Invading the domain of science

A spurious notion of ‘harm’ is being used by the regulator to silence critics of the risky gender medicalisation of vulnerable minors

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.

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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.

Harm, in medicine, used to mean injury you could describe: a damaged organ, a missed diagnosis, a drug that failed its trial. Feelings matter, and cruelty in the consulting room is unprofessional. But if “harm” includes the discomfort of hearing that a favoured protocol rests on weak evidence, then the regulator has annexed the ordinary business of science. New ideas always offend someone who has invested in the old ones.

Ignaz Semmelweis was mocked for telling obstetricians to wash their hands. Barry Marshall in Western Australia drank the bacterium Helicobacter pylori because the textbooks insisted ulcers were a disease of stress. In each case, the people who were “harmed” were the custodians of a consensus. Had their feelings been the test, we would still be burying women from childbed fever and suffering ulcers.

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.