Enough!

A veteran psychologist has walked away after five years hoping the Australian Psychological Society would choose evidence over ideology

Photo by Vitaly Gariev on Unsplash

Vanessa Spiller

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Follow the data

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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