No federal rescue

Australian Health Minister Mark Butler rules out stop-gap restrictions on blockers and hormones for gender-distressed minors

The gist

Australia’s centre-left Labor Party Health Minister Mark Butler has ruled out for now any federal restriction on paediatric gender medicine pending new national guidelines expected in 2028.

At the National Press Club in Canberra on Wednesday, the federal minister was asked by a journalist if he were considering “any kinds of restrictions” in the light of local and international developments adverse to the “gender-affirming” treatment model with its poorly evidenced puberty blockers and cross-sex hormones for minors.

“I’ve done what I think is appropriate from the Commonwealth,” Mr Butler said. The minister recapped his January 31 announcement that the National Health and Medical Research Council (NHMRC) would develop new countrywide treatment guidelines for gender-distressed minors.

He had also asked the NHMRC to carry out “a comprehensive review” of the current de facto national guidelines used by state-based health services and issued in 2018 by the gender clinic of the Royal Children’s Hospital (RCH) Melbourne.

Under the NHMRC timeline, the expert committee to draft the new guideline was expected to have been established by July 2025 as part of the first stage of the project.

Asked about any delay, a spokeswoman for the NHMRC said the first stage was “well advanced” and the expert committee would be set up “in coming weeks”.

“Interim advice on the use of puberty blockers is still expected to be available in mid-2026,” she told GCN.

The full guideline is scheduled for approval and release in March 2028.¹

In December last year, Minister Butler’s office sought urgent advice from officials in his department on puberty blockers, including “the evidence around the safety of current Australian practice [and] the weight of evidence in support of a pause or ban in the Australian context”.²

This was prompted by news that his UK Labour counterpart, Health Secretary Wes Streeting, had imposed an indefinite ban on puberty blockers, declaring it “a scandal that [this] medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.”

The April 2024 Cass report, consistent with systematic reviews in multiple overseas jurisdictions, had found the evidence for hormonal treatment of gender-distressed minors to be remarkably weak, meaning there is no firm basis for saying whether these interventions help or harm.

The detail

At the press club on Wednesday, the questioning journalist cited significant events since Minister Butler’s January 31 announcement.

These included the Family Court’s re Devin ruling highly critical of the RCH Melbourne gender clinic and of the lead author of its 2018 gender-affirming guidelines.

The journalist also made reference to news of a retired judge who said it was now clear that a much-celebrated “trans health rights” case of 2013, re Jamie, was mistaken in its assumption that puberty blockers were reversible and not risky.

In his answer to the journalist on Wednesday, Mr Butler emphasised the federal demarcation between the national standards-setting role of the NHMRC and the state-based delivery of puberty blockers and cross-sex hormones to minors.

“The NHMRC has a statutory charter to do that [guideline development] work,” he said.

“Its capacity to do that, I think, is unparalleled, and frankly, given the level of debate and contest around this [subject of paediatric medical transition], I thought it was appropriate that the most esteemed body in this area in the country, do that work, rather than have these debates play out in different ways in different jurisdictions.”

He said the NHMRC would provide “the most up-to-date, most expert clinical advice”.

“In the meantime, these [hormonal transition] services are all provided by state governments across the country. They are the ones who fund the services, employ the clinicians, make these decisions.”

State governments have subsidised off-label puberty blockers for gender-distressed children. These hormone suppression drugs do not have regulatory approval for this purpose and are not funded by the national Pharmaceutical Benefits Scheme (PBS).

However, state children’s hospitals which host gender clinics are in receipt of federal health funding.

And Mr Butler’s federal Department of Health and Aged Care appears to condone the practice of federally subsidised testosterone being prescribed for transgender-identifying females on the grounds that they suffer from the PBS indication of “androgen deficiency/testicular disorder”.

The department has been unable to give a clear answer to the question whether this is lawful.

Recently, a spokesperson for the department told GCN that the criteria for PBS testosterone simply “state that a patient must have an established pituitary or testicular disorder.”

“The listing does not specify any gender-based eligibility for treatment access.³ Further, the listing does not specify particular pituitary or testicular disorders.”

Diagnosis of these female patients was up to “the clinical judgement of the prescriber,” the spokesperson said.

There is no evidence that females who identify as trans or “non-binary” suffer from any hormonal anomaly before they begin to take supra-physiological doses of cross-sex hormone drugs, meant to be taken lifelong, with known and unknown health risks.

1. In his January 31 statement, Minister Butler said treatment advice on puberty blockers “will be completed in the middle of 2026.”

He repeated that timing at the press club on Wednesday, saying the NHMRC had been asked to “expedite” this advice, meaning it would come before the March 2028 deadline for the complete national guideline. In his answer to the journalist’s question, the minister said he recognised there was “a little bit more urgency to get clear advice about the use of puberty blockers, which is why that will come in the middle of next year.”

On Thursday, Mr Butler’s office confirmed to GCN that there had been no “change in approach or timeline” for the guideline project.

2. Mr Butler’s January 31 NHMRC announcement, unopposed by the LGBTQ gender medicine lobby, came three days after the new centre-right government in the state of Queensland ordered a pause in new hormonal treatment of minors in the public sector pending an independent review of the evidence for puberty blockers and cross-sex hormones. That January 28 Queensland decision was denounced by the gender medicine lobby.

On January 29, senior officials in Mr Butler’s federal department and in the NHMRC began to exchange emails—marked “urgent” and “sensitive”—about the new national guideline project, according to documents obtained under Freedom of Information law.

The hurried nature of Mr Butler’s January 31 decision was confirmed by the lack of any information about the project on the NHMRC website on the day of the announcement, with the minister promising it would be available “shortly”. It took some days to appear.

On January 31, at a media conference, Mr Butler said he had invoked the NHMRC guideline project and the cause of national consistency to urge Queensland to abandon its independent review. The state went ahead anyway, and its inquiry led by psychiatrist Professor Ruth Vine is due to report by November 30.

If Queensland’s initiative did influence the timing of Mr Butler’s January 31 announcement, it is nonetheless the case that the option of a national guideline project had been put to the federal minister in December 2024 as part of the brief requested from his departmental officials following news of the UK ban on puberty blockers.

3. The PBS requirement that patients be male was removed in 2015 following complaints of “discrimination” from the lobby group now known as LGBTIQ+ Health Australia, which wanted subsidised testosterone for females who identify as male. That lobby had a seat on the federal government’s LGBTIQA+ Health and Wellbeing 10-year National Action Plan Expert Advisory Group, which was chaired by Mr Butler’s deputy, former Assistant Health Minister Ged Kearney.

The 10-year plan was launched by Mr Butler in December 2024 as “an Australian-first roadmap to improve the health and wellbeing of the LGBTIQA+ community.”

The plan uncritically endorses “gender affirmation” as an “umbrella term for a range of actions and possibilities involved in a person living, surviving, and thriving as their authentic gendered selves. This may involve social, medical and/or legal steps that affirm a person’s gender.”

The plan also asserts that “a person’s sex can change over the course of their lifetime and may differ from their sex recorded at birth.”

The senior official responsible for the development of the plan—the “Director—Men’s, LGBTIQA+, Children and Young People’s Health” in the Health Equity Branch of Mr Butler’s department—was involved in the hurried preparations for the January 31 announcement of the NHMRC project.