Warning on blocker imports
Regulator advises extreme caution as an online gender clinic promotes a cheaper way to block unwanted puberty
A prominent gender doctor, who serves on the board of gender medicine lobby the Australian Professional Association for Trans Health (AusPATH), has set up an online clinic where his legal advice on access to hormonal treatment for minors has been challenged as inaccurate.
Dr Darren Russell’s new Australia-wide clinic, Prism Health, also highlights savings of almost $1,000 a year if puberty blockers are imported from overseas suppliers, which his website says is legal with a doctor’s prescription.
Asked about this, federal regulator the Therapeutic Goods Administration urged people to take “extreme caution before importing unapproved medicines into Australia for personal or family members’ use.”
Puberty blocker drugs, which suppress natural sex hormones, are approved for various medical conditions but not for the psychological distress of gender dysphoria, where they are used “off label.”
There is a lack of long-term safety data for this relatively recent use of blockers to interrupt the normally timed puberty of children who reject their birth sex. The effect of hormone suppression on the still developing adolescent brain is unknown.
Dr Russell’s website says these drugs are usually started in early puberty (between the ages of 9 and 13) and “may be taken for some years before the young person is mature enough to start [cross-sex] hormone treatment.”1
Last month, Queensland became the first Australian state to pause new treatment of gender-distressed minors with puberty blockers or cross-sex hormones in the public health sector, pending an independent review of the evidence. In the UK, routine use of blocker drugs has been restricted in both public and private health.2
The advice from Dr Russell’s Australian online clinic is that under the law, puberty blockers can go ahead in the state of Victoria with only one parent’s consent, and that cross-sex hormone treatment in Queensland does not require parental approval if the minor is mature enough.
Emeritus professor of law Patrick Parkinson said both those claims, which favour easier access to these contested treatments, are incorrect.
“In all cases, and in all states and territories, the consent of both parents must be given for any child or young person under 18, or in the alternative, the [federal Family Court] must give its approval,” Professor Parkinson told GCN.
“Yes, the court may well accept the right of a young person to decide for herself if she is sufficiently mature enough to do so; but the High Court has said that the reason for seeking court approval is for the judge to be satisfied that she does have that level of understanding to make the decision for herself.
“There are occasional decisions of state courts in which judges have expressed a contrary view; but these do not rise to the level of authoritative precedent.
“I am rather surprised that a doctor is purporting to give legal information on a public website.”
Whistleblower alert
Queensland’s Health Minister, Tim Nicholls, said last month that one of the triggers for the state’s treatment pause and evidence review was the provision of “apparently unauthorised paediatric gender services” at the public Cairns Sexual Health Service in the state’s north, following concerns raised by a whistleblower last May about the prescribing of puberty blockers to a 12-year-old.
Dr Russell’s new website says that he was Cairns sexual health director until late 2024, when he moved to Victoria to establish the private provider Prism Health, which is promoted as an “online gender-affirming healthcare service.”3
Gender medicine lobby AusPATH has reacted to Queensland’s freeze by claiming the state government “has left kids without care.” Minister Nicholls has said that psychiatric and psychological support is still available in the public system, while hormonal treatment continues for existing patients.
AusPATH has launched a fundraiser called Project 491, a reference to the 491 minors reportedly on the waiting list for the public Queensland Children’s Gender Service, where new treatment with subsidised puberty blockers or cross-sex hormones has been paused.4
AusPATH, which is a hybrid professional/activist group, invokes a low-quality anonymous online survey to state as fact that there is a “48.1 per cent suicide attempt rate among [trans and gender-diverse] youth.” This “transition or die” narrative has been criticised as unfounded and irresponsible.
AusPATH complains that providers of full-cost hormonal interventions in the private health sector may be beyond the reach of “lower-income families.”
Dr Russell’s Prism Health website says—
“Puberty-blocking medications are not available under the PBS (Pharmaceutical Benefits Scheme) and the cost of these medications is high and unfortunately not affordable for many families.
“State and Territory governments may make these medications available at low cost in the public hospital system but accessing them can be difficult and there may be lengthy waiting lists stretching out for 2 years or more.
“They can be purchased privately from your local pharmacy with a prescription from a doctor but currently cost over $700 per injection (which lasts 3 months).
“Alternatively, they can be imported from overseas suppliers at a cost of around $460 per injection—in Australia this is legal with a doctor’s prescription.”
Dr Russell’s interest in the importation of generic puberty blocker drugs pre-dates the Queensland ban.
The Therapeutic Goods Administration (TGA) said Australia’s “personal importation scheme” could be used under certain conditions, one being possession of “a valid written authority,” such as a doctor’s prescription.
However, in response to GCN’s questions about importation of generic puberty blockers, the TGA spokesperson warned that—
“The TGA does not evaluate unapproved medicines for quality, safety and efficacy when imported via the Personal Importation Scheme and urges consumers to exercise extreme caution before importing unapproved medicines into Australia for personal or family members’ use.
“Products the TGA does not regulate may not meet Australian manufacturing quality standards and could contain undisclosed harmful ingredients or may be fake. When importing these products, consumers must be prepared to take this risk for themselves and their family.”
On Sunday, Guardian Australia reported that a 15-year-old from Brisbane, Queensland, had been prescribed cross-sex hormones and “all it took” was a 40-minute video call with Dr Russell.5
“You could see the instant change in his mental health,” the child’s father told the media outlet.
Guardian Australia quoted Dr Russell as saying: “I’m sure other doctors around the country are already receiving inquiries. So yep, we certainly expect to get [a] bit busier as a result of [the Queensland ban].”
Also quoted in the news report was gender clinician Dr Fiona Bisshop, a former AusPATH president, who said her Brisbane clinic, Holdsworth House, had staff working overtime to handle new treatment following the Queensland moratorium.
“There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing [gender dysphoria]. Methodologically rigorous prospective studies are needed to understand the effects of this intervention…
“Since the current best evidence, including our systematic review and meta-analysis, was predominantly very low certainty, clinicians must clearly communicate this evidence to patients and caregivers.”—Miroshnychenko et al, peer-reviewed article, Archives of Disease in Childhood, 24 January 2025
Guideline error
Dr Russell’s Prism Health clinic states that it “adheres to the highest standards of care” and follows the de facto national treatment guidelines first issued by the Royal Children’s Hospital (RCH) Melbourne in 2018 and endorsed by AusPATH.6
In 2020, a Family Court judge said the RCH guidelines incorrectly stated the law on the need for parental approval before a minor is started on irreversible cross-sex hormones. A corrected version of the document was published.
On behalf of AusPATH, Dr Russell was given leadership of plans for the first major revision of the RCH Melbourne treatment guidelines in early 2023 after the guidelines’ first author, paediatrician Dr Michelle Telfer, stepped down as director of the RCH gender clinic.
Last month, reportedly at AusPATH’s request, Australia’s federal government announced that the National Health and Medical Research Council (NHMRC) would develop new treatment guidelines in close consultation with AusPATH.
Australia’s Health Minister, Mark Butler, and his deputy, Ged Kearney, have sent mixed messages about whether the NHMRC project is to develop new national guidelines or merely to update the RCH guidelines as requested by AusPATH.
Ms Kearney, who chairs the government’s “LGBTIQA+ health care” advisory group, described the RCH treatment guidelines as “excellent,” whereas Mr Butler said they would be subject to a “comprehensive review” by the NHMRC.
GCN sought comment from Dr Russell, Dr Bisshop and Queensland Health Minister Nicholls. This reportage is not suggesting wrongdoing by gender clinicians, but highlights the international scientific and ethical debate about the practice of paediatric gender medicine. It is not disputed that gender-affirming clinicians believe their interventions benefit vulnerable young people. Comments on this post have been closed for legal reasons.
In 2020, gender clinicians and researchers discussed the “ethical dilemmas” in the case of “EF,” a 15-year-old “non-binary” patient at the Royal Children’s Hospital Melbourne, who wanted to remain on puberty blockers “long term,” despite the side effect of low bone density.
“[EF’s] bone mineral density has regularly fallen and is now in the lowest 2.5 percentile, although there have been no fractures,” says the article in the journal Paediatrics. “EF, whose desire for biological children in the future remains unclear [hormonal treatment can lead to sterility], wishes to continue puberty suppression until they are at least 18.”
A small-scale audit of the Queensland Children’s Gender Service, where puberty blockers are subsidised by the state, found that almost half of the patients on hormone suppression at this public clinic (45 per cent of 11 patients) were first prescribed these drugs in the private sector.
Queensland is going ahead with its independent evidence review, as well as inquiries into the Cairns service, a spokesman for state Minister Nicholls told GCN. Federal Health Minister Mark Butler had announced a national treatment guideline process and asked Queensland to abandon its evidence review.
The cross-sex hormone, testosterone, is supplied to female patients, who identify as trans or non-binary, under the diagnosis for the male condition of “androgen deficiency/testicular disorder,” thereby securing public subsidy within the federal Pharmaceutical Benefits Scheme.
Dr Russell’s website says: “Please be aware that everyone is unique and assessment time is highly variable depending on the individual circumstances and the complexity of the young person’s needs.”
Last week in QNews, Dr Bisshop blamed the Queensland treatment pause on the influence of England’s “infamous” Cass review, which she said had lacked “any consultation with trans youth, their families and the expert clinicians involved in their care.” This claim is one of the incorrect talking points used by gender clinicians and activists internationally; it has been rebutted by the Cass review.
Dr Bisshop said puberty blockers were “safe and reversible” and “a safety net” for young people, providing “time for them to receive counselling and further assessment.” The QNews article did not mention the multiple systematic reviews showing the evidence for puberty blockers to be very weak and uncertain. Nor did it acknowledge research data suggesting that the vast majority of children started on blockers will proceed to cross-sex hormones, undermining the “time to think” rationale.
A week after Queensland’s evidence review was announced, Dr Bisshop complained that it had “no time frame” for reporting. On January 28, the day of Queensland’s announcement, ABC News coverage included the detail that the government had set a reporting deadline 10 months from the reviewer’s appointment.