Complaint to global psychiatry body alleges Australian college is shutting down debate on gender medicine
Prominent psychiatrists deplore the targeting of Dr Andrew Amos and Dr Jillian Spencer, who have questioned the lack of safety and evidence for puberty blockers and cross-sex hormones for minors
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.
Joint statement, April 2026: “The undersigned organisations—the Society for Evidence-based Gender Medicine, the Clinical Advisory Network on Sex and Gender and the Observatoire des discours idéologiques sur l’enfant et l’adolescent—wish to express their deep concern regarding the increasing number of conference cancellations, institutional pressures, and attempts to intimidate researchers, clinicians and academics working on issues related to gender medicine for minors.
“These repeated restrictions on scientific debate constitute a serious violation of the fundamental principles of research, medicine and democracy. They contribute to creating a climate of fear that is incompatible with the free exercise of critical inquiry and the plurality of perspectives, both of which are essential to the advancement of knowledge and the quality of care.”
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.
University College London Professor of Sociology Alice Sullivan, July 2026: “[The] prominent examples of ‘no platforming’ that you hear about are very much the tip of the iceberg, and they aren’t the most important thing; they’re just the visible manifestation.
“What’s going on under the surface is discrimination and harassment, campaigns of denunciation, and then, even more insidiously, internal bureaucratic barriers to people carrying out research on sex and gender.
“For every prominent victim of cancel culture, [many more are silenced]. You hear sometimes people saying, ‘Oh, well, this has only happened to a few people.’ It only needs to happen to a few people, because most people are going to keep their heads down rather than have that happen to them.”
This is from Professor Sullivan’s talk at a London conference on Rethinking Youth Gender Medicine.
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.
Dr D’Angelo is president of the Society for Evidence-based Gender Medicine, while Professor Morris is president of the National Association of Practising Psychiatrists, which was an early adopter of a cautious treatment response to youth gender dysphoria. However, all those who signed the letter to the WPA did so in their capacity as fellows of the RANZCP.
THE TWISTED LOGIC OF THE WPA
There can be no question that persons who undergo gender transition suffer long-term with elevated suicide, HIV, psychiatric comorbidities and early death.
The WPA does not dispute this reality claiming that it is a result of systemic stigma, limited access to care, housing and employment discrimination and social exclusion.
Regardless, the WPA’s ethical position would seem to be that the price paid for a life of misery is justified by the principles espoused by their body in the inherent righteousness of a model of care.
. . . I salute the integrity of Dr’s Amos and Spencer
Consistently and overwhelmingly positive?
No..https://pubmed.ncbi.nlm.nih.gov/38030953/
Thank you as usual for your great reporting!