Doctors for disease

Gender clinics create harmful hormonal disorders in children who come to them with healthy endocrine systems

Medical impunity

Only in the field of “gender-affirming care” can doctors create lifelong hormonal disorders with no fear of professional rebuke, according to Australian paediatrician Dr Dylan Wilson.

He pointed out that endocrinologists, who work to restore hormone imbalances in all other areas of medicine, instead suppress the natural sex hormones of gender-distressed children, denying them the benefits of puberty, and then go on to prescribe hormones at high levels meant for bodies of the opposite sex.¹

“[When children] walk into a gender clinic, they don’t have any hormone problem, but they leave with one. This is the only time when [doctors] can do this permanently² with impunity,” Dr Wilson told last weekend’s inaugural Adelaide conference of the Coalition for Advancing Scientific Care (CASC), which opposes the practice of gender-affirming care for its lack of safety and evidence.

Dr Wilson said a physician who deliberately tampers with growth or performance hormones in sport or bodybuilding or who used insulin for an unlawful mercy killing would be subject to professional sanctions, even criminal penalties.

“Hormones cause problems if they’re outside the normal range, and those problems are either mild, moderate or severe—and severe means death in some cases,” he said.

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Bloodwork: At age 17, Prisha Mosley, identifying as a boy, was prescribed testosterone as a cross-sex hormone; two years before, she had been sexually assaulted. She has since ceased testosterone, re-embraced her female sex, and is suing her doctors in the US state of North Carolina

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Safeguarding natural development

As a paediatrician with 24 years’ experience, Dr Wilson told the Adelaide CASC conference that he saw his role as watching over his patients as they follow the developmental pathway from infancy to late adolescence—“and anything that interrupts that pathway tends to make me sit up and take notice”.

Puberty blocker drugs, known as gonadotropin-releasing hormone (GnRH) analogues, are given to gender-distressed children at the outset of their normally timed puberty, suppressing the sex hormones that promote physical, sexual and cognitive development.

(Putting synthetic GnRH analogues into the body causes an initial surge in sex hormones, but in time this overstimulation of the pituitary gland desensitises it, resulting in a sharp decline in production of sex hormones.)

In his October 18 talk at the CASC conference, Dr Wilson highlighted a striking contradiction.

He noted that the Royal Children’s Hospital (RCH) Melbourne, which pioneered gender-affirming care and early puberty blockers in Australia, has an online information sheet alerting parents to the rare condition of Kallmann syndrome where, in the hospital’s words, “the body [of a child] does not make enough of a hormone called gonadotrophin-releasing hormone (GnRH)”.

This is a form of hypogonadotropic hypogonadism, a hormonal disorder.

“The role of GnRH is to stimulate the testicles in males and the ovaries in females to make sex hormones,” the RCH Melbourne information sheet says. “If not enough of these hormones are made, the child will not enter puberty and will not be able to have children of their own without special treatment.

“As well as helping with development during puberty, these hormones are essential for your child’s body to lay a good foundation for bone strength and to reduce the risk of osteoporosis (weak bones) in later life.”

Despite these warnings, the RCH Melbourne gender clinic is creating the hormonal disorder of hypogonadotropic hypogonadism in children with gender dysphoria, for which the diagnostic criteria include preferring to play with toys “stereotypically used” by the opposite sex, Dr Wilson said.

“What happens when gender clinics give children puberty blockers?” he said. “They give children hypogonadotropic hypogonadism at a time when puberty is meant to occur and would otherwise occur naturally.

“They cause the consequences that are seen in the condition they would otherwise treat [such as Kallmann syndrome].”

He said data obtained under Freedom of Information law suggested that more than a thousand children across Australia had been given this hormonal disorder in recent years by children’s hospital gender clinics, potentially making gender-affirming care the most common cause of hypogonadotropic hypogonadism.

“So, an interesting thought experiment would be, what would happen if a child with Kallmann syndrome came to a gender clinic with gender distress? What would they do? Would they say, ‘Oh, our work here is done? We don’t need to do anything’?”

Puberty blockers are approved for use with central precocious puberty when a child begins sexual development unusually early, but this suppression of sex hormones is stopped once these children reach the age at which they can go into puberty with their peers.³

With “off-label” transgender puberty blocking, however, this typically starts at the outset of normally timed sexual development and in the vast majority of cases is followed by cross-sex hormones supposed to be taken lifelong. The likely outcomes include infertility, sexual dysfunction, a range of cardiovascular disorders and elevated cancer risk, Dr Wilson said.

He said cross-sex hormone treatment was also iatrogenic medicine—where the intervention causes rather than cures disease—in that unnaturally high levels of testosterone or oestrogen bring a series of risks including vaginal atrophy, blood clots and mood disturbance.

“Childhood gender dysphoria is not an endocrine condition, but it becomes one through iatrogenic puberty blockade and high-dose cross-sex hormones. The consequences of this gender-affirmative therapy are not trivial and include potential sterility, sexual dysfunction, thromboembolic and cardiovascular disease, and malignancy.”—Laidlaw et al, letter to the editor, the Journal of Clinical Endocrinology & Metabolism, 23 November 2018

Desirable disease

Large-scale gender-identity medicalisation of minors is relatively new, and Dr Wilson said the full extent of the long-term effects was not yet known but he doubted these patients would lead long, healthy lives.

“If you significantly elevate hormones or suppress them outside the normal range, you have health implications. And this is the only situation in medicine where it’s considered okay to do this permanently,” he said.

“Endocrinologists do the exact opposite of what they otherwise normally do, and they do it with impunity, and this will lead to harm.⁴

“Is it acceptable for a doctor to knowingly harm a patient, to knowingly to give a patient disease just because they want it?”

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Keynote: UK journalist Helen Joyce, director of advocacy for the group Sex Matters, has posted the first section of her talk given at the Adelaide CASC conference

Why gender medicine isn’t science, and isn’t medicine, Part 1

The duty to warn

Also at the CASC conference in Adelaide, Professor Riittakerttu Kaltiala, a leading figure in the international debate over paediatric gender medicine, said it was clear in retrospect that the decision to open youth gender services in 2011 in her home country of Finland was the result of “political pressure”.

Professor Kaltiala, who was given oversight of the establishment of the gender identity service for minors, said there had been “great enthusiasm” in Europe about the new Dutch treatment protocol driven by puberty blockers with its promise of good outcomes for gender-dysphoric minors.

The impetus for a medicalised response to a minor’s declared gender identity did not come from child and adolescent psychiatry, which viewed a consolidated identity as the outcome of active development during the crucial period of adolescence, said Professor Kaltiala, who is an adolescent psychiatrist and chief psychiatrist at Tampere University Hospital.

“Therefore, it was difficult for us to start thinking one facet of identity [gender] would be consolidated so early that we should intervene in [healthy] bodies in the middle of the developmental years,” she said.

In medicine generally, she said, “we intervene in the bodies of people because they have diseases that may progress, may make them more sick—and may even be fatal without intervention.

“In gender medicine, we intervene in healthy, functioning bodies because people believe that their mental wellbeing will improve by making the body—to be quite honest—more sick.

“Gender medicine means interventions that make you a lifelong patient—you need to be on hormonal treatment, and it has lots of harmful side effects that are usually not so much discussed as are the desired effects on mental wellbeing.”

Professor Kaltiala described the dismay of clinicians in Finland when they realised that the patient numbers, profile and treatment outcomes were quite different from what they had been led to expect by the scientific literature from the Amsterdam clinic of Dutch protocol fame.

As other gender clinics internationally were discovering, patient numbers exploded in the mid-2010s. And unlike the classic Dutch profile of otherwise coping boys with gender distress since early childhood, these new patients were chiefly teenage females and many had serious psychiatric and other problems predating their adolescent-onset gender distress.

In a series of studies drawing on Finland’s comprehensive health registry data, Professor Kaltiala and her colleagues showed that medical gender reassignment did not resolve these mental health issues, nor improve school and social functioning.

And in a sizeable number of cases, new psychiatric disorders demanding treatment emerged after medical transition.

At first doubting their results so at odds with the reassuring data reported by the Dutch clinic, Dr Kaltiala said she spoke to European colleagues who confirmed they were noticing the same discouraging patient profile of serious psychiatric disorders.

In 2021, an Australian team led by psychiatrist Professor Kasia Kozlowska began publishing papers with cautionary findings similar to those of the Finns, but Professor Kaltiala was surprised there was not more such research emerging elsewhere to put on the public record what clinicians knew: that the positive results predicted by the Dutch treatment protocol could not be relied on.

“Colleagues around Europe were telling me, ‘This is exactly what we are seeing in our clinic [and that] it was a relief to see this paper of yours published’. I expected to see many similar papers coming in a few years … but it did not happen,” she said.

She said clinicians were “talking about this behind the scenes” but not in the public domain.

Professor Kaltiala felt she had a duty to inform the public about the unexpectedly poor outcomes of medical gender reassignment, and felt “so devastated” for the Australian whistleblower psychiatrist Dr Jillian Spencer, who faces the loss of her job for going public with concerns about the potential harms of the gender-affirming treatment model.

Dr Spencer had told the Adelaide CASC conference that she decided to speak up because colleagues who privately shared her concerns had stayed silent, and her attempts to ventilate those concerns within her children’s hospital had come to nought.

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Video: US paediatric endocrinologist Dr Quentin Van Meter talks about his long-standing concerns over the use of cross-sex hormones with trans-identified minors—“hormones that don’t belong in that body, creating disease states”

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Not normal science

The key 2011 and 2014 Dutch studies that drove the global expansion of gender clinics have come under intense scrutiny in recent years and Professor Kaltiala is not alone in detecting serious methodological flaws in this research.

The Dutch protocol for paediatric medical transition, starting with puberty blockers, rested on fewer than 100 patients and yet it was swiftly adopted as routine treatment in rich countries around the world.

Professor Kaltiala said that early on, the Dutch research had “appeared relevant and innovative … but it totally escaped the lab”.

“Normally, if you present new research and something really revolutionary, you would expect in medicine that other centres would replicate it,” she said. Attempts in the UK and the US to reproduce the benefits of puberty blockers claimed by the Dutch both failed.

“And if there is a preliminary study that may not be so rigorous as to methodology, it will [normally] be followed by more rigorous research or large-scale multi-centre studies that confirm the findings,” Professor Kaltiala said.

“This did not happen [with] the Dutch model of care. It just started to be used elsewhere, with a lower and lower threshold [for minors to access medical treatment], with wider and wider patient populations [including the vague ‘non-binary’ patient profile], and this is the problem in paediatric gender medicine.”

Meanwhile, since 2018, multiple independent systematic reviews of the scientific literature on the use of puberty blockers and cross-sex hormones with gender-distressed youth have concluded that the evidence base is very weak and uncertain.

“We have not been able to demonstrate that medical gender reassignment, initiated during developmental years, would improve mental health, reduce suicidality, improve quality of life or improve function,” Professor Kaltiala said.

She said paediatric medical transition had to meet the “same requirements of medical evidence as any other medical interventions”.

“And the research community must not tolerate any defamation and attacks on scientists who bring unpleasant news” of, for example, the lack of evidence for gender-affirming medical treatments or the troubling prevalence of psychiatric problems in gender clinic caseloads, she said.

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1. Gender clinicians in the US have used the false diagnosis of “endocrine disorder, unspecified” when in truth their gender-distressed patients suffer from no endocrine disorder until they are given puberty blockers or cross-sex hormones. Young adult detransitioners have recalled being given this diagnosis before any blood tests; it was assumed these patients were to be treated because of a self-declared transgender identity, not any likelihood of an endocrine disorder.

The practice has been an open secret. In 2021, a journal article noted that this diagnosis (coded E34.9 within the World Health Organisation’s ICD classification system) had become a proxy for trans-identifying patients otherwise hidden in health insurance data, with the authors stating: “‘Endocrine disorder not otherwise specified’ is often used to bill for transgender-affirming services instead of ‘gender identity disorder’ to avoid the stigma of labeling the person as transgender or to avoid denials of payment [by insurers]”.

However, Republican-run administrations have begun to target this potentially unlawful practice. In Texas, where paediatric medical transition has been banned, Attorney-General Ken Paxton has sued Dallas physician Dr May C. Lau. It was alleged in court documents that she had “falsely billed [a minor’s] insurance using the diagnostic code for an ‘endocrine disorder, unspecified’.

“In fact, Lau diagnosed [the minor] with gender dysphoria and began ‘treatment’ for that condition by prescribing and inserting a puberty blocker device in the patient for the purposes of transitioning their biological sex or affirming their belief that their gender identity is inconsistent with their biological sex.” It was also alleged that Dr Lau had changed the minor’s sex from male to female in medical and billing records.

In January 2025, with the case ongoing, Dr Lau agreed she would “not treat, write prescriptions, or bill for treatments that are for the purposes of transitioning a minor’s biological sex or affirming their belief that their gender identity is inconsistent with their biological sex using false diagnoses or billing codes”.

Under the US Trump administration, the Federal Trade Commission has launched a public inquiry into unfair or deceptive trade practices in “gender-affirming care” for minors. On 9 July 2025, the commission hosted a workshop where psychiatrist Dr Miriam Grossman gave evidence about what she said was the “fraudulent use” of the “endocrine disorder not otherwise specified” diagnosis, which is intended to be used when a specific endocrine disorder cannot be identified but there are “clinical signs or symptoms suggestive of an endocrine disorder” and “laboratory or imaging studies indicating endocrine dysfunction”.

2. Dr Wilson said that in rare cases, females with cancer undergoing chemotherapy are given puberty blockers temporarily to stop their periods.

3. Puberty blockers are also approved for use with hormone-fed cancers, such as prostate cancer, where these potentially fatal diseases are advanced. Puberty blockers are used off-label—without regulatory approval—by gender clinics, where children as young as age 9-11 are started on hormone suppression. The vast majority go on to cross-sex hormones, according to international data.

4. Australia is not among the countries that have restricted paediatric medical transition, apart from a pause in new hormonal treatment in the state of Queensland pending an independent review of the evidence due to report by November 30 this year.