Gender decision a welcome step

Done properly, the federal government-ordered review of national treatment guidelines for the care of young people with gender distress is a positive step for bringing order to a highly fraught medical arena.

It is too early to say exactly how the National Health and Medical Research Council review will proceed.

But if it follows the same path that has been taken in other jurisdictions it will likely find that new protections are urgently needed.

As Bernard Lane wrote on Saturday, a precondition for the new NHMRC guideline would be a systematic review of the evidence base.

Since 2019, in jurisdictions as different as Finland, the UK, Florida and Sweden, systematic reviews have found the evidence for hormonal treatment of gender-distressed minors to be very weak and uncertain.

But this is a highly politically charged arena with a powerful lobby for vested interests.

A less optimistic view of developments might conclude that the federal government has been forced to act only because of the decision by Queensland’s new LNP government to freeze controversial hormone treatment services for new patients under 18 years of age.

The Queensland action followed allegations that puberty blockers were prescribed to adolescents without proper medical support or parental consent.

Peter Dutton is right to say that Queensland should go ahead with bans on gender transition therapies regardless of what happens federally. The precautionary principle would be to hit pause and await the outcome of the NHMRC and state-ordered investigations. As things stand, no terms of reference have been announced for the federal review and it will not report until mid-2026 at the earliest. In Queensland an eminent researcher and clinician will advise in 10 months whether we should be offering these treatments to young patients at all and, if so, to whom and in what circumstances.

In calling a national review, Health Minister Mark Butler has taken a brave stand that has proved too difficult for successive state health ministers. He has said the new national guidelines will be put together using NHMRC standards and the international GRADE system for assessing the quality of evidence claimed to underpin treatment recommendations.

Lane says that from what has happened in other jurisdictions we already know the existing guidelines could not satisfy this test. There is an opportunity to put things right. In the meantime, Queensland is entitled to follow the medical maxim, first do no harm.