Rachel Hannam

Complexity and the limits of medicalisation

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

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

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

Cultural shifts that demand ethical scrutiny

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

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

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

Counter-arguments and ethical responses

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

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

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

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

Clinical ethics and exploratory therapy as skilful care

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

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

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

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

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

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

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

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

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

• What experiences helped this belief take shape?

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

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

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

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

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

Conclusion: From moral certainty back to ethical care

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

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

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

Dr Rachel Hannam is a Brisbane-based psychologist.

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

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Asch, Solomon E. (1955) ‘Opinions and social pressure’, Scientific American, 193(5), pp. 31–35.

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

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

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

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

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

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

Gender exploratory therapy (n.d.) In Wikipedia. Retrieved March 8, 2026.

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

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

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

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

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

Gary Geelhoed

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

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

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

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

A distinction without difference

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

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

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

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

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

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

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

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

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

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

Inside info

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Language games

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Free speech, with undefined limits

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

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

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

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

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

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

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

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

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

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

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

Mr Untersteiner: “No formal assessment.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Armour for dissidents

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

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

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

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

No hate here

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

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

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

Silence from the regulator

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

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

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

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

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

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

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

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

Some guidance, please

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Confusing the young

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

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

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

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

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

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

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

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

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

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

Affirmative taxpayers?

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

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

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

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

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

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

Any therapy goes

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

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

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

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

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

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

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

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

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

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

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

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

GCN global briefs

By any other name

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

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

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

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

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

ROGD milestone

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

Visibility

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

Big as Texas

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

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

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

Not rare enough to ignore

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

No informed consent

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

Just an opinion

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

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

Safe from debate

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

Resource rich

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

Double standards

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

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

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

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

Wait and see

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

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

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

Data vacuum

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

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

Thumb on the scale

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

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

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

Benefit-harm ratio

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

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

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

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

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

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

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

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

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

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

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

Good in theory

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

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

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

No to surgery

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

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

Money ill-spent

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

School to clinic pipeline

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

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

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

Psychology first

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

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

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

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

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

Council vetoed

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

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

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

Dutch courage

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Not our problem

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

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

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

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

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

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

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

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

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

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

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

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

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

Strictly feedback

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

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

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

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

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

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

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

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

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

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

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

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

Unreliable guide

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

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

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

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

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

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

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

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

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

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

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

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

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

No surrender

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

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

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

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

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

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

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

The Cairns connection

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Agents of influence

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

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

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

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

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

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

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

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

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

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

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

GCN global briefs

Renunciation

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

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

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

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

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

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

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

Dubious diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

Whose theory?

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

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

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

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

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

Rhetoric v reality

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

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

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

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

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

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

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

Third degree

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

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

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

Tomboys at risk

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

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

Defiant gender clinics

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

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

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

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

It’s cosmetic

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

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

Language games

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

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

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

Apologies then, regrets now

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

GCN has sought comment from the ANMF.

Transition for toddlers

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

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

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

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

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

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

Breaking the silence

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

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

Point of no return

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

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

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

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

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

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

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

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

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

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

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

Critical mass

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

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

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

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

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

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

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

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

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

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

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

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

Sandra Pertot

Out in the open

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

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

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

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

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

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

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

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

No: 82.6 per cent

It depends on the sport: 8.2 per cent

I don’t know: 4.9 per cent

Trans women are women: 4.2 per cent

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

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

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

It’s more than academic

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

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

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

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

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

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

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

The ABC of censorship

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

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

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

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

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

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

Extraordinary claims

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

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

Anthropological, historical, and biological evidence indicates that no culture in human history has been entirely without members who experience same-sex attraction. While societies have vastly different ways of defining, accepting, or regulating these behaviours, same-sex desire and relationships are a recognised part of the human experience across all populations.

Suddenly, in the 1980s, a small group of people in the Western world decided not only that a man can be a woman, but that being gay, homosexual, is not same-sex attraction but same-gender attraction. This was part of the agenda of the queer theory movement to break down what they regarded as the heteronormative, male/female binary stranglehold on sex, sexuality and gender.

I say “suddenly”, because in 2024 when I was writing an article on the Australian Human Rights Commission there were two definitions of lesbian on their website, which indicates just how recent and sudden the change was—

Back then, according to the commission sexual orientation “refers to a person’s romantic or sexual attraction to another person, including, amongst others, the following: heterosexual, gay, lesbian, bisexual, pansexual, asexual or same-sex attracted [Emphasis added].”

Now the commission claims that sexual orientation “is understood to refer to each person’s capacity for profound emotional, affectional and sexual attraction to, and intimate and sexual relations with, individuals of a different gender or the same gender or more than one gender [Emphasis added]”.

In the same way that any opposition to the “men can be women” claim is punished, any disagreement with this new definition of sexual orientation leads to punishment.

How did they gain this power? They traded, and continue to trade, on the image of the poor gender-confused, sexuality-confused young people who will self-harm if they aren’t “affirmed”.

More significantly, over time, trans advocates have gained positions of power. The current Sex Discrimination Commissioner Dr Anna Cody is a true believer that a male/man can be a woman and a lesbian. As well as Ms Grover’s case, Dr Cody intervened in the case involving the Lesbian Action Group when they wanted to hold public lesbian events in Victoria that exclude males who claim to be a lesbian.

Intellectual malpractice

There is the same pattern of manufactured claims in the health professions. Where is the evidence that a child “knows” they are the other gender/sex (these terms continue to be conflated when it suits)? Where is the body of research that reveals this? Claiming that affirmed children are happier doesn’t meet the criteria of rigorous research.

A man can be a woman? How and by what criteria?

Health professionals should be on the front line of the fight to restore biological reality across our society, safeguarding children from irreversible changes to their bodies and supporting female sex-based rights.

Instead, these ideological claims are forced onto health professionals by the same pattern of bullying and punishment noted above, as the cases of Dr Jillian Spencer1 and Dr Andrew Amos demonstrate. It is time to change the dynamic and make the health associations accountable for their claims and demands.

It came as a shock to me to find that many if not all health professional associations embrace trans ideology and will not accept any comments that challenge their position. My disillusionment came about some years ago when I noticed the Royal Australian College of General Practitioners (RACGP) had this definition of sex on the website—

“A person’s assigned sex at birth, determined by sex characteristics observed at birth or infancy. A person’s sex can change over the course of their lifetime and may differ from their assigned sex at birth.”

Naively I contacted the RACGP to suggest they add the explanation that only individuals with specific Disorders of Sexual Development (DSDs) can appear to change sex, because as the college’s definition stood, it implied anyone could change sex. It stunned me that after a few email exchanges they told me to stop contacting them; they were confident in their definition.

The following quote from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) gives a good summary of the position that health profession associations promote—

“[This New Zealand draft law] would define ‘woman’ in law as ‘an adult human biological female’ and ‘man’ as ‘an adult human biological male’. RANZCOG’s submission explains that this is not a scientifically or clinically accurate description of human sex, which is a complex product of chromosomes, genes, hormones and other factors that exists on a spectrum rather than as a strict binary. Around 1–2 per cent of people have intersex variations or differences of sexual development that this definition fails to account for.”

These irrational beliefs are also taught in some tertiary education departments of health and, worryingly, in the biological sciences. How can any health profession, but especially one whose area of expertise depends on knowing the difference between a woman and a man, possibly justify this position? Further, disorders of sexual form and function are not natural variations any more than a child born deaf or blind has a natural variation in hearing or sight.

This is the brick wall facing health professionals who know that a woman is an adult human biological female. Denial of biological reality underpins all of these gender ideology claims, including their justification for “gender-affirming” interventions for children and adolescents.

Call to action

Those of us who know that biology is what makes us human and determines our sex need an action plan. Professional associations and university departments that promote the dogma that biology doesn’t matter must be held accountable, despite any determined efforts to silence dissent.

I propose that these associations and education bodies are flooded with demands that they answer the following questions—

1. Why is there a human characteristic called sex? What is its form and function?

2. If sex isn’t binary, what are the other sexes?

3. What role do these other sexes play in reproduction?

4. If a person with a DSD is fertile, do they produce gametes that are neither sperm nor ova?

5. If sex is a spectrum, how does sex change across the sex dimension from XX to XY?

6. Setting aside individuals born with a DSD, outline the process by which a man (a human born male) becomes a woman (a person born female)? What biological parts and functions change?

7. Women know they are women because they are adult female humans – what criteria does a man use to decide he is a woman?

8. Do all trans women use the same criteria?

9. Can a person with a penis be a woman? A lesbian?

10. How would you explain to a child how babies are made?

I encourage anyone—health professionals, concerned parents, schoolteachers, anyone—concerned that some health professionals deny biological reality, to contact the relevant health association or state health service. The various associations and health departments are easily found on the internet and usually have a position statement that outlines their opinion of biological reality, as well as contact details.

For example, the emails for RANZCOG are ranzcog@ranzcog.edu.au and ranzcog@ranzcog.org.nz.

We must dispel the illusion that only a silent minority acknowledges the reality that sex is binary and immutable.

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.”