty to consider the implications when a regulator [such as AHPRA] “places significant restrictions on a member’s clinical practice”.

“Suspension of membership is a serious step. It is not taken lightly, and it is not a substitute for regulatory processes,” she said.

The college told GCN that it “values clinical debate and the careful consideration of emerging evidence, and supports respectful professional discussion among its members, including where views differ”.

The group of 22 also sought “clarification about potential conflicts of interest, given the [college] president’s leadership role in an organisation providing gender interventions to minors”.

This is a reference to Dr Tomar’s roles with the youth mental health organisation Orygen, which operates a gender-affirming Trans and Gender-Diverse Health Service aimed at patients aged 12-25 in collaboration with Australia’s most influential gender clinic at the Royal Children’s Hospital (RCH) Melbourne.

In reply to the group of 22 psychiatrists, Dr Tomar said it was not true that the college advocated for “a particular model of care” and she rejected any “allegations of conflicts of interest related to my workplace”.

In a statement to GCN, the RANZCP said: “The president’s employment history is a matter of public record and has been appropriately disclosed. It has no bearing on the college’s position on this [gender dysphoria] issue, which is developed through the college’s established governance and policy processes.”

There is no suggestion of any wrongdoing by Dr Tomar.

Since its brief endorsement of puberty blockers prescribed according to RCH Melbourne’s low-quality treatment guideline in 2019, the college has issued two position statements on the mental health of “trans and gender-diverse people” with some conflicting elements influenced by division over the medicalised gender-affirming model.

The current statement from 2023 itself acknowledges the existence of differing professional opinion on the best treatment for gender-distressed patients.

Orygen of youth

As president-elect and president of the RANZCP Dr Tomar has had roles with Orygen. From June 2023 to July 2025, she was listed as clinical services director of Orygen’s Specialist Program, a job described by the organisation in 2024 as one “of huge responsibility overseeing clinical governance and ensuring all legal requirements are met in the delivery of care”.

Since July 2025, according to her LinkedIn page, Dr Tomar has been the medical director of the Melbourne-based Parkville Youth Mental Health and Wellbeing Service, which is characterised as the independent successor to the Orygen Specialist Program.

Her profile at the Parkville service says: “Young people aren’t passive recipients of care—they’re active partners in their recovery. [Dr Tomar’s] role is to ensure clinical frameworks honour that partnership while maintaining the highest standards of safety and evidence-based practice.”

Orygen’s Trans and Gender-Diverse Health Service reportedly offers cross-sex hormones to minors but not puberty blockers. Online material says the service follows the 2018 RCH Melbourne treatment guideline.

That guideline confidently recommends hormonal treatment for gender-distressed minors. It advises clinicians that even psychosis in a patient is not necessarily an obstacle to medical transition.

Although the Orygen service is said to exclude puberty blockers—which are still available to younger minors at the RCH Melbourne gender clinic—Orygen’s 2024 Evidence Summary makes an upbeat case for using these drugs to suppress a child’s naturally timed puberty.

“Overall, the peer-reviewed literature suggests that [puberty blockers are] correlated with improved general functioning and peer relations, and reduce depressive symptoms, suicidal ideation, and behavioural and emotional problems in trans and gender diverse young people,” the summary says.

By contrast, the University of York systematic review, commissioned by the 2020-24 UK Cass inquiry, concludes: “There is a lack of high-quality evidence to support the use of puberty suppression in adolescents experiencing gender dysphoria/ incongruence, and large well-designed research is needed.”

How can two assessments of the same evidence base differ so markedly?

The Orygen summary offers five studies as evidence of the positive mental health outcomes of puberty blockers. The quality of those studies is not discussed.

All five studies were evaluated by the University of York’s systematic review. One was rated low quality (Turban 2020), three were moderate quality (Carmichael 2021, Costa 2015 and de Vries 2011) and just one was high quality.

Exclude, for the moment, the high-quality study. Of the four remaining papers cited by Orygen to promote puberty blockers, two of them (Costa 2015 and Turban 2020) have had their findings challenged by University of Oxford Professor of Sociology Michael Biggs.

The third is the failed attempt (Carmichael 2021) to replicate an earlier “Dutch protocol” study (de Vries 2011), which in turn is the fourth study cited by Orygen.

The two key Dutch protocol studies (de Vries 2011 and de Vries 2014) “suffer from such profound limitations that they should never have been used as justification for propelling these [hormonal] interventions into general medical practice,” according to a recent paper (Abbruzzese 2023).

What about the fifth study (van der Miesen 2020) referenced by Orygen and rated as high quality by the University of York researchers?

This Dutch study, according to Orygen’s summary, shows “that trans and gender-diverse young people who had received gender-affirming care including [puberty blockers] (n=178) reported fewer internalising problems, self-harm/suicidality, and stronger peer relationships than trans and gender-diverse young people who had not yet received gender-affirming care (n=272)”.

High-quality evidence for puberty blockers?

But Orygen’s summary makes no mention of a crucial qualification by the authors of the van der Miesen paper—

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

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

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

Hence the University of York’s conclusion: “No high-quality studies were identified that used an appropriate study design to assess the outcomes of puberty suppression in adolescents experiencing gender dysphoria/incongruence [Emphasis added].” (The van der Miesen study was the only high-quality study found by the York researchers; 24 others were rated low quality.)

In addition to those five studies on puberty blockers and mental health outcomes, Orygen calls on another research paper (Brik 2020) to support the claim that, “When gender dysphoria continues for young people during puberty, it is unlikely to subside”. In other words, a claim favouring gender medicalisation.

But Brik—and other studies said to support this claim—have been examined and found wanting by MIT philosopher Professor Alex Byrne, whose tweet captured the essence of his paper—“Is childhood-onset gender dysphoria that persists into early puberty highly persistent in adolescence and adulthood if untreated? In the opinion of many experts, yes. But—as far as I can see—this is not supported by the evidence.”

Brik itself makes a more careful claim than Orygen. The Brik authors’ statement is that “if the gender dysphoric feelings intensify during puberty, they are thought to be unlikely to subside [Emphasis added].”

And Brik contains a warning which is ignored by Orygen. “The observational design does not allow conclusions about any possible effect of [puberty blocker] treatment on gender identity development,” the authors say.

The Orygen summary does hint at the poor quality of the research it relies on—“Most studies included in [our literature] review were uncontrolled observational studies with small to moderate sample sizes and limited follow up”.

Elsewhere, however, Orygen ignores the weak evidence base and claims: “The evidence that gender-affirming care is correlated with enhanced youth mental health and wellbeing outcomes is consistently and overwhelmingly positive [Emphasis added]”.

The peer-reviewed University of York study contradicts Orygen, and concludes: “Limited and/or inconsistent evidence was found in relation to [the effect of puberty blockers on] gender dysphoria, psychological and psychosocial health, body satisfaction, cardiometabolic risk, cognitive development and fertility.”

But it may be wrongheaded to weigh the credibility of Orygen’s Evidence Summary. Orygen seems to depart the world of evidence-based medicine entirely when its summary declares that gender-affirming treatments “seek to operate beyond a clinical, medical, or deficit model”.

GCN, which does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable youth, sought comment from Orygen and the WPA.

The gist

A good argument can be made for setting 26—roughly the age of cognitive maturity—as the minimum age for transgender surgery, according to a prominent American plastic surgeon.

Dr Scot Glasberg, a past president of the American Society of Plastic Surgeons (ASPS) and its research arm the Plastic Surgery Foundation, made the remark on July 5 at a London conference on “Rethinking Youth Gender Medicine”.

An attendee had questioned whether the society’s minimum age of 19 for gender surgery failed to protect distressed young adults, particularly those with autism or ADHD, who could be “profoundly vulnerable”.1

Dr Glasberg said “a cogent argument” could be made for adopting 26 as a minimum age—the point at which the brain is fully developed—and in any event, trans surgery above 19 also required good evidence.2

On 3 February 2026, the ASPS became the first major American medical association to adopt a policy advising against the gender medicalisation of adolescents. After researching the issue, the society had found the evidence base to be of low quality and insufficient to demonstrate a favourable risk:benefit ratio.

“We don’t seek to minimise what these children are going through,” Dr Glasberg told the London conference on Sunday. “We believe that it’s real [distress] ... We just don’t necessarily believe that surgery is the best course of action, given the evidence.”3

Advocates for puberty blockers, cross-sex hormones and trans surgery sidestep the weak evidence base by appealing to the combined authority of “every major medical association” endorsing gender-affirming care.

Hence the title of Dr Glasberg’s talk—“Breaking the mould: How ASPS decided to follow the evidence”—at the July 5 session of the conference hosted by the Society for Evidence-based Gender Medicine (SEGM) and the Clinical Advisory Network on Sex and Gender.4

Dr Glasberg revealed details of the ASPS process culminating in the decision to follow the evidence and recommend that members “delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old”.

“ASPS made repeated formal outreach attempts seeking collaborative dialogue [with WPATH] on the evidence base [including a] specific request for methodology tables,” he said.

He asked why “a reputable organisation”—one that claimed to follow evidence—would “not want to show us their methodology tables?”5

WPATH ultimately told the society it could not discuss its methodology because of legal proceedings involving its 2022 eighth edition Standards of Care.6

In 2024, as Dr Glasberg recalled, court documents showed that WPATH had “buried” systematic reviews of evidence because the results did not favour confident gender-affirming medical treatment.

At the London conference, he invoked a recent Finnish registry study, which showed an increase in the need for specialist psychiatric care after medical transition.

Dr Glasberg said this study was important because it highlighted the risk that “it actually could be worse for these children” post-transition. “I thought, this is pretty telling.”

He suggested that Nordic countries such as Finland and Sweden were “10 years ahead of the US” in the gender field, and the ASPS’s more cautious position statement was not so much a break with American medical policy as a case of following the Nordic lead. He also cited the independent evidence assessment undertaken during the 2020-24 UK Cass review.

The detail

Dr Glasberg said a fast-growing segment of his New York City practice involved seeing detransitioners unable to find care elsewhere, although it was “impossible” to reverse genital surgery.

Just as gender-affirming care had called for “multi-specialist groups”, so too detransitioners needed access to this kind of comprehensive health service, he said.

At the London conference, he said the closest parallel to trans surgery was frontal lobotomy.

He was responding to a comment from an audience member that gender medicine, abortion and euthanasia were all unusual in attracting heated demonstrations, with the explosive elements being “religion and sex”.

Dr Glasberg said he believed religion was a distraction from the evidence-based focus of the paediatric transition debate. He suggested the argument for stopping under-19 trans surgery was the same for lobotomies—“there was no evidence to show that [these interventions] were of any benefit, and we were harming people in the process”.

He also emphasised the limitations and risks of trans genital surgery.

Dr Glasberg cited a lack of data for “overall sexual well-being” after surgery. He had been asked a question about whether there was any data or long-term follow-up “on sexual function, sensation, orgasm, strictures, any endocrine problems that those people may have”.

With genital or “bottom” surgery, he said, “fistulas and things like that are incredibly common, and there are some studies now [showing] up to 50 per cent morbidity on bottom surgeries, and that’s pretty significant. A lot of it tracks with whether or not the patient has gotten endocrine therapy leading [into surgery].”

The ASPS policy did note in passing that hormonal treatment, like surgical interventions, suffered from a weak evidence base. The ASPS statement highlights “substantial uncertainty” about the long-term benefits of puberty blockers and cross-sex hormones.

“We didn’t call it out in our [policy] recommendation, because that’s not our expertise, but we would be foolish not to admit to the fact that we saw the same low-certainty, low-quality [evidence] in the endocrine world,” he said.

In the 2010s and early 2020s, he said, medical associations were “deferring to” a gender-affirming consensus. Although that consensus “wasn’t based on any kind of evidence”, the evidence for hormonal and surgical responses to gender distress in minors was “treated as settled”.

Dr Glasberg characterised his conference presentation as “a humbling talk, to be honest with you”. Prior to 2022, his own society’s position on paediatric trans surgery was “basically non-existent”.

But the society knew this surgery “was really taking off and continuing to exponentially grow”, and so began a process of examination and policymaking. And gender surgeons themselves, presumably not expecting a cautious approach, had asked the society for a policy statement and guidelines.

As the society worked towards its 2026 policy, it decided to advise its members to be cautious.

“In the United States, you can go online and order a letter for your gender-affirming evaluation/mental health evaluation by answering a few questions,” he said.

In October 2024, as president of the Plastic Surgery Foundation, Dr Glasberg decided to convene a panel talk including a prominent gender surgeon and UK paediatrician Dr Hilary Cass, whose gender dysphoria review found the evidence for hormonal treatment of minors to be “remarkably weak”.

Dr Glasberg said the inclusion of Dr Cass “created a huge stir” and he had cancelled the panel, describing this as a postponement. “I regret that decision … I sort of caved to the pressure, and shouldn’t have.”

In early 2025, the society created a Gender Surgery Task Force—inviting people from WPATH and non-members such as psychiatrists—to test whether a consensus was possible.

However, the presence of non-members meant this task force “was never to set policy” for the ASPS. (Some task force members complained of not being consulted over the new position statement.)

With the release of the new policy, Dr Glasberg and his colleagues were “excited” and thought other medical associations might follow their example.

The American Medical Association (AMA) did make a statement that appeared to endorse the society’s new restrictive advice.

On 4 February 2026, the AMA said in a statement that because “the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement … the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood”.

The statement seemed to be “hedging”, Dr Glasberg said. “And for the last five months [the AMA have] done nothing but try to pull back on that [apparent agreement].”

And his own society itself came under attack.

“The fact that we’ve been called out on this [policy] is quite alarming to me. Isn’t that what we do every single day in medicine? … we decide the risk:benefit ratio for our patients.”

He said the media “attacks” included claims—

that Dr Glasberg was “driving this whole statement”, whereas he was no longer on the society board when it voted for the new policy;

that the new policy was a capitulation to the Trump Administration, which seeks to shut down paediatric medical transition;

that Dr Mehmet Oz, administrator of the US Centers for Medicare and Medicaid Services, had somehow pressured the society to act;

that many members within the society disagreed with the policy.

Dr Glasberg said a petition against the new position statement was signed by 350 surgeons, but the total membership was 9,000 in the US.

“I’m not suggesting that everyone agrees with the [policy] statement, but there’s 8,650 surgeons that decided not to sign the [petition] because they were all approached in an email chain,” he said.

Back then, Dr Glasberg defended the position statement on CNN as the result of “an iterative process that took time, with no outside pressure”.

On the society’s board there was apprehension about “mass resignations”. Letters were coming in with threats to resign. “To date, as of yesterday, we’ve had one resignation.”

Dr Glasberg said he was getting frequent inquiries from other medical associations “trying to figure out” how the ASPS had manoeuvred into a cautious position.

“Obviously, I say, follow the evidence. I wish it were that simple, because there’s politics in all of these organisations. And so, I’ve said … let me speak to them. I’ve had a few that have reached out.

He recited the standard arguments used to support business as usual in the gender medicine field.

There was the claim that trans surgery was being held to a higher standard than breast reduction surgery or cosmetic rhinoplasty.7

“[Unlike trans surgery] we have great evidence on … both the physical and psychological benefits of a breast reduction,” he said.

“And I’m not promising anybody who gets a rhinoplasty at 16 [that] I’m going to either stop their suicidal ideation or help their mental health.

“In addition, no insurance is paying for [a rhinoplasty], they’re paying out of pocket, which incredibly changes the dynamic.”

As for not intruding on shared decision-making by surgeon and patient, this did not allow treatment indifferent to the evidence base.

Nor did doctors have to follow every request of a patient. “I had a patient come in; he asked me to shave off his fingerprints. Could I do it? Sure. Did it make sense medically? No. Did I do it? Absolutely not.”8

Dr Glasberg quoted an observation attributed to the philosopher Arthur Schopenhauer: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

Dr Glasberg: “I’m hopeful that we are entering this last phase soon.”

The gist

The Health Council of the Netherlands has acknowledged the weak evidence for paediatric medical transition, the side-effects and uncertainty of hormonal interventions, as well as the unknown rate of patient regret, but concludes that treatment should continue.

In advice issued earlier this week, the council said the puberty blocker-driven Dutch protocol fell within the country’s health law framework, although it based this view on the content of treatment guidelines and had “not evaluated the delivery of care in daily practice”.

The council said the Dutch gender clinics were also seeing the troubling shift in patient profile which in Finland, Sweden and the UK has led to restrictions on puberty blockers and hormones for minors.

Dutch referrals had more than doubled between 2020 and 2022, reaching a total of 2,772, with long waiting lists, the council said, and classic early-onset dysphoric boys had given way to teenage-onset females, often with non-binary identities and conditions such as autism, depression, anxiety and ADHD.

This was the flip in patient profile that made Finland’s health authorities think again—and become the first to adopt a more cautious, less medicalised approach than the Dutch protocol in 2020.

Still, the Health Council of the Netherlands insists that “exploration is central to the Dutch model”.

“Treatment with GnRH agonists [puberty blockers] does not primarily serve as a stepping stone to further treatment [with cross-sex hormones], but as an intervention which—albeit within specialist care—creates time for further exploration,” the council says.

“Not all young people who present for [blockers] ultimately commence this [potentially lifelong hormone] treatment, but the majority do.” More than 90 per cent, according to international data, the Netherlands included.

Thumbs on the scale

The request for the Health Council’s independent advice arose from two 2024 resolutions passed by the Dutch House of Representatives seeking medico-legal scrutiny of paediatric gender transition and research comparing the Dutch protocol patient outcomes with those of European countries, such as Sweden, which have shifted to caution.

Half the members of the 12-strong council committee were directly involved in Dutch protocol treatment, and the impartiality of its advice has been questioned. Declarations of potential conflicts of interest for committee members have been published. The main advice document shows internal contradictions, with vague positive claims for continued treatment undercut by acknowledgement of poor data and uncertain outcomes.

In that main document, the council notes that minors had to have “the emotional and cognitive maturity required to give informed consent” but concedes that the cognitive effects of hormonal treatment during the crucial brain-development phase of adolescence are not known.

“The greatest uncertainty surrounds mental health outcomes, namely the extent to which hormone treatments—particularly GnRH agonists (puberty blockers)—have a lasting impact on the psychosocial and cognitive development of young people,” said the council, calling for more research.

Director’s cut: Dr Jay Bhattacharya, director of the US National Institutes of Health, talks with authors of the Gender Dysphoria Report commissioned by the US Department of Health and Human Services

Brain freeze

As long ago as 2006, clinicians from the famous Amsterdam gender clinic admitted it was “not clear yet how pubertal suppression will influence brain development”. British neuropsychologist Professor Sallie Baxendale has argued that puberty blockers may interfere with critical windows of cognitive development in adolescents, whose brains are not fully matured until age 25.

In 2024, another prominent Dutch clinician, psychiatrist Dr Annelou de Vries, said the Amsterdam clinic had intended in the past to carry out magnetic resonance imaging (MRI) studies of patients’ brains.

“We were planning to do such MRI studies, but we were not given the grants,” Dr de Vries told GCN?

Gaps abound

In its June 30 advice, the Health Council says: “Another significant knowledge gap is the lack of data on long-term outcomes, both physical and mental. There is also much uncertainty regarding the possibilities and outcomes of fertility preservation and how young people will view this in adulthood. Another knowledge gap concerns the lack of information on the clinical relevance of most of the observed effects.

“The [hormonal] treatments may also have undesirable effects, but the Health Council sees no reason, based on the limited data available on this, not to offer the treatments, particularly as doing nothing can also have harmful consequences for mental health.”

The suggestion that alternatives to the medicalised Dutch protocol represent “doing nothing” also implies that the benefits of blockers and hormones are well attested.

In some passages, the council appears to claim exactly that: “Research into the physical and mental outcomes of hormone treatments for young people with gender dysphoria generally shows consistent results. Physically, the treatments have the intended effects (they do what they are supposed to do), and mentally there are indications of some improvement.”

Elsewhere, the council is more candid: “The systematic reviews that summarise and assess the research into physical and mental outcomes agree that the strength of evidence for the observed effects is low to very low.

“There are several reasons for this. The available research consists solely of observational studies, most of which lack an (adequate) control group. Studies that do include such a control group often provide little or no information about possible differences between the groups and do not (sufficiently) adjust for these in their analyses (so-called confounding).

“As a general rule, it is not really possible to demonstrate a causal link between treatment and outcome on the basis of observational research. Furthermore, the study population in most studies was small in size, and it was not always clear how the study population compared in size and composition to the population that would be eligible for study participation (possibility of selective inclusion).

“Another important methodological limitation is that the follow-up period was short in many studies. Those studies that did have a long(er) follow-up period experienced substantial participant dropout during the study period. This can lead to selective bias, meaning that the results are no longer representative of the entire study group. Due to the generally short follow-up period and the substantial participant dropout, it is difficult to draw conclusions about long-term effects.”

Knowing, unknowing

In confident mode, the health council at one point contrives to see “indications … that the number of cases of regret is low”.

And, then, more candour: “[B]ased on the available literature, it is difficult to determine the number of people who regret their decision due to the generally short follow-up periods and substantial dropout rates in studies.”

Next, this: “These uncertainties do not give the committee cause to recommend any changes to the way care is organised.”

Regret rates below one per cent from the Amsterdam Cohort of Gender Dysphoria Study (1972-2015, with a median follow-up time of 6.4 years) are often cited internationally, but not the fact that 36 per cent of former patients were “lost to follow-up” in this study, meaning the clinic had no data for them and their regret rate might be significantly higher.

Over there, not here

Despite the missing data and unknowns, the new advice from the Health Council protests that gender clinics in the Netherlands have been immune to slipshod use of the Dutch protocol internationally.

“In the Netherlands, any somatic treatment is only considered following extensive assessment, diagnosis, psychological support and a determination of eligibility by a multidisciplinary team,” the council says.

The council appears to compare the careful ideal of the Dutch quality standard for physical interventions with actual delivery overseas, such as at the London-based Tavistock clinic, where treatment did not live up to the promise of cautious, multidisciplinary care.

“The starting point [in the Dutch standard] is not the affirmation of a pre-determined identity, but the careful assessment of the individual child’s needs from various perspectives,” the council says.

“This distinguishes the model from care practice elsewhere, as described in the [UK] Cass review and the Tavistock ruling, where treatment was based on a strongly affirmative approach with insufficient attention to alternative explanations for suffering.”

However, the new, revised Dutch guideline for hormonal treatments is to be aligned with the 2022 standards of care from the World Professional Association of Transgender Health (WPATH).

Those current WPATH standards were rated 35/100 for the rigour of their development in a peer-reviewed, University of York evaluation of international guidelines commissioned by the Cass review. The current Dutch guidelines are based on WPATH’s 2012 standards, which scored 26/100. Neither WPATH guideline was recommended for use by the York University researchers.

The perception of the Dutch as more rigorous and prudent has come under new challenge. In 2024, two detransitioners launched litigation against the Amsterdam clinic, claiming they were misdiagnosed. The Dutch protocol’s foundational studies from 2011 and 2014 have had their methodology re-examined critically. In any event, that earlier research data may not apply to today’s troubled teenage female patients.

Dr Hanneke Kouwenberg, a Dutch radiologist and nuclear physician who has followed the gender clinic debate, said: “While the term ‘careful’ may apply to the guidance prior to medical intervention, the accounts of both some persisters (such as Thiuri in the Zembla documentary) and especially desisters, detransitioners and/or their parents paint a very different picture.

“Diagnostics were not ‘extensive’ or exploratory; no questions were raised about the stated ‘gender identity’, no investigation was made into possible underlying causes, and the focus was simply on confirmation and steering towards intervention,” Dr Kouwenberg told GCN.

“Alternatives such as watchful waiting were not presented as serious options, as is also clear from Lieke Vrouenraets’ studies and from tweets by parents responding to the report. The gender clinics in the Netherlands therefore seem to illustrate the old saying: when your only tool is a hammer, everything looks like a nail.”

Unjustified treatment

On the eve of the release of the Health Council’s advice, a group including clinicians and ex-politicians put their names to an opinion article in the newspaper Trouw calling for deep inquiry into the Dutch protocol’s rationale. What follows is their initial assessment of the council’s June 30 report; the subject-matter experts of the group are still considering their individual “detailed and carefully weighed responses”—

“The [Health Council] advice contains some important acknowledgements of uncertainty and calls for better long-term research and monitoring. We welcome that. But those acknowledgements make the central problem more urgent, not less: the council has not answered the core question of whether the Dutch protocol itself is scientifically and ethically justified.

“Instead, the council has largely assessed the implementation of the protocol. It looks at whether the Dutch procedure is carefully organised, but it does not seriously return to the underlying question: is this medical pathway for minors justified in the first place? A careful procedure is not the same as a sound medical indication.

“This matters because one of the parliamentary motions that led to the advice explicitly asked for research into the physical and mental health outcomes after treatment with the Dutch protocol methodology, compared with cohorts in other European countries with different standards of care. In our view, that question has not been answered. The council has not provided such an outcomes-based comparison, nor has it made a serious attempt to establish whether the Dutch protocol produces better long-term health outcomes than alternative approaches.

“That omission is especially serious because these are far-reaching and partly irreversible interventions: puberty blockers, cross-sex hormones and, in some cases, surgery. They may have consequences for fertility, sexual function, bone development and lifelong medical dependency. For interventions of this kind, the evidentiary threshold should be high. Yet the strength of the evidence, the balance between benefits and harms, and the question whether these interventions produce real long-term health gains remain seriously contested.

“A further problem is that the council appears to adopt much of the conceptual framework behind the Dutch protocol at the outset: the existence of ‘gender identity’, the idea that everyone has one, and the idea that gender dysphoria may require medical alteration of the body because ‘doing nothing’ is not an option. But these are precisely the assumptions that should have been examined.

“The international comparison is also problematic. The council presents countries such as England, Sweden and Finland as if their concerns mainly relate to poor implementation elsewhere, while the Netherlands supposedly applies the protocol more carefully and is therefore largely vindicated.

“But the criticism from Dr Cass, Professor Kaltiala in Finland, Sweden and other recent literature goes deeper. It concerns the weak evidence base, the changed patient population, psychiatric comorbidity, the lack of robust causal evidence for long-term health benefit, and the question whether medical transition in minors is the right treatment pathway at all. This is particularly striking in the case of Finland, whose registry-based long-term follow-up studies should have been central to any serious international comparison.

“Finally, if the council recognises that robust long-term evidence is still lacking, it should also explain why available long-term data have not been analysed.

“The Netherlands has decades of clinical experience with this pathway, and relevant data sources exist in clinical databases, insurance records and national registries. The council cannot simply point to a lack of long-term evidence without asking why these data have not been linked and studied to examine outcomes such as psychiatric morbidity, physical health conditions, treatment discontinuation, detransition and mortality.”

And while the term ‘careful’ may apply to the guidance prior to medical intervention, the accounts of both some persisters (such as Thiuri in the Zembla documentary) and especially desisters, detransitioners and/or their parents paint a very different picture. Diagnostics were not ‘extensive’ or exploratory; no questions were raised about the stated ‘gender identity’, no investigation was made into possible underlying causes, and the focus was simply on confirmation and steering towards intervention. Alternatives such as watchful waiting were not presented as serious options, as is also clear from Lieke Vrouenraets’ studies and from tweets by parents responding to the report.

The gender clinics in the Netherlands therefore seem to illustrate the old saying: when your only tool is a hammer, everything looks like a nail.

GCN global briefs

Shameful Pride

Finland | Pride celebrations in Helsinki at the weekend included trans rights activists holding aloft a banner urging “Out with transphobia, down with Kaltiala. To Hell with Tuisku, Kettula, Ruuska and Heino”. These are the names of Finnish researchers whose scientific work has cast doubt on the dogmas of “gender-affirming care”. A photo of this activist call-to-arms was published by the widely read newspaper Helsingin Sanomat.

“I am horrified that the Pride organisation allows that [personal attack] and Helsingin Sanomat gives it room,” Professor Riittakerttu Kaltiala told GCN.

She and her colleagues had been among the earliest in offering the Dutch protocol hormonal treatments for adolescents from 2011. However, the Finnish clinicians shifted to a less medical, more psychological approach in 2020 after noting the poor outcomes of a troubled patient group significantly different from the Dutch protocol studies.

Professor Kaltiala has emerged as an international critic of the “gender-affirming” medicalisation of minors. Her concerns follow the evidence, including unusually comprehensive studies thanks to Finland’s health registers.

Out with transphobia, etc. Photo from a gallery published by Helsingin Sanomat

Fake news

In a recent article, the Finnish Medical Journal documented cases of “hot-topic” researchers, Professor Kaltiala included, who were targeted for harassment and cancellation. Journalist Heli Väyrynen reported that Professor Kaltiala’s statements had been “distorted”.

“It has been [falsely] claimed that she wants to ban gender-reassignment treatments or regards an identity that diverges from biological sex as a mental health disorder,” Väyrynen wrote. “Activists have tried to influence the organisers of training events and demanded that lectures be cancelled. They have spread lies about her clinic, her work, and her research to Tampere University and [its associated hospital] TAYS.”

“Kaltiala emphasises the correct timing of physical treatments. When gender identity is still forming, a cautious approach is justified because the changes are partly irreversible. Young people coming for assessment who hope for corrective treatment often have serious mental health disorders that cannot be interpreted as caused by gender, so the issue is complex and challenging. They may need other help first.”

Professor Kaltiala told Väyrynen it had never occurred to her that the topic of paediatric transition “wouldn’t follow the same rules as the rest of medicine”. Professor Kaltiala appreciated her university’s measures to support staff coming under activist attack. “I have received thanks from the scientific community and colleagues for raising issues that not everyone dares to speak about,” she said.

Respect the science

America | In a letter to The Wall Street Journal, endocrinologist Dr Roy Eappen, of the watchdog group Do No Harm, has hailed a recent Finnish study on the poor mental health outcomes after paediatric medical transition as “a scientific tour de force”.

“The question now is whether US medical societies will respect the evidence and uphold their ethical obligation,” Dr Eappen wrote. “The American Academy of Pediatrics still unquestioningly supports providing invasive and irreversible medical interventions to adolescents, including hormones and surgeries. So does the Endocrine Society, of which I am a member. While the society is planning to publish new treatment guidelines this year, it’s an open question whether the new version will be grounded in evidence or more ideology.”

“Medical societies have an obligation to follow the science. For the sake of struggling children confused about their gender—to say nothing of the societies’ own reputations and influence—these organizations should use the release of the Finnish study as an opportunity to finally do what’s right.”

Go deeper

Holland | The Health Council of the Netherlands, scheduled to report on paediatric medical transition on June 30, must go beyond the evidence base to scrutinise the assumptions of the Dutch protocol, according to an opinion article in the centre-left newspaper Trouw. The council, asked for advice by the Dutch House of Representatives in 2024, has already referred to its subject matter as “transgender children and young people”. That is problematic, according to the article for Trouw, which was signed by a broad group including clinicians and ex-politicians.

“Is a young person with gender dysphoria someone with a fixed, inner gender identity that needs to be affirmed?” the article asked. “Or is it a matter of discomfort regarding the body, sexual orientation and societal expectations, the origins, meaning and development of which remain open to interpretation?”

“That choice determines how research is interpreted, how diagnoses are made and what care a young person receives. Should the focus initially be on comprehensive assessment and psychological support? Or should the process move relatively quickly towards a medical pathway, with far-reaching and often irreversible consequences for fertility, sexual experience, bone density and lifelong dependence on hormones?

“Gender dysphoria in young people can have multiple causes. It is therefore not sufficient to examine medical outcomes alone. We must also ask: what alternative pathways have been considered? How do young people develop differently without medical intervention? And who actually benefits from a radical medical intervention?”

The opinion article argued that the Netherlands “bears a special responsibility” as the source of the medicalised Dutch protocol for gender transition, and cannot continue to ignore the international shift towards a more cautious, less invasive response to gender-distressed youth.

“It is precisely during puberty that many young people gain greater clarity about their bodies, sexuality and sexual orientation,” the article said. “A longitudinal study from the Groningen TRAILS cohort shows why caution is warranted: feelings of dissatisfaction with one’s own gender were relatively common in early adolescence, but later subsided in a significant proportion of young people. Such findings underline that discomfort regarding one’s gender can change during development and that it is therefore risky to interpret this discomfort too quickly as a fixed gender identity.”

One of the article’s authors, publicist Geert-Jan Edelenbosch, a former coordinator of the youth and education program at the LGBTI organisation COC Nederland, told GCN that the Trouw article was significant because it had appeared “in a serious mainstream Dutch newspaper, just before the Health Council publishes its advice, and with a broad group of signatories rather than from one predictable political or activist corner.”

“Until now, concerns about the Dutch protocol have often been treated in the Netherlands as marginal, ideological, or as something happening ‘abroad’,” Mr Edelenbosch said. “This article helps move the debate into the mainstream: doctors, psychologists, parents, writers and politicians are openly asking whether the evidence base is strong enough for such far-reaching medical interventions in minors.”

Earlier attempts to raise awareness about the shortcomings of the Dutch protocol include a 2023 documentary, the Transgender Protocol, and two opinion articles in NRC by the writer Jan Kuitenbrouwer and media sociologist Dr Peter Vasterman in 2022 and 2024. In 2020, women’s organisation Voorzij put its concerns about the gender medicalisation of minors to a Dutch parliamentary committee.

Mortality as an afterthought

International | The Amsterdam clinic, home of the widely adopted Dutch protocol, has no good basis for its recent claim that, after three decades of research, clinicians can have “more confidence” in the use of puberty blockers, cross-sex hormones and trans surgery. This is the critique of a new paper in the European Journal of Developmental Psychology by psychiatrist Dr Kathleen McDeavitt and J Cohn of the Society for Evidence-based Gender Medicine. The authors said the Dutch research lacked “methodologically robust” designs, and the Amsterdam clinicians had ignored six years of high-quality systematic reviews confirming the weakness of the evidence base.

Child and adolescent psychiatrist Dr Annelou de Vries and her Dutch colleagues had underplayed the risks when relegating the death of one patient in their pioneering study to the “methods” section of a paper, according to the McDeavitt-Cohn paper.

“They did not explain that this death was directly attributable to the penoscrotal hypoplasia caused by [puberty blocker]/oestrogen exposure. Consequently, the mortality associated with the Dutch protocol approach has never been identified as a harm by systematic reviews.”

Domino theory

America | The US Federal Trade Commission (FTC), together with Texas and other states, has begun legal action against the World Professional Association for Transgender Health, claiming that WPATH “has provided the means for medical providers to make false and unsubstantiated claims to parents in order to sell pediatric medical transition services”. The FTC’s 123-page complaint alleges that WPATH’s treatment recommendations “misled parents and children about the medical consensus and medical necessity, as well as the safety and effectiveness, of such services, in violation of the FTC Act”.

In UnHerd magazine, commentator Leor Sapir said an FTC success against WPATH would have knock-on effects. “WPATH has spent the past two decades infiltrating bona fide medical groups such as the Endocrine Society with the goal of getting them to launder its credibility by staking their own on it,” Mr Sapir wrote. “WPATH’s downfall would thus likely trigger a larger collapse, bringing public scandal—and potentially legal and financial liability—to other doctor groups.”

Mr Sapir featured in an X space talk on the litigation, hosted by the group Democrats for an Informed Approach to Gender. In a statement, WPATH protested that the FTC “has no place interfering with the process of individualised medical decision-making and the FTC also does not have any jurisdiction over WPATH and its non-commercial speech”.

Not what you think: British barrister Dennis Kavanagh, a gay man, likens Labour’s draft ban on “conversion practices” to the Margaret Thatcher-era s28 law against promotion of homosexuality.

Criminalising caution

United Kingdom | The ruling Labour Party government has introduced a draft “trans-inclusive” criminal law against “conversion practices” with penalties up to five years’ prison and unlimited fines. A conversion practice could be conduct with the intention of causing someone to “believe that they have or do not have” a particular sexual orientation or trans identity. There is conditional protection for those providing “health care services”, but not for parents.

Bev Jackson, co-founder of the LGB Alliance, said the law would “criminalize a parent who says: ‘No, you’re a boy. Maybe you’re gay. That’s fine: Let’s get you some therapy to explore the causes of your distress’. It will criminalize a parent who says ‘No, I refuse to pay for binders, blockers, testosterone. You’re a girl. It’s fine to be a lesbian.”

US detransitioner Jonni Skinner, a young gay man, said he believed such conversion practice bans were “a work around to solidify the affirmation-only approach to pediatric gender distress into law—[something] which has already and will continue to have catastrophic consequences for gay, gender non-conforming, and other vulnerable youth into the future.”

In the UK Parliament, Labour MP Tonia Antoniazzi asked if the draft law would allow “detransitioners to bring retrospective cases against therapists and professionals who transitioned them using that affirmative approach”.

The parents’ group Bayswater Support said the new statute would “harm the very people it purports to protect by enshrining in law a belief that is inextricably bound up with rejection of the body and psychological distress”. “Individual parents, parent-led support groups like Bayswater Support and healthcare professionals (including the NHS paediatric gender services) continue to be subjected to a barrage of false accusations that they are engaging in ‘conversion’. This draft bill adds the threat of criminal prosecution to those wildly inaccurate claims.”

The Free Speech Union (FSU) has begun a petition against the draft law. “Speech is always curtailed in the name of preventing ‘harm’,” the FSU said. “But stopping parents talking honestly to their children about the risks of irreversible medical procedures will cause actual, real-world harm. This is a fight we have to win.”

Columnist Sonia Sodha saw Labour’s draft law as a device “to smuggle a new concept into criminal law of an undefined ‘gender identity’ that is defined nowhere else in [UK] law, and which pulls against the emerging medical consensus that children and young people don’t have fixed ‘gender identities’, their identities are in flux”.

In her analysis, barrister Sarah Phillimore found no sign that the bill’s drafters had considered its likely effect on the family justice system. In the worst-case scenario, she said, prosecution of parents for a conversion practice could lead to orders for removal of the child, or even all their children.

Thought control

International | A paper by US paediatrician Dr Julia Mason and colleagues has warned that overly broad bans on conversion practices conflate psychotherapy with coercion and put a political chill on normal clinical inquiry. “The case of youth gender dysphoria illustrates how political institutions can shape psychology not only by regulating interventions, but by narrowing the scope of permissible clinical thought,” Mason et al argued in the journal Current Opinion in Psychology.

“When uncertainty is reframed as harm and exploration as misconduct, psychology risks abandoning its foundational commitments to formulation, pluralism, and developmental sensitivity. Preserving space for psychotherapeutic inquiry is therefore not merely a clinical concern, but a disciplinary imperative.”

Inner soul-searching

Germany | The concept of gender identity, claimed to be something that humans have known since time immemorial, is in fact “entirely new”, according to a new book by the American sociologist Rogers Brubaker. His book, Gender Identity: The Career of a Category, has been reviewed in the German newspaper Die Welt under the headline “The invention of ‘gender identity’ and its destructive consequences”. “The concept of gender identity, as Brubaker writes, actually originates from medical diagnostics and referred to a disorder,” Die Welt’s reviewer said.

“By appropriating and redefining the term, transgender activism was in turn able to drive medicine forward, as in the justification for ‘gender-affirming treatments’. The crux of the matter is that perceived gender is now regarded as innate, whilst biological sex is seen as arbitrarily adaptable—a complete reversal of the old gender theory.

“[According to Brubaker] the triumph of gender identity was not the result of a major public debate, but of ‘insider activism’ that specifically influenced state and party bureaucracy: a ‘silent revolution’ through the back door. The great debate is now coming after the event, Brubaker observes, with regard to the ‘Trans Wars’ that are now raging,” Die Welt said.

The recent Finnish study, which radically undermines the “transition or suicide” rationale for gender-affirming care, has been reported in the Frankfurter Allgemeine Zeitung (FAZ). The article’s main headline is “A different gender, yet still unhappy”, with a secondary heading “Young people with gender dysphoria do not feel better after [hormonal] therapy—possibly because their psychological problems are not resolved by it.”

A well-known German critic of the affirmative treatment model, child and adolescent psychiatrist Dr Alexander Korte is quoted by FAZ. “The study shows once again how important it is to clarify what is mentally burdening children or teenagers before starting an invasive therapy,” Dr Korte said.

FAZ wrote: “If a young person wants transition, one must first find out why they want it, says Korte. ‘Perhaps they are looking for an explanation for why they constantly feel down or anxious or why they are being bullied. Because there is now a hype around being trans, they think that must be the case for them too and see the only solution in a transition—but that does not solve their psychological problems’.”

“Korte’s tip for those affected who have undergone transition and are still suffering: ‘Go to your former psychiatrist, or find a new one, and inform yourself through self-help groups. There are still opportunities now to alleviate your complaints with psychotherapy’.”

Unmothering

Argentina | The 2012 law for gender self-ID in Argentina—believed to be the world’s first jurisdiction to introduce this radical change—leaves minors unprotected, according to Miriam Domínguez, a spokesperson for parents’ group MANADA. In an interview with MDZ, Ms Domínguez said: “A minor says they’re trans, and they’re automatically validated and encouraged to start the path toward gender transition. The transition begins socially. So, schools, without informing the parents, allow a boy or girl to change their name and pronouns when they ask”.

She said the operation of the law also distorted a mother’s life story. “The registration change on the ID card isn’t limited to the ID card; the birth certificate is also changed. So, if you’re a mum, they also change your life story because you go from having given birth to a girl to having given birth to a boy.”

In February 2025, Argentina’s president Javier Milei issued a decree to prohibit gender medicalisation of minors. Ms Domínguez said this decree did not stop hormonal interventions that had already begun. “The issue is that when the state funds this, hormones automatically become like candy—that is, they’re handed out, and this costs a huge amount of money.”

Desistance to be desired

International | The therapeutic goal with gender dysphoric youth should be desistance—a non-medical resolution of distress—and not transition, according to a paper by sexologist Professor J Michael Bailey and clinical psychologist Dr Ken Zucker. Advocating cognitive behavioural therapy for gender-distressed children and adolescents, the authors noted that medical transition “has serious social and medical complications”.

In their paper for Current Opinion in Psychology, they argued that ideology, not empirical evidence, explained the rise and dominance of the gender-affirming care model. And they asked: “Could so many professional [medical] organizations support irrational and destructive clinical guidelines? Unfortunately, the answer is ‘yes’.”

Three types of gender dysphoria in young people are distinguished in the paper: childhood onset, autogynephilic, and rapid-onset gender dysphoria (ROGD). The latter two types, the authors said, have been targets for an attempt to shut down scientific debate.

“The temporary ascension of gender-affirming care over other approaches was achieved, not with data and reason, but with suppression and intimidation. We expect that it will not be long before the recent gender-affirming era will be retrospectively viewed with disdain, if not with horror. We are less certain, but more hopeful, about the aftermath.”

Trial unblocked

United Kingdom | The PATHWAYS clinical trial of puberty blockers, which had been put on hold in February because of safety and ethical concerns, is to go ahead in modified form, with recruitment of gender-distressed minors as young as 11 to begin on August 1. Modifications include clearer criteria for discontinuing blockers in the event of concerns such as brain impacts.

Opposition Leader Kemi Badenoch, who forced a parliamentary vote on the trial, said: “It is NOT ok to experiment on kids as young as 11 and make irreversible changes to their bodies. We must protect children from dangerous ideology.”

The motion to stop the trial was moved by Shadow Health Minister Dr Caroline Johnson, a paediatrician. She said gender incongruence—the diagnostic rationale for the trial—was subjective. “The trial will take 226 children who are physically healthy—who are developing normally—and inject them with powerful drugs to delay that normal development in a way that may weaken their bones, affect their ability to think, damage their sexual function, and leave them unable to have children of their own,” Dr Johnson said. The motion was defeated by 283 votes to 112.

Some critics of the trial have argued that the National Health Service’s Data Linkage Study—to follow up the 2,000-odd patients given blockers as minors at the Tavistock gender clinic—should be done before the new prescribing of a trial. The Data Linkage Study will be completed, Health Secretary James Murray told Parliament, but he said it would deliver “much more limited” information than the clinical trial. There are 30-plus questionnaires for the trial, including intimate material, such as “In the last year have you had oral sex with another person?”

Baroness Cass, the paediatrician whose 2020-24 review had recommended a clinical trial, stood by the project during debate in the House of Lords. “I am not worried about the children in the trial, but I am seriously worried about the children not in the trial. Approximately 240 children who have come to the new [NHS gender] clinics have admitted to being on an extraordinary cocktail of medications, including testosterone from age 11, with facial hair at 13.”

“Why are they doing this? They are not being perverse: we have told them for 15 years that these drugs are safe, effective and even life-saving, so is it any surprise that they will now go to any lengths to get them [from rogue providers]?”

Olivia is OK with it

United Kingdom | In The Times, former senior BBC editor Rob Burley has analysed the gender ideology capture of the broadcaster. He also recorded the thwarted attempts of staff who pushed back against the undue influence of trans rights activism. “One [of these troubled journalists] even told me how her manager responded to her concerns about the way the BBC was covering trans stories by offering, as evidence, that her 14-year-old daughter was OK with it,” Mr Burley wrote.

Tour of duty

International | Trans rights activists are wrong to insist that parents have a moral duty to support their children’s gender medicalisation, according to a paper in the Journal of Controversial Ideas. The authors presented two cases: the first 12-year-old boy wishes to undergo “an extreme form of genital mutilation” as a religious initiation rite; the second 12-year-old boy is considering surgical transition to the female gender. In each case, the authors argued, the minor “lacks requisite cognitive development”, and the parents are morally obliged to oppose these drastic interventions.

In the same journal, philosophers Professor Alex Byrne and Dr Moti Gorin ponder what is meant by the term “trans kids”. They rejected the view that the trans child was nothing more than a cultural fiction; they also disagreed with the formulation “that some children are transgender, just as some children have brown eyes or are naturally outgoing”.

Instead, they concluded that trans kids are “created”. “[A] social process that in part involves classifying people as transgender children is responsible for new transgender children, molding them from the raw material of cross-sex identification and behavior.” This, they said, poses a new question: “whether we should continue to create” trans kids.

Teens at risk

France | In an interview with clinical psychologist Dr Céline Masson of the watchdog group The Little Mermaid, a French transwoman working in the voluntary sector has argued for a more cautious approach with minors. “I’m against surgery before the age of 18. People say it doesn’t happen, but we know full well that there are professionals who do it anyway. Especially on girls—those who want to become boys. The main operation remains a mastectomy. And teenagers, they want everything, right away.”

Crazy as normal

America | As chief executive of the Foundation for Individual Rights and Expression, Greg Lukianoff is a seasoned observer of free speech and its enemies. “In my career defending academic freedom and free speech, I never saw anything become as immediately radioactive as views that ran counter to the narrative on trans issues,” Mr Lukianoff said.

“Papers were retracted, compelled speech was treated as normal, and people were canceled for saying things that would have sounded like common sense just a few years earlier. It seemed to become a kind of secular blasphemy overnight. And usually, that is a sign that the true believers know, at some level, that they are on shaky ground.”

Each-way bet

America | Using Freedom of Information documents, journalist Jesse Singal has revisited the flagship National Institutes of Health (NIH) study of puberty blockers led by gender clinician Dr Johanna Olson-Kennedy and her affirmative colleagues. Mr Singal showed that in 2014, when Dr Olson-Kennedy was applying for the grant, NIH reviewers had reservations about the weak design of the proposed multi-clinic research.

It was observational, not experimental (and Mr Singal pointed out that experimental studies did not have to be double-blinded). In response to this concern, Dr Olson-Kennedy and her colleagues made two contradictory claims.

First, Mr Singal wrote, they said “there existed ‘no data’ on the ‘mental health impact, safety, or tolerability’ of blockers, particularly in this cohort … but [they also insisted] that it would be unethical to withhold this medication from any patients. These two claims are very much in tension.”

The “unethical” claim rested on the assertion that Dr Olson-Kennedy and colleagues already knew that puberty blockers worked. But, as Mr Singal noted, there was no good data to support that “knowledge”, which amounted to no more than the statement, in Mr Singal’s summary, that “The small group of early practitioners of youth gender medicine believed puberty blockers worked as a treatment for youth gender dysphoria and enshrined their belief in the early guidelines [by the Endocrine Society and the World Professional Association for Transgender Health].”

Enby boss

International | Philosopher Miroslav Imbrišević has classified “non-binary” identity as a “self-posited social kind”, as opposed to a natural kind such as tiger, rip tide or volcano. In this sense, he argued, self-posited or privately determined kinds were “deeply undemocratic, because their representatives aim to impose their own reality on all other members of the social world; their fellow human beings have no say about it. Tellingly, supporters of these social kinds tend to exhibit an authoritarian streak.”

Rachel Hannam

The old expression “throwing the baby out with the bathwater” refers to accidentally discarding something valuable while trying to get rid of something unwanted.

It is a useful metaphor for the current debate surrounding gender care.

Most clinicians would agree that we needed to challenge and discard the old “bathwater” of pathologising homosexuality, enforcing rigid gender roles, disparaging gender nonconformity, and assuming that clinicians always know best. These were genuine advances that needed to be made.

The problem is that, in our determination to remove those outdated assumptions, we also discarded some of the things we still needed. In rejecting stigma, we rejected diagnostic curiosity. In rejecting paternalism and conservatism, we rejected thoughtful clinical judgement. In rejecting “gatekeeping”, we rejected careful assessment. In rejecting certainty about gender, we abandoned our tolerance for uncertainty itself.

History reminds us that some of medicine’s greatest mistakes were made by compassionate professionals genuinely attempting to relieve suffering. Conversion therapy, lobotomies, and thalidomide were not born from cruelty. They emerged from a genuine desire to help, coupled with misplaced certainty about what would fix it and a failure to adequately weigh long-term risks against immediate hopes or ideas of the time.

Good intentions have never been enough.

The debate over gender medicine is therefore not simply about transgender identities, healthcare, or politics. At its heart, it is a debate about how we understand and grapple with human suffering.

For much of modern history, psychology and medicine have wrestled with a difficult question: when should distress be accepted, explored, and understood, and when should it be treated with interventions? Increasingly, I believe we have lost our capacity to hold that tension.

I believe the future of psychology and good psychotherapy depends less on discovering new treatments and more on recovering an older wisdom: that human discomfort and struggles are often complex, meaningful, and resistant to quick solutions.

On complexity

Modern medicine excels at solving complicated problems like fixing a broken leg or removing an appendix. The challenge is recognising when a problem is complex rather than merely complicated. It is also a challenge to determine when something is truly a problem at all—not all discomfort is a problem—and psychology has long known about optimal discomfort and its importance for learning and growth (Vygotsky, 1978). And yes, sometimes young people have gender dysphoria and find it deeply distressing. But in these cases, the distinction between complicated and complex matters.

Complicated problems can be broken down into discrete parts, analysed, and solved through technical expertise. Complex problems involve multiple interacting factors, uncertainty, and outcomes that cannot be predicted with confidence. Some of these factors are likely to be philosophical, moral and ethical, rather than just physical or technical.

Many of the disputes surrounding youth gender care stem from disagreement about what kind of problem gender dysphoria actually is.

The rhetoric I often encounter is that “trans people have always existed”. I see the issue differently. As a psychologist, I find the definition of “trans” very broad and too imprecise to be useful. I know the term “trans” is intended to be broad and imprecise, and reflects a “lived experience”, but I also know it is a modern construct that hasn’t always existed. However, the experience of diverse gender expression and ambivalence (or dislike of one’s body or role in society) has always existed.

I have spoken with enough older lesbian, gay, bisexual, and gender-nonconforming individuals to know that many wrestled for years with discomfort about their bodies, their sexuality, or the cultural expectations of their sex. Looking back, many describe these experiences not as problems with simple solutions, but as part of the complexity of becoming fully human.

The question is not whether (that which we now label) gender dysphoria exists. The question is: What kind of problem do we understand gender dysphoria to be?

In recent years, gender dysphoria in young people has increasingly been treated as though it were a complicated problem with a straightforward solution: discuss the distress, give it a name, affirm the identity, get schools and families on board, modify the body, and the patient feels better.

Yet gender-related distress appears to be a profoundly complex phenomenon involving developmental, psychological, familial, socio-cultural, neurodevelopmental, and biological factors that interact in multi-directional ways we do not fully understand.

As Meadows (2008) argues, simplifying a complicated problem can be very helpful. Simplifying a complex problem can be very dangerous.

Gender distress is experienced by an individual, but its causes are contextual, layered and complex. When complex human problems are reduced to a single explanation and set of interventions, we risk mistaking simplification for understanding. Human struggles are not always problems to be fixed. Sometimes they are realities to be understood, explored, and accepted.

Sometimes we need to say to a young person: “I really understand that you wish you had been born female, but you were born male.” Or vice versa. Then we explore what that means.

A medical lens

The gender medicine debate reflects a broader cultural shift.

Modern society has become increasingly uncomfortable with ordinary human suffering and inclined to medicalise it. Experiences once understood as part of personality differences, developmental struggles, or the ordinary challenges of growing up, are now routinely viewed through a diagnostic lens. Our profession of psychology has become exceptionally skilled at naming suffering and less patient with understanding it. In our desire to help, we often teach people that ordinary struggles are symptoms to be treated rather than experiences to be navigated.

The gender medicine debate therefore exposes a larger question: have we become too quick to medicalise human discomfort and avoid the complex struggles of the human experience?

Psychologist Nick Haslam’s (2016) concept creep thesis argues that concepts such as trauma, abuse, harm, and mental disorder have gradually expanded to encompass an ever-wider range of human experiences. This expansion has undoubtedly increased awareness of genuine suffering. But it has also reduced our tolerance for normal human adversity.

When every struggle becomes a disorder, the space for personal growth, adaptation, and resilience begins to shrink. This concept creep coincides with the current cultural exaltation of minority status and oppression. Such confluence of sociocultural factors in therapeutic culture has revealed important issues, but it has concealed others and created blind spots in our practice.

Curiosity disappears

The consequences of medicalisation trends often become visible in the therapy room. Increasingly, clients arrive with diagnostic labels already attached to their experiences. This is not just in the gender space but also with neurodiversity where clients come in saying: “I think I have ADHD/Autism/Dissociative Identity Disorder”. Sometimes these labels are helpful or appropriate. They can provide relief, validation, or a framework for understanding distress. However, they can also create significant therapeutic blind spots.

The clinician’s task is not to reject a person’s understanding of themselves, but neither is it to endorse it. The most valuable question in therapy is not, “What do you believe?” but rather, “How did you come to believe that?” The task of therapy is not to affirm a story at face value. It is to understand how that story was written.

The danger is what clinicians sometimes call diagnostic foreclosure. Once a label becomes an answer, curiosity disappears. We stop asking “Why?” because we believe we have already established “What”. Once a diagnosis is attached, everything can start looking like evidence for it—classic confirmation bias. Labels that initially illuminate complexity can gradually collapse it.

Respecting complexity matters because when diverse experiences are grouped together in a single category, we lose sight of the individual. The more significant the intervention being considered, the greater our obligation to understand the unique story that precedes it. Labels can bring clarity, but should never become substitutes for understanding.

Psychology loses its way when understanding is replaced with validation. When therapy becomes a process of confirming conclusions rather than investigating them, opportunities are lost. The goal is not to challenge people for the sake of challenging them. The goal is to ensure that important questions have not gone unasked.

I believe that what psychology as a discipline needs now is not more rhetoric, nor more sympathy.

Psychology needs more curiosity.

Missing the individual

One of the mistakes in this field has been to treat gender dysphoria as a single phenomenon with a single explanation (or no explanation). The most natural question for psychologists and doctors alike should be: “What might be driving this client’s rejection, dislike, repulsion or distress related to their body?”

The question is not whether dysphoria is real. Of course, it is. People have disliked their bodies in various ways for many years, e.g., due to their weight (eating disorders), or their perception of their nose being too big (body dysmorphia). The important questions are: “Have we been too quick to assume that everyone is experiencing the same thing? And what contributes to the experience in the first place?”

In practice, we have grouped together very different people under the same umbrella, despite profound differences in histories, motivations, developmental pathways, and experiences. A girl whose hatred of her body is linked to trauma, bullying, or sexualisation may be experiencing something very different from an autistic or gender-nonconforming boy who believes life would be easier as a girl. Both may differ significantly from an adult male who has spent years entertaining erotically-charged fantasies about becoming a woman.

There are many roads that lead to gender dysphoria; there is danger in assuming they begin in the same place.

Perhaps the most important unresolved question in gender care is whether distress arises because the body is wrong, or because the person’s relationship to their body has become troubled.

These are not merely semantic differences. They represent fundamentally different formulations of the problem and lead to very different therapeutic responses.

Many clinicians I know privately acknowledge this dilemma, one that has little to do with politics. We are told that gender diversity is a natural and healthy variation of human experience, yet gender dysphoria is simultaneously conceptualised as a medical condition requiring irreversible interventions.

We tell young people that bodies do not determine their gender, yet body modification is often presented as a primary pathway to resolving distress.

These inherent contradictions are difficult to ignore.

If gender identity is independent of the body, why does treatment so often focus on changing the body? If gender diversity is a normal variation, why is it approached through a medical framework?

These are legitimate clinical questions. Asking them should not be considered controversial, nor should challenging logically inconsistent answers be dismissed as transphobic.

A profession that questions itself

Good clinical care requires the ability to hold compassion and critical thinking at the same time. These qualities are not opponents. They are partners.

The question is not whether a particular approach is right or wrong. The question is whether we remain free to examine its assumptions, limitations, and outcomes. When certain questions become difficult to ask, the quality of our clinical thinking suffers.

This is particularly important in areas involving significant uncertainty and potentially irreversible interventions. Scientific progress has never depended upon unquestioned consensus. It depends upon the freedom to examine, challenge, refine, and sometimes abandon prevailing ideas when the evidence warrants it.

A mature profession is not one that never makes mistakes. Every profession and professional makes mistakes. The mark of maturity is the willingness to identify blind spots, revisit assumptions, and tolerate disagreement in the service of better care. Psychology and medicine should be confident enough to examine themselves without fear.

What therapy can offer

If gender-related distress is often complex, then our response should reflect that complexity. Given the increasing visibility of (and lawsuits involving) detransitioners, we should be far more cautious than we have been. Medical intervention has increasingly become a substitute for the deeper exploration that identity struggles often require.

Importantly, affirmation and exploration should not be treated as opposites. The deepest form of affirmation is taking a young person’s experience seriously enough to explore it fully. Genuine curiosity communicates respect. It says, “Your experience matters enough that I want to understand it in all its complexity”, knowing that this takes time.

Therapy can provide an opportunity to slow everything down, not just for the sake of it, but because exploration, understanding, and personal growth, especially growing into our adult identities, should take time. Time allows clinicians and families to explore the onset and development of gender-related distress, examine social influences such as peer groups and online communities, and consider the broader identity formation processes. It creates space to assess for autism, trauma, anxiety, depression, obsessive-compulsive disorder, eating disorders, and other psychological concerns that have historically contributed to distress.

Therapy also allows clinicians to work collaboratively with parents rather than excluding them from the process. The gathering of information from different perspectives has been a typical component of therapy, not an anomaly. The therapeutic process encourages humility about self-diagnosis and resists the temptation to collapse complexity into a single explanatory framework.

At its best, therapy provides an opportunity for people to build tolerance for uncertainty, ambiguity, and emotional discomfort. It cultivates self-compassion, resilience, and reflective capacity.

Therapists should continually ask: “What is going on here?” And then follow with a second question that is equally important: “What else might be going on here?”

Rather than assuming the body is the problem, therapy can help people cultivate hope for a more peaceful relationship with the body they already have.

Your body is not a mistake

Psychology has traditionally helped people cultivate self-acceptance. We should not abandon that principle. Across virtually every area of mental healthcare, the goals of self-understanding, self-compassion, and resilience remain foundational therapeutic aims. It is deeply embedded in Acceptance and Commitment (ACT), compassion-focused and psychodynamic therapies.

As therapists in this space, we must be careful not to collude with self-rejection. The deepest forms of therapy help people reconcile with themselves rather than divide themselves against themselves. Self-love does not mean complacency. It means learning to treat yourself as a person to be understood rather than a problem to be fixed.

A healthy society should teach young men and women that they do not need to modify their bodies in order to be worthy of love, belonging, or dignity. Young people deserve to hear that their bodies are not mistakes and that they are already their “true selves”, even if it makes them feel uncomfortable at times. During adolescence and early adulthood, identity is often fluid, dynamic, and evolving. Under the age of 30, a changing sense of self is a sign of healthy development rather than pathology.

A culture that genuinely celebrates diversity should also be capable of communicating a simple message: it is possible to learn to feel at home in your body. Supporting clients to inhabit their bodies with acceptance remains one of our most important therapeutic tasks as psychologists.

Before we ask whether a body should be changed, we should first ask whether the person has been given every reasonable opportunity, over time, to learn to love and accept themselves as they are.

The baby we need to keep

A psychologist’s role is not simply to make suffering disappear. It is to help people find meaning, dignity, resilience, and growth within it. The capacity to sit with discomfort and suffering is becoming a neglected clinical skill in an age increasingly focused on immediate relief.

There is something profoundly healing about discovering that you do not need to become someone else to be worthy. Human flourishing begins with the radical idea that you are worthy of care before you change anything about yourself.

That principle sits at the heart of psychology’s traditional commitment to self-understanding, self-acceptance, and human development. It is the foundation beneath curiosity, reflective capacity, resilience, and the ability to tolerate uncertainty.

The debate over gender medicine is often presented as a conflict between affirmation and exploration, or between validation and caution. It is neither. The real challenge is whether we can preserve the ethical foundations of clinical care while responding to genuine distress.

In our effort to remove the bathwater of stigma, discrimination, rigid gender roles, and outdated assumptions, we have discarded some of the very things that make good therapy possible: curiosity, careful assessment, developmental understanding, tolerance for uncertainty, and respect for complexity.

Those are not obstacles to compassionate care. They are compassionate care.

And that is the baby we need to keep.

Dr Rachel Hannam has been a practising psychologist since 2002. She works in private practice in Brisbane, Australia.

List of references

Haslam, N. (2016). Concept creep: Psychology’s expanding concepts of harm and pathology. Psychological Inquiry, 27(1), 1–17. https://doi.org/10.1080/1047840X.2016.1082418

Meadows, D. H. (2008). Thinking in Systems: A Primer. Chelsea Green Publishing.

Vygotsky, L. S. (1978). Mind in Society: The Development of Higher Psychological Processes. Harvard University Press.

What follows is, in my opinion, a well-articulated and moderate case for restricting further use of puberty blockers and cross-sex hormones with gender-distressed minors.

Cory Bernardi, a minority party member in the Upper House of South Australia’s Parliament, delivered on Wednesday the second reading speech for his Health Practitioner Regulation National Law (South Australia) (Childhood Gender Dysphoria) Amendment Bill.

Mr Bernardi, a representative of the One Nation Party, may not get the numbers for his Bill to pass the Upper House, unless the governing Labor Party allows a conscience vote, which in the recent past it has refused to do on the issue of the gender medicalisation of minors. In the Lower House, Labor has a huge majority.

Even so, Mr Bernardi’s speech deserves a wide readership. August 19 is the earliest date for a second reading debate and a vote on the Bill in the Upper House.

Bernard Lane

Cory Bernardi, 17 June 2026, second reading speech, Health Practitioner Regulation National Law (South Australia) (Childhood Gender Dysphoria) Amendment Bill—

This Bill seeks to place into legislation a prohibition on the prescription and administration of puberty blockers, cross-sex hormones and other prescribed drugs for the primary purpose of treating gender dysphoria in persons under the age of 18 years.

This Bill is about safeguarding children.

It recognises that children experiencing distress regarding their sex and identity deserve counselling and support.

Irreversible or life-altering medical interventions should not be undertaken in circumstances where the evidence base remains uncertain, and the long-term consequences may be profound.

This legislation reflects the precautionary approach recently adopted in Queensland through a Ministerial Direction issued in 2025, which prohibited the prescription of puberty blockers and hormone therapies to new patients under the age of 18 diagnosed with gender dysphoria within the public health system. The difference is that this Bill provides certainty through legislation rather than an administrative direction.

The Bill does not affect treatment already commenced prior to commencement of the Act. Nor does it interfere with the legitimate use of puberty suppression for conditions such as precocious puberty, treatment relating to medically verifiable disorders of sex development, or the use of medications for purposes unrelated to gender dysphoria.

The Bill makes it an offence for a registered health practitioner to prescribe or administer a prescribed drug to, or for, a minor under 18 years for the treatment of gender dysphoria.

The Women’s and Children’s Hospital Gender Diversity Service accepts referrals from across South Australia for children and young people up to the age of 17 years who have concerns regarding their gender identity.

Approximately 160 referrals were reportedly made to the service during 2024.

Despite the significant increase in presentations across Australia over recent years, there remains a troubling lack of publicly available information regarding the number of South Australian children receiving puberty blockers and cross-sex hormones.

Six of Australia’s eight states and territories have refused to release data relating to the number of children prescribed puberty blockers for gender dysphoria.

This lack of transparency would not be tolerated in relation to almost any other emerging area of medical practice involving children.

This Bill is informed by international developments that have occurred over recent years.

Countries once regarded as leaders in what has been termed “gender-affirming care” have fundamentally reassessed their approach.

In the United Kingdom, the independent Cass Review found that the evidence underpinning the use of puberty blockers for gender dysphoria in children was weak and insufficient to justify routine clinical practice. Importantly the review emphasized psychological support over early medical interventions.

Following that review, the National Health Service ended the routine prescription of puberty blockers for children outside formal clinical research settings.

Finland revised its treatment guidelines to prioritise psychosocial support and psychological interventions as the first-line treatment for minors experiencing gender-related distress. This change was prompted by a systematic review of evidence that found inconclusive results regarding the benefits of medical transition for minors.

Sweden similarly restricted the use of puberty blockers and cross-sex hormones to exceptional circumstances, citing concerns regarding uncertain benefits and potentially serious risks. The Swedish National Board of Health and Welfare has updated its guidelines, prioritising psychotherapy and supportive care over medical interventions.

The debate has not been confined to Europe.

Across the United States, numerous states have enacted legislative restrictions on the prescription of puberty blockers and cross-sex hormones to minors.

Queensland has taken its own steps within Australia.

These changes are in line with the fact that the evidence does not support the confidence with which these treatments were once promoted.

Members [of the Upper House] should also consider the developmental stage of the patients involved.

It is well established that adolescence is a period of profound emotional, psychological and neurological development.

Research consistently demonstrates that the human brain continues to mature well into early adulthood, with development of areas associated with judgment, impulse control, future planning and risk assessment continuing into the mid-twenties.

This reality should give Parliament pause before endorsing medical interventions that may permanently alter a young person’s reproductive capacity, sexual function and physical development.

The risks associated with these treatments cannot simply be dismissed.

Evidence points to concerns regarding reduced bone density during critical developmental periods.

Questions remain regarding impacts on cognitive development and psychosocial growth.

There are concerns about cardiovascular risks associated with cross-sex hormones.

Of particular significance is the fact that the overwhelming majority of children prescribed puberty blockers for gender dysphoria proceed to cross-sex hormone treatment and often surgery with irreversible consequences.

International studies have suggested that this figure exceeds 90 per cent.

Children experiencing gender distress frequently present with co-existing mental health challenges.

Many experience anxiety, depression, autism spectrum conditions, trauma histories, social isolation or other psychosocial difficulties.

These young people deserve counselling and evidence-based psychological care.

Questions must be asked regarding the extent to which broader mental health supports are available to children awaiting appointments through South Australia’s Gender Diversity Service.

The Women’s and Children’s Hospital itself acknowledges the existence of significant delays between acceptance of referrals and initial consultation due to high demand.

What counselling services are available during these waiting periods?

What interventions are being offered to address underlying mental health concerns?

Are families being provided with sufficient support and information regarding all available treatment pathways?

These questions warrant answers.

The Parliament should also be concerned by reports that, between July 2023 and July 2024, 22 South Australian children received gender-affirming treatment from a doctor without prior psychiatric assessment.

If accurate, such reports raise serious concerns regarding safeguards and oversight in what remains a contested field of medicine.

The first duty of medicine is to do no harm.

Where the evidence is uncertain, where the long-term consequences are significant, and where the patients involved are children who cannot fully appreciate those consequences, Parliament has both the authority and the responsibility to act.

This Bill establishes clear legal standards, promotes accountability and places the welfare of children above ideology.

Future generations may well ask whether governments exercised appropriate caution at a time when evidence remained limited and uncertainty persisted.

This Parliament has an opportunity to ensure that South Australia takes a careful, measured and child-centred approach.

Members may hold differing views about the broader social and political debates surrounding gender identity.

However, we should all be united in one principle: children deserve the highest standard of evidence before they are exposed to medical interventions with potentially lifelong consequences.

This Bill reflects that principle.

GCN global briefs

One for the ages

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

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

Fluid billings

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

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

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

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

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

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

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

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

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

Schtum!

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

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

Closed for business

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

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

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

We have to talk

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

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

Rogue or routine?

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

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

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

Caution discriminates

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

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

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

Systematically misleading

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

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

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

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

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

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

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

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

Pride in PR

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

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

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

Judicial activism

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

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

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

Gender Gilead

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

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

Into the fray

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

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

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

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

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

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

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

Who benefits?

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

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

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

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

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

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

Informers

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

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

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

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

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

Irregular rule

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

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

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

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

Case 1

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

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

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

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

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

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

Case 2

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

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

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

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

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

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

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

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

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

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

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

Anti-conversion law in NSW

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

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

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

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

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

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

No response needed

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

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

Instead, this was the response from the NSW HCCC—

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

“Outcome of Assessment

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

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

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

Ahpra, please explain

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

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

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

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

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

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

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

Signs of capture

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

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

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

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

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

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

No investigation

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

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

Her email signature block included—

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

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

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

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

Unreliable guide

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

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

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

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

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

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

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

Teen talk

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

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

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

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

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

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

Dropping ACON

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

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

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

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

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

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

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

Who guards the guards?

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

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

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

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

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

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

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

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

‘Safe regulator’

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

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

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

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

‘Not transparent’

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

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

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

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

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

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

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

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

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

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

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

Dissent and debate

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

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

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

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

Not-so-free speech

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

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

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

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

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

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

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

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

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

Guidance vacuum

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

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

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

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

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

Skin in the game

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

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

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

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

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

Last year’s model

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes, Minister

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

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

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

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

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

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

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

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

The chosen

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

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

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

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

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

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

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

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

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

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

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

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

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

Tipping the balance?

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

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

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

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

Was the “comprehensive review” going ahead?

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

A missing review

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

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

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

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

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

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

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

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

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

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

Cass controversy

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

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

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

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

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

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

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

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

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

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

Medical politics

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

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

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

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

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

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

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

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

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

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

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

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

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

Everything about us

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vanessa Spiller

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Follow the data

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lost connection

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Red light

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

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

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

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

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

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

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

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

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

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

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

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

Mix & match

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health Minister Ong Ye Kung replied—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Paul Tyson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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