Parents’ problematic decisions on puberty blockers

The Supreme Court of Victoria directs that the mother of a 12-year-old child can consent to them being prescribed drugs to slow the onset of puberty. The biological male has identified as a girl since age seven and has the support of her loving mother. The child’s pediatrician and psychologist support treatment starting as early as possible. But the Royal Children’s Hospital in Melbourne was sufficiently concerned about what judge Melinda Richards called “the uncertain state of the law regarding consent to treatment for gender” to ask the court to decide whether the mother alone in this specific case could decide. Judge Richards has decided she can – the biological father, absent throughout the child’s life, has not been asked.

But this decision on specific circumstances will settle nothing in the fierce debate over the medicine and morality of the routine use of puberty blockers. It does not deal with circumstances where families are split or there is recognisable risk of a young person changing their mind.

Transgender activists demand their choices be available to teens and accuse critics of too-easy access to puberty blockers of putting young people at risk of self-harm. However, the medical and psychological science is certainly not settled on how to identify cases where puberty blockers are essential. Certainly, the debate is starting to shift in Britain and Europe, particularly since the National Health Service for England’s Cass review of the Tavistock Clinic in London. Pediatrician Hilary Cass found an ideologically informed approach there led to routine availability of puberty-blocking drugs for early-year teens.

“The rationale for early puberty suppression remains unclear … the effect on cognitive and psychosexual development remains unknown,” the NHS overview of Dr Cass’s report states. And, in what must become an enduring counsel of caution, Dr Cass found “clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity”. These are messages being heard in Australia by some medical specialists, notably the Royal Australian and New Zealand College of Psychiatrists. But as health editor Natasha Robinson has reported, most health ministers and children’s hospitals rejected the Cass review as irrelevant to our circumstances. Not good enough. Not for young people for whom puberty blockers may not be a path to their lifelong identity and not for families struggling to help children and early teens in distress.