Psyops

The Australian Psychological Society has trashed high-quality evidence contrary to the gender-affirming treatment model

Photo by Jose A.Thompson on Unsplash

We’re psychologists, not script-writing medicos, and so we don’t need to know that the evidence for puberty blockers and cross-sex hormones is so weak that there is no firm basis for claiming these interventions improve the mental health of minors.

My paraphrase, but that, in effect, appears to be the official line from the Australian Psychological Society (APS).

In a 2024 draft position statement on transgender mental health support, an APS taskforce had included the UK Cass report and gold-standard systematic reviews of the evidence base, which had led to more cautious guidelines on the medicalisation of minors in England, Finland and Sweden.

In the 2026 final statement, signed off by the APS board, all those up-to-date international studies disappeared.

One mother, whose child has complex problems as well as gender distress, contacted the APS to ask why psychologists were not being told about the poor state of the evidence and this new caution in the field of gender dysphoria treatment.

On April 10, the day after the public release of the position statement—“Supporting the mental health and wellbeing of transgender and gender-diverse people”—she got a reply from psychologist Andrew Chua, who said he was speaking for the APS board.

“It is critical to understand that as psychologists, we are not involved with implementing medical and physical interventions, hence the title of our position statement,” Mr Chua said.

“As medical interventions are outside of our sphere of practice, the international studies you quoted are not referenced in our position statement. If you have concerns about current medical interventions, please contact the Australian Medical Association or the Royal Australasian College of Physicians…

“We are very confident, up to the date of the publication, that we have considered the relevant robust psychological evidence…”

Assume, for the moment, that psychologists play no role whatsoever in a minor ending up on blockers or hormones. Now can we make sense of the disappearing references?

Among the studies not adopted from the 2024 draft was a systematic review of the evidence on psychosocial support for gender dysphoric youth. Surely this is relevant psychological evidence. Robust, too, because systematic reviews sit at the top of the evidence pyramid. But this one was commissioned by the Cass review, which activists smear as “anti-trans”.

Social transition—new pronouns and a new name for a child adopting a cross-sex role—also falls within the non-medical domain of psychology. The 2024 draft advised caution here—“[S]ome practitioners suggest that the use of a new name or pronouns in children who are yet to be assessed may be considered a form of active intervention”. Why was this caution abandoned in the final APS position statement?

Clinical psychologist Ken Zucker, an international authority on youth gender dysphoria, is one of those practitioners who believes that parents should be made aware of the long-term implications of early social transition. In a 2019 article for the journal Child and Adolescent Mental Health, Dr Zucker says—

“A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).

“Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterised as iatrogenic.”¹

The 2024 APS draft included a recent, Cass-commissioned systematic review of the scientific literature on social transition; another piece of relevant and robust psychological evidence missing from the 2026 final statement. Instead, psychologists will read that asking for a client’s pronouns is part of “inclusive practice”. If this position statement is taken to heart, parents won’t be advised by a psychologist that early social transition of their child is likely to lead to lifelong medicalisation.

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Gay, not trans: US detransitioner Jonni Skinner tells his harrowing story of gender medicalisation

Pushing a medical model

It should be obvious that psychologists do not have to do the prescribing or perform the surgery to promote and enable medical transition of minors.

The 2024 draft stated that, “Medical gender affirmation is not the only way to support transition”. The final version says: “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”. Here, the APS cites the Australian guideline used to justify blockers, hormones and mastectomies for minors.

This treatment guideline—first issued in 2018 by the Royal Children’s Hospital (RCH) Melbourne—scored 19/100 for the rigour of its development, according to peer-reviewed research commissioned by the distinguished paediatrician Dr Hilary Cass, who led the 2020-24 review in the UK. But all the research associated with Cass, including several systematic reviews, was removed in the final APS statement, while the low-quality guideline from RCH Melbourne remained.

How does Mr Chua justify retention of this document, which has medical and surgical—not psychological—interventions at its core? In 2019, paediatrician Dr Michelle Telfer, first author of the RCH guideline and director of its gender clinic, appeared before a royal commission into mental health.

She said: “… it’s not just the mental health clinicians within our [RCH gender clinic] team that are there to support mental health, because for trans and gender-diverse children it’s actually the medical interventions as well as some surgical interventions that help their mental health”. There is no good evidence to support her claims, according to the systematic reviews cited in the 2024 APS draft.

Citing such reviews, the worried mother who exchanged emails last week with Mr Chua said she believed the 2026 APS statement was “notably out of step”.

“Not because it lacks compassion, compassion is essential, but because it does not fully engage with the level of clinical uncertainty now recognised internationally, nor does it clearly support psychologists to navigate that uncertainty through careful, exploratory practice,” she said.

“Psychologists occupy a critical safeguarding role, particularly for children and adolescents. Where guidance does not explicitly protect the space for thorough assessment and formulation, there is a real risk that complex presentations are prematurely simplified.”

When the APS taskforce began its review in 2022, there was an explicit policy mandating the gender-affirming approach, despite the weak evidence base. The 2024 draft statement did better by acknowledging that the field is contested: “Scientific literature and professional guidelines vary considerably in recommendations regarding the best way to provide care for gender-diverse and transgender people”. As for the 2026 final statement, it is muddled but can be read as a return to an affirmation-only stance.

The document does offer some reassurance to practitioners who would avoid the gender-affirming model as incompatible with mainstream psychological norms and methods. The new 2026 statement says—

“The APS recommends an individualised approach to psychological care which is fundamentally person-centred. The approach to treatment should be formulated on a ‘case-by-case’ basis in close collaboration with the client. In all cases, care should be respectful and evidence-informed with particular attention to being culturally sensitive and considerate of the intersectionality of multiple minority identities.”

And the statement also says—

“As with all clients, a thorough psychological assessment and case formulation is recommended to gain a comprehensive understanding of acuteness of distress, socio-cultural background, as well as risk and protective factors and differential diagnoses. Treatment approaches to address psychological distress should be discussed clearly and openly with the client.”

But this is undercut, elsewhere in the document, by the requirement for “inclusive practice” including the practice of “asking for and [making] the correct use of a person’s name, pronouns and terms for their gender and body, as they prefer”. This sounds like immediate affirmation, not a comprehensive assessment with differential diagnosis. Is it “inclusive” for a psychologist not to consider whether awkward same-sex attraction or mental health problems better explain the distress that a teenager presents as gender dysphoria?

The 2024 draft statement would have alerted psychologists to the fact that, far from being the gold standard, the gender-affirming model and its claim to “lifesaving” outcomes have been seriously challenged—

“The best way to provide psychological care for people with gender dysphoria is debated in the scientific literature, professional guidelines, and in broader social discourse. Emerging research including multiple international, independently conducted systematic reviews and evaluations from national health services [in the UK, for example, Sweden and Finland] have investigated elements of the dominant medical gender-affirmation model.”

And elsewhere in the draft—“More systematic and longitudinal research is needed to determine the long-term impacts of social, medical, and surgical transition, detransition, and retransition particularly of children and adolescents, as well as the specific needs of neurodivergent children, adolescents, and adults with gender-related distress.”

That sobering reality is gone from the final APS statement, which makes an unreferenced and circular claim that—“Scientific literature, professional guidelines, and professional bodies including the APS, support the use of affirming practices that enable transgender and gender-diverse people to thrive.” Nothing is said about the low quality of these sources.² This kind of exuberant, evidence-lite claim is typical of the affirmation-only mindset.

The 2024 draft APS statement also contained better protection for perfectly ethical exploratory psychotherapy—

“One role of any psychologist may be to discuss an individual’s understanding and meaning of gender in the context of client self-discovery. It is important that this gender-reflection (exploration) work is taken with care, client-led, and outcomes consider the needs and wishes of the client.

“It is important to note that such processes are not considered conversion therapy unless a particular gender or gender expression is promoted as ‘correct’ or ‘proper’ by the practitioner… [P]articular care should be taken when undertaking gender related work with child and adolescent clients.”

In some jurisdictions, conversion therapy is not only unethical but illegal. The 2026 APS statement adopts a distinctly less reassuring tone for practitioners who work in the mainstream tradition of exploratory psychotherapy—

“One role of psychologists may be to discuss an individual’s understanding and meaning of gender in the context of client self-discovery. If this work is to be conducted, it is integral to ensure that this is client initiated and led, due care and consideration is taken, and outcomes are driven by the needs and wishes of the client and not others (e.g., the psychologist, a parent or partner).

“Psychologists must ensure that these processes do not constitute conversion therapy practices (i.e., efforts to alter, suppress, or change a person’s gender), such as by not promoting a particular gender or gender expression as ‘correct’ or ‘proper’.”

The 2024 APS draft statement cited an important paper by Australian psychoanalyst Dr Roberto D’Angelo and colleagues with the self-explanatory title “One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria”. It’s banished from the 2026 position statement. What remains in the final statement is a paper by Canadian legal academic and bioethicist Florence Ashley, who argues that “gender exploratory therapy” may be nothing more than a mask for opposition to the affirmative model.

In this 2022 paper Dr Ashley poses a series of questions for clinicians, including this—

“Given concerns that premature affirmation may foreclose gender identity and exploration and considering that puberty blockers arguably have far less of a foreclosing impact on gender than endogenous puberty, do you think that clinicians should offer and encourage puberty blockers for all questioning and even perhaps all cisgender kids? Would your answer change if you were absolutely certain that puberty blockers had no negative long-term side effects?”

In another paper, Dr Ashley has argued that blockers, hormones and “more rarely” surgery for trans adolescents must be judged effective to the extent that they serve an individual’s “embodiment goals”.

“Offering transition-related medical care to adolescents is ethically justified regardless of proven mental health benefits, that is, regardless of whether it is proven that adolescent medical transition causes an improvement in mental health such as by reducing distress.” Dr Ashley is trans.

Presumably, this radical approach would be outside the psychologists’ “sphere of practice” invoked by Mr Chua.

But the APS has endorsed the RCH treatment guideline, and it is worth keeping in mind the views of Dr Telfer as first author of that document. At the 2019 royal commission, she said—

“[I]t’s really interesting when we think about mental health clinicians within the context of trans and gender-diverse children, because you don’t really need someone to diagnose a person with gender dysphoria, because a trans identity is something that’s so innately personal that really only that young person or adult, depending on what time of their life they’re coming in, only they know how they feel about their gender and whether that’s a problem or not for them.”

In April 2025, Dr Telfer was criticised by an Australian Family Court judge for giving testimony as a trans health “advocate”, not as an objective expert witness. In this case, with the mother’s approval but the father’s opposition, the RCH gender clinic was proposing puberty blockers for a 12-year-old boy, Devin, who was gender non-conforming.

Devin’s treating clinician was a psychologist identified only as Dr N. The boy had been attending the clinic for more than three years, but a (legally necessary) diagnosis of gender dysphoria was only made as the trial date approached. The judge, Andrew Strum, was troubled to find no evidence of “a comprehensive biopsychosocial assessment” of Devin in Dr N’s notes. Justice Strum made orders protecting the boy from the puberty blocker intervention.

The judge found that the RCH clinic “has a single approach; gender dysphoria, if diagnosed there, is treated with puberty blockers and attendances upon Dr N or one of her colleagues. No alternative treatment options are offered by the [clinic] for gender dysphoria diagnosed there, other than prescription of puberty blockers by a paediatrician…”

“[I]n response to a question by me, [the treating psychologist] Dr N could not identify a single case of a child who had been referred by her, or one of her colleagues, to a paediatrician at the [clinic] who had not been prescribed puberty blockers.”

Unsuccessfully, the mother sought to strengthen the case for puberty blockers by invoking the affirmation-only position expressed in a September 2019 media statement issued by the APS with the heading “APS Refutes ‘Social Contagion’ Arguments”. Justice Strum was not persuaded—

“[That media statement] was over five years ago; much proverbial water has passed under the bridge since then, including the Cass report in 2024 and, as [expert witness] Dr R said in cross-examination (which evidence is uncontroverted), this statement is under review. Accordingly, I place little weight upon the official, but possibly, if not probably, outdated position of the Australian Psychological Society.”

Now, in 2026, the APS is pretty much back to where it started five years ago. The board cannot say it was unaware of the risks posed by the gender-affirming model.

As recently as February this year, a group of APS members sent a 12-page letter to the new president, Dr Kelly Gough, and the board.

The letter cited parent reports of troubling practices by some psychologists, including—

“A clinical psychologist initially described herself as ‘gender exploratory’, but after six sessions declared the adolescent ‘definitely trans’ and endorsed the adolescent’s assertion of no future regret—without disclosing recent suicidality to the parent.

“A second clinical psychologist, after a one-hour meeting with the parent (having never met the autistic adolescent), stated affirmation was necessary to prevent suicide risk.

“Psychologist tells a 15-year-old boy to cut off contact with his mother, with whom he lived, because she did not support gender transition.

“Psychologist refers 14-year-old girl in one session to RCH Gender Service.

“Psychologist at a state gender service considered that ALL minors referred to the service were good candidates for transition, because the waiting list was so long that any who were not serious would have dropped out.

“Psychologist refuses to engage with a young person with gender distress after the mother voices concern about affirmation.

“Psychologist takes parents aside to tell them that unless they affirm their child’s transgender identity, proceeding with therapy would be pointless and that they have one last chance to have a relationship with their child.

“Psychologist provides incorrect advice to a minor that consent from both parents is not required, when parents are questioning hormonal treatment.

“Psychologist sends a letter home with a gender-distressed young adult to deliver to his parents, admonishing them for not affirming their son’s gender identity then refuses to engage any further with them.”

The group letter also warned the APS of litigation risk. “If APS members are led to believe gender affirmation is evidence-based, they risk contributing to patient harm and exposure to litigation,” the letter said.

“The APS is therefore responsible for providing accurate, evidence-based recommendations given the serious long-term health effects of medical transition and the limited quality evidence for mental health benefit.

“Litigation is increasing, including cases brought against professional associations. An up-to-date list of more than 35 international cases is available upon request.

“Last month [January 2026], in the first of its kind, a New York jury awarded US$2 million to a detransitioner in a malpractice case concerning a double mastectomy at age 16.³

“Seventy percent of fault was attributed to the psychologist, based on inadequate psychological evaluation, insufficient risk disclosure, and inadequate safeguards prior to irreversible surgery.

“Several malpractice suits against Monash gender clinic [in the Australian state of Victoria] were settled out of court in the early 2000s, and we understand several such cases are ongoing in Australia.

“Financial liability may end up driving policy change where evidence review has not.”

Certainly, there is little foundation for the APS claim that the non-medical nature of psychology explains the decision to impose on practitioners a position statement stripped of high-quality (but inconvenient) studies.

GCN invited Mr Chua to write an opinion article arguing the case for the changes made to the 2024 APS draft statement. In response, 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”. GCN does not dispute that gender-affirming clinicians believe their interventions help vulnerable youth.

1. Before the era of puberty blockers taking off in the 2010s, the vast majority of patients—chiefly boys with early-onset gender dysphoria—outgrew this distress as they matured, with many of them emerging as (unmedicalised) gay or bisexual adults. The rate of “desistance” in the current patient profile—mostly teenage girls with mental health issues predating their adolescent-onset dysphoria—is unknown.

2. Consensus-based treatment guidelines, akin to expert opinion, represent a lower quality source of evidence than a systematic review.

3. According to detransitioner Fox Varian, psychologist Kenneth Einhorn “served as an enabler, repeatedly assuring her that the mastectomy she desired would greatly improve her well-being,” journalist Benjamin Ryan reported.

“[U]nder cross-examination, the psychologist acknowledged that for all his and Varian’s talk of suicide, he didn’t actually believe she was at serious risk of an attempt during that period. And as her case file demonstrated, he never once saw a cause to note that Varian was suicidal until after the operation.”

There was expert evidence from plastic surgeon Dr Loren Schechter that the psychologist had misunderstood the rationale for a gender mastectomy. “Surgery in and of itself is not a treatment or a mechanism to prevent suicide,” Dr Schechter said.