Counter directive
An official ban on blockers and hormones looks like it's up against an organised workaround
A government ban on puberty blockers and cross-sex hormones for new patients in Queensland, Australia, is reportedly under challenge from within the system by the statewide Queensland Children’s Gender Service.
On January 28, the state government department Queensland Health issued a directive immediately halting all new prescribing of puberty blockers and cross-sex hormones for gender-distressed minors in the public system, pending an independent review of the contested evidence for these interventions.
However, the government-run gender service stands ready to keep triaging and assessing new patients for these hormonal treatments, with the prescribing done by private doctors unfettered by the official directive, according to a social media post by a Queensland general practitioner (GP, or primary care doctor) who is listed as a “gender-affirming” provider.
The GP reported that gender medicine lobby the Australian Professional Association for Trans Health (AusPATH) has been “communicating closely with staff” at the public gender service and has “raised a significant amount of money”—with the costly treatment in mind being unsubsidised puberty blockers sought by families in the private health sector.
Puberty blockers, started as young as age 9-13 to suppress natural sex hormones, lack long-term safety data for this novel use, and their effects on the still-developing adolescent brain are unknown, casting doubt on the claim they are reversible.1
The GP said the public gender service was at liberty to “share care” with external providers and cited as one example Dr Darren Russell, an AusPATH board member and former director of the Cairns Sexual Health Service in far north Queensland who now operates an online gender clinic offering blockers and hormones to minors.
AusPATH, which claims the Queensland government “has left kids without care,” has put out a call for more medical practitioners in the private health sector to help work around the treatment pause.2
The fundraising campaign run by AusPATH—called Project 491 in reference to the 491 minors reportedly on Queensland’s gender service waiting list—cites a low-quality anonymous online study to suggest that as many as one in two patients will attempt suicide if denied treatment.
This familiar “transition or suicide” narrative of the “gender-affirming” worldview has been criticised as baseless and recklessly at odds with mental health advice on how not to talk about suicide risk.
Queensland child and adolescent psychiatrist Dr Jillian Spencer, who believes the gender-affirming treatment model prevents proper exploration of the reasons for a child’s distress, said the reported “shared-care” arrangement was “extremely concerning.”
Dr Spencer said it suggested that clinicians at the public gender service failed to understand the concern that these hormonal interventions “are not evidence based and have serious long-term risks and consequences for children.”3
Meanwhile, the LGBTQ lobby Equality Australia has published an open letter to Queensland’s Premier David Crisafulli, suggesting “potentially fatal outcomes” if the ban on new hormonal treatment is not lifted.
The letter ignores the international scientific debate about how best to respond to gender-distressed minors.
Dr Spencer advised the government to “disregard” the letter, which she said was dominated by LGBTQ activist groups with “vested interests in transitioning children.”
Video: Whistleblower psychiatrist Dr Jillian Spencer explains her concerns about the gender-affirming approach
Queensland got it right
Another Queensland psychiatrist critical of the current approach to treating gender distress, Dr Andrew Amos, invoked the competing open letter to Australia’s Prime Minister Anthony Albanese last month urging him to establish an independent national inquiry into paediatric gender medicine, which that letter described as “a potential public health disaster of generational significance.”
“The Queensland Government was right to pause new initiations of gender-affirming hormonal treatments in order to protect vulnerable Queensland kids,” Dr Amos told GCN. “We simply don’t have the evidence base to know whether puberty blockers and hormones will seriously and permanently harm them.”
Under the mandatory requirements of the government’s January 28 directive, all Hospital and Health Services (such as the gender service) must, “Ensure Stage 1 [puberty blocking] treatment and Stage 2 [cross-sex hormone] treatment is not prescribed or otherwise given to a new patient for gender dysphoria.”4
The official given responsibility for the directive is Queensland Health’s executive director of patient safety and quality, Kirstine Sketcher-Baker.
Queensland’s Health Minister Tim Nicholls cited three triggers for his government’s dramatic intervention on January 28—
The contested evidence base for hormonal treatment and the shift to more cautious treatment policy in Europe
Concerns about “apparently unauthorised” gender dysphoria treatment at the Cairns Sexual Health Service5
“Criticism” directed at the statewide gender service and a contentious government-run evaluation of that service last year under the former Labor administration
That 2024 evaluation, which dismissed criticism of the gender service and urged an expansion of its gender-affirming model, is promoted on the service’s webpage immediately below an account of the directive to stop initiation of new patients on hormonal treatment.
The gender service has added the claim that the treatment pause, together “with the media coverage and public debate on gender care in Queensland can be distressing, cause feelings of uncertainty or negatively impact the wellbeing of trans and gender-diverse children and young people.”6
Equality Australia’s open letter, whose most prominent signatory is former Australian of the Year Professor Pat McGorry, makes the unsupported claim that “the vast weight of scientific and medical evidence” favours puberty blockers and cross-sex hormones.
“Governments should not be intruding into an area which requires expert clinical decision-making based on the best available scientific evidence,” Professor McGorry, a psychiatrist and mental health advocate, told Queensland’s Courier Mail newspaper.
“The medical care of young people should not be distorted by unhelpful culture wars.”
Neither that news article nor the open letter makes any mention of the multiple systematic reviews of the scientific literature undertaken independently in jurisdictions as different as Finland, Florida, the UK, Sweden, Germany and Canada. Those reviews have concluded that the evidence for blockers and hormones as therapy for youth gender dysphoria is very weak and uncertain.
Also unacknowledged in the media coverage and open letter is the fact that Orygen, the youth mental health organisation run by Professor McGorry, operates a gender-affirming health service offering cross-sex hormones and following the same low-quality treatment guideline used by the Queensland gender service.
The Orygen Trans and Gender-Diverse Service in the state of Victoria, aimed at young people aged 12-25, is run in collaboration with the gender clinics of the Royal Children’s Hospital (RCH) Melbourne and Monash Health, and also involves activist organisations Transgender Victoria and Transcend.
The RCH Melbourne treatment guideline, promoted as “Australian standards of care” and also used by other public children’s hospital gender clinics across the country, was found to be low in rigour and not recommended for use.
That conclusion was reported in a peer-reviewed paper following an independent evaluation of international treatment guidelines on gender dysphoria commissioned by England’s landmark 2020-24 Cass review.
The RCH Melbourne guideline advises that psychosis in a minor is not necessarily an obstacle to medical transition. The document suggests a stark choice between gender-affirming treatment and self-harm, and makes no mention of the phenomenon of detransitioners.
Contacted by GCN, Professor McGorry would not comment on whether he should declare a conflict of interest arising from Orygen’s gender-affirming health service, nor would he explain in what way the Queensland treatment pause involved a “culture war.”
Queensland’s centre-right Liberal National Party Government followed the UK in opting to continue the hormonal treatment of existing patients in the public health system.
However, the UK Labour Government went further by imposing an indefinite ban on private prescribing of puberty blockers because of concern that an online clinic, GenderGP, was seeking to undermine the new more cautious treatment policy in public health.7 (GenderGP is another provider that uses the “untrustworthy” RCH Melbourne treatment guideline.)
Professor McGorry told GCN he saw “blanket bans” on hormonal treatment as “a crude instrument.”
“In my view, it’s not a one size fits all. There is a very clear-cut group who need the classic gender-affirming approach. There is another group who are more complex and have broader needs and a more cautious approach is needed.”
There is no sign of that caution in Equality Australia’s open letter. Professor McGorry did not reply when asked if Orygen’s gender service publishes treatment data.
GCN sought comment from Children’s Health Queensland, which is responsible for the public gender service; Queensland Health Minister Nicholls; and AusPATH. This reportage is not suggesting wrongdoing by health providers or advocates, but highlights the international scientific and ethical debate about the practice of paediatric gender medicine. It is not disputed that gender-affirming clinicians believe their interventions benefit vulnerable young people. Comments on this post have been closed for legal reasons.
Children who identify as transgender or “non-binary” and do not want to go through the “wrong puberty” are given injections of drugs known as GnRH analogues to suppress their natural sex hormones, sometimes for years. These drugs are approved for medical conditions such as prostate cancer and precocious (or premature) puberty, but not for gender dysphoria.
This off-label use of puberty blockers is not funded under Australia’s Pharmaceutical Benefits Scheme. The annual cost in the private sector is about $3,000 a year. State governments with children’s hospital gender clinics subsidise the cost of puberty blockers.
Queensland’s Health Minister Tim Nicholls has said that, in addition to the ongoing hormonal treatment of existing patients, the gender service will continue to offer psychiatric and psychological support for gender-distressed children with mental health co-morbidities.
GCN has been told by a psychologist and mother who took her daughter to the gender service that a medicalised approach dominated, and they were told they would have to go to the private health sector for mental health support.
Dr Spencer said the reported “shared care” arrangement reinforced the case for disbanding the public gender service. She said it appeared to have “attracted a group of clinician zealots who are unwilling to heed the findings of the [systematic] evidence reviews.”
“We need services for children with gender distress to be taken over by mainstream child and youth mental health services who can provide comprehensive psychosocial care.”
Dr Spencer was suspended from clinical duties at the Queensland Children’s Hospital after she raised concerns about the safety of the mandated gender-affirming treatment approach and following a complaint of “transphobia” from a troubled teenage patient.
The directive is silent on Stage 3 or surgical treatment, so the gender clinic would be free to refer female patients to private surgeons for trans mastectomy. A 2021 work instruction for the gender service says “chest reconstructive surgery (also known as top surgery) is not offered by the QLD Children’s Gender Service, although it is considered an integral part of the transition process for many trans males and non-binary young people with chest development [i.e., females].”
The instruction says mastectomy may be indicated “in exceptional circumstances” before the age of 18 and discusses the assessment process. It notes Family Court rulings that two 15-year-olds were competent to consent to transgender surgery.
On social media, the Cairns Sexual Health Service has noted that, following the government’s intervention, it must not “take on NEW referrals for gender services for young people under 18 years…” Its advice for would-be patients and families is: “Please speak to your local GP about your options for referrals to Queensland Children’s Gender Service or a private service.” It also recommends AusPATH’s list of gender-affirming providers.
The suggestion seems to be that the potential harm of contentious treatment cannot be discussed in public because discussion itself would cause distress to patients. This idea can be traced back to a flawed review conducted in 2019-20 by the Royal Australasian College of Physicians, which failed to declare conflicts of interest.
England’s Cass review, which notes the “remarkably weak” evidence for life-altering hormonal treatment of minors, has enjoyed bipartisan political support in the UK.
I assume and hope those GP’s prescribing these drugs understand that this make themselves personally liable to claims of medical negligence which I suspect a conservative estimate of damages would come to at least $1 million.
Thanks for compiling all this news.