Puberty blockers still a worry

Queensland's government has been prompted to reject plans for a gender clinic expansion following contradictory media coverage of the issue

There has been an unprecedented surge globally in teenagers, chiefly girls, presenting with gender distress. Photo by Carolina on Unsplash

The new centre-right Liberal National Party government in the Australian state of Queensland has reaffirmed concerns about puberty blockers and put on the record its rejection of the former Labor administration’s plan to expand the state’s gender clinic.

“We do not support the expansion of gender services for children in Queensland,” Deputy Premier Jarrod Bleijie said on Sunday, adding that the state health department had been told to “halt any further delivery” on the recommendations of an audit of the clinic appointed by Labor in 2023.

“Our priority is safeguarding children and ensuring they receive appropriate and balanced care,” Mr Bleijie said.

Also on Sunday, LNP Health Minister Tim Nicholls reiterated concerns expressed when the party was in opposition about the gender clinic and especially puberty blockers “in light of evidence that’s coming in from around the world.”

Puberty blockers, licensed to treat the medical condition of precocious (or premature) puberty, are used off-label by gender clinics to suppress the normally timed puberty of children as young as age 10-12 who reject their birth sex, identify as transgender or non-binary and express distress about going through “the wrong puberty.”

There is no good quality evidence that puberty blockers improve the mental health of these children, according to independent systematic reviews of the scientific literature, and there is no long-term safety data.

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Video: US detransitioner Chloe Cole visited Australia last year to tell her story of regret and harm after gender medical interventions. Queensland psychiatrists Dr Andrew Amos and Dr Jillian Spencer joined Ms Cole in public speaking engagements

Emeritus Professor of Endocrinology Ashley Grossman—“Treating children with drugs to create an abnormal situation [by blocking normal puberty] with no very clear outcome or benefit does seem to me to be wrong. There’s been a massive increase in what used to be a small number of mainly males identifying with gender incongruence when they’re very young and that’s completely changed with a massive increase in adolescent girls who often have a whole variety of other mental problems.

“The idea that we should treat that [with pharmaceuticals], and that’s going to cure them, in the absence of evidence, is wrong and it’s not what we do in medicine generally.”—Professor Grossman was quoted in news coverage published since Saturday in Brisbane’s Courier Mail, Sydney’s Daily Telegraph, Melbourne’s Herald Sun and Adelaide’s Advertiser, with the headline “The British government has banned puberty blockers but they remain legal in Australia”

Policy blockers

So far, no government within Australia’s federation has acted upon the findings of international systematic reviews—culminating in England’s landmark 2024 Cass report—showing the absence of good quality evidence for puberty blockers and cross-sex hormones as responses to gender distress among minors.¹

The change of government in Queensland has focused attention on the state’s large paediatric gender clinic, where data suggests per capita use of puberty blockers exceeds that of the London-based Tavistock clinic, which was the world’s largest youth gender service.²

The weekend commentary of Queensland’s LNP Deputy Premier Bleijie and Health Minister Nicholls was posted to social media after contradictory and muddled reporting on the future of the Brisbane-based gender clinic—the Queensland Children’s Gender Service—by the Courier Mail newspaper on Saturday.

At first, the newspaper stated that a steering committee would oversee implementation of the report from a 2023-24 audit of the clinic appointed by the former Labor government. A sub-heading for the news article declared, “LNP accepts all 25 recommendations of [audit] panel [which] child psychiatrist slams as ‘stacked’.”

“The government will consider expanding [the] Queensland Children’s Gender Service, the health minister has confirmed, despite the LNP last year voting to ban puberty blockers at its annual [state] party conference,” the Courier Mail reported.

Later on Saturday, the article was changed online without explanation, now stating, “The government will consider whether it implements 25 recommendations of the Queensland Children’s Gender Service review, the health minister has confirmed, after the LNP last year voted to ban puberty blockers at its annual [state] party conference.”

Both versions of the Courier Mail coverage quoted remarks by Queensland whistleblower psychiatrist Dr Jillian Spencer criticising the “gender-affirming” treatment model used by Australia’s children’s hospital gender clinics and characterising the audit panel, led by government psychiatrist Dr John Allan, as “stacked” with gender activists.³

The seven-person panel included at least three members of the gender-affirming lobby the Australian Professional Association for Trans Health (AusPATH) and none of Australia’s well-known clinician-critics of the medicalised gender-affirming treatment model.

The audit panel was asked by the former government to “examine the [Queensland gender clinic’s] current model of service delivery against the Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents.”

Those gender-affirming guidelines, first issued in 2018 by the gender clinic of the Royal Children’s Hospital Melbourne and cited nationally, were found to be of low quality and not fit for use by an independent evaluation of international guidelines commissioned by the Cass review.

“For reasons that appear ideological, the [audit of the Queensland gender clinic] ignored the evidence provided by the Cass Review that neither gender-affirming care itself, nor the specific treatments, improve health or mental health; and ignored the fact that the clinical guidelines on which the [Queensland clinic] based its practice are fundamentally flawed,” said an analysis of the government-appointed audit by psychiatrists Dr Jillian Spencer, Dr Andrew Amos and Dr Patrick Clarke.

Child and adolescent psychiatrist Dr Jillian Spencer—“We need to decommission the [Queensland] gender clinic and redistribute the funds to the mainstream child and youth mental health services, because they can provide psychosocial interventions for the gender distress and evidence-based interventions for any co-morbid conditions [such as depression]. We also need to ban puberty blockers, cross-sex hormones and gender surgery for minors.

“[And we] need to have an open, extended, transparent conversation about whether there’s anything we can do to protect vulnerable adults aged from 18 to 25—often with developmental conditions and mental health problems—from mistakenly viewing transition as a solution to their complex problems.”—Dr Spencer, tweet, 5 January 2025

Wrong direction

In July last year, the Allan audit panel reported that it “found no evidence of children, adolescents or their families being hurried or coerced into making decisions about medical intervention” at the Queensland children’s gender clinic.

The panel’s recommendations included the roll-out of a statewide network of gender services. The then Labor government promised an extra $2.6 million in funding to bring the annual budget to $5.2 million.

On Sunday, Deputy Premier Bleijie appeared to question the independence of the Labor-commissioned audit of the gender clinic, stating, “We made it abundantly apparent—before the election—to Queenslanders that there was no external review.”

“As other jurisdictions were restricting the children’s gender services around the world, the former Labor government was expanding the services.” ⁴

Mr Nicholls referenced the concerns he expressed in June 2023 when opposing Labor legislation enabling “self-ID” change of the sex marker in official documents, including a mechanism for the courts to approve legal sex change for minors under 16 against the wishes of both parents. The sex marker can be changed every 12 months.

“If the person is 16 years or more, the person may apply to alter the record of sex of the person in the relevant child register,” the 2023 law says.

During parliamentary debate on the rushed bill, Mr Nicholls noted the contradiction between insistence on the “agency” of a child to change legal sex and the youth justice campaign to raise the age of criminal responsibility on the grounds that children “do not understand the consequences of their actions…”

He also drew a link between self-ID and gender dysphoria—

“Young people suffering gender dysphoria often have complex emotional issues. It has been clearly commented on that they often fail to appreciate the long-term consequences of their actions and decisions.

“We have only recently seen a series of articles in national media that have highlighted the very serious concerns of parents about the effect it has on children in relation to being able to make that decision at a young age without careful thought.

“I do not say that people make this [self-ID] decision either flippantly or quickly, but there does need to be a serious amount of consideration in relation to allowing it to go ahead, particularly without parental consent for children 16 and under, because it is well documented that the brains of young people do not fully develop until they are well into their twenties.

“Children are often heavily influenced, as we know, by social media and peer pressure and can be reactionary towards parents and authority figures. Anyone who has children knows that to be the case; science and research show that to be the case.

“The experience of numerous clinicians at the Gender Identity Development Service (GIDS) at Tavistock in the UK was that many of the children accessing that service were vulnerable and distressed and that rushed assessments of their needs led to woefully inadequate care and inappropriate treatment.

“They found that many of these children were dealing with a multitude of other issues, including anxiety, depression, traumatic backgrounds, a high incidence of autism … homophobic bullying … and sometimes very chaotic living conditions.

“Further, the clinicians could not agree on what they were treating: were they treating children distressed because they were trans, or were they [treating] children who identified as trans because they were distressed, or a combination of both?

“Many of these children needed psychotherapy, but [Tavistock] GIDS [was] not funded to provide that treatment. Consequently, if they met the diagnostic criteria for gender dysphoria, which they invariably did simply by self-identifying as trans, they would proceed down the medical pathway—that is to say, they were referred for medical intervention involving puberty blockers before, in some cases, proceeding to irreversible treatment.⁵

“In the US, lawsuits are now being launched by detransitioners. The Economist reports that in California a person, Chloe Cole, is suing a large medical provider, Kaiser Permanente, for medical negligence.

“Ms Cole decided at the age of 12 that she was a boy. She was put on blockers and testosterone at the age of 13 and underwent a double mastectomy at the age of 15.

“At the age of 16 she changed her mind and began detransitioning. Her complaint alleges that the medical provider subjected a vulnerable young girl to a ‘mutilating, mimicry sex-change experiment.’

“We can put that through the filter of the way the US legal system works and how their claims are made, but the claim is basically that they went down that medical process instead of focusing on her complex mental health needs.

“Ms Cole, who meets the criteria for autism spectrum disorder, says she is concerned about her fertility and pain and has been permanently disfigured for profit.

“It is not suggested that this [Queensland self-ID] bill promotes a process for medical intervention in the cases of young people wishing to change their sex, however … young people who are confused about these issues can often have complex mental health issues and an application to change their sex descriptor must involve a more rigorous process than proposed by the bill.”

Following the international activist template, the former Labor government presented legal sex change by self-ID as having nothing to do with demand for medical treatment.

In fact, self-ID is likely to lead to more gender medicalisation of minors, in the opinion of a number of clinicians and researchers internationally, including the German child and adolescent psychiatrist Dr Alexander Korte, who is an expert on youth gender dysphoria.

More

Open letter from clinicians and researchers in support of Dr Spencer’s nomination to lead the Royal Australian and New Zealand College of Psychiatrists

Critique of the Australian Professional Association for Trans Health (AusPATH) by Dr Spencer and fellow psychiatrist Dr Patrick Clarke

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GCN has sought comment from Mr Nicholls and Dr Allan.

1. In Queensland, whistleblower psychiatrist Dr Jillian Spencer and colleagues have called for an independent inquiry into gender medicalisation of minors. Western Australia’s centre-right Liberal Party, which is in opposition in that state, has a policy to restrict hormonal and surgical interventions and to review treatment. In 2024 Tasmania’s then Health Minister, Guy Barnett, recommended a national review of gender treatment of minors, but was undercut by his own premier and rebuffed by federal Health Minister Mark Butler. In South Australia, independent MP Frank Pangallo sought to broker cross-party support for a state inquiry, but was stymied by Premier Peter Malinauskas. In New South Wales last year, the Liberal Party endorsed a state council motion for a ban on medicalised gender change for minors, although this is not binding on the parliamentary party. In Victoria, the Labor government has ignored calls for a gender clinic inquiry from Liberal MP Moira Deeming and Libertarian MP David Limbrick. Australia’s federal Senate has voted down a number of motions for a parliamentary inquiry put by the One Nation party.

2. The Tavistock was closed in March 2024 as a consequence of the Cass review.

3. Dr Allan, a past president of the Royal Australian and New Zealand College of Psychiatrists, is executive director of the Mental Health Alcohol and other Drugs Branch in the Department of Health.

4. Jurisdictions restricting hormonal treatment of youth gender dysphoria include the UK, Finland, Sweden and America’s Republican-governed states.

5. The claim that puberty blockers, unlike cross-sex hormones, are reversible has been called into question. The gender clinic at the Royal Children’s Hospital Melbourne has acknowledged that the effects of puberty suppression on the still developing adolescent brain are unknown.