False consensus on puberty blockers is a danger to our kid
Hence the significance of the rethink by Diana Bryant, chief justice of the Family Court in 2013 when it accepted the one-sided evidence of experts and liberalised access to puberty blockers in the “re Jamie” case. If the court had held firm, then its judges would still be supervising each decision to start a gender-distressed child on blockers, even when both parents agree. And if the judges lacked caution in a given case, the legal process itself would apply a brake to the rollout of blockers.
Now, as The Australian has reported, Bryant doubts the wisdom of relaxing judicial oversight of blockers 12 years ago. She has acknowledged the court was misled by experts. There are concerns that blockers are harmful and lock a child into medicalisation with no good evidence of improved mental health. Since re Jamie, our gender clinics have prescribed blockers at an estimated per capita rate higher than at the London-based Tavistock clinic, which was the world’s largest youth gender dysphoria service before its closure as a result of the landmark 2020-24 review by UK pediatrician Hilary Cass.
Pharmacological interference in normally timed puberty – which is a fundamental process in development and arguably a human right – has become routine treatment for children who report mental distress with a range of potential underlying causes other than a nebulous gender identity. This hybrid of identity politics and medicine has had the approval of our Family Court charged with safeguarding the best interests of minors. The judges in re Jamie were told of a new international consensus favouring the early use of puberty blockers to avert self-harm, with no alternative apart from callously doing nothing.
The only experts heard from were those championing “gender-affirming care”, which is a radical Americanised form of the puberty blocker-driven treatment protocol elaborated by Dutch clinicians since the late 1990s. Known as the “Dutch protocol” it rested on one small methodologically flawed study of 70 “juvenile transsexuals”. The idea was that suppressing puberty would produce more convincing and therefore happier adult transsexuals, especially biological males who struggled to “pass” as female.
For this improbable venture to go mainstream, compelling evidence or at least a solid medical consensus would be necessary, you would think. In fact, gender-affirming judges and journalists have accepted and propagated a manufactured consensus. In this way, distressed minors and their parents have been denied the full picture and pressured with an unethical “trans youth suicide” panic. Confronted with the lack of evidence, gender clinicians and activists cry “culture war”.
Politicians are reluctant to intervene in medical controversies. But the self-regulation of health professional bodies has failed, and apart from this year’s watershed re Devin ruling by Justice Andrew Strum, the Family Court has been used to promote experimental medicine for minors.
In 2015, just two years after the court in re Jamie had been assured there was an “international consensus” in favour of “fully reversible” puberty blockers, the Dutch researchers themselves did a reality check. In the spirit of ethical honesty, they surveyed experts in the field of gender dysphoria and documented profound disagreement about the use of blockers.
In 2017, our Family Court handed down another ruling hailed as a victory for “trans health rights”. In this case, re Kelvin, the court freed up access to cross-sex hormones. Again, experts claimed scientific advances made it safe to shift more responsibility to clinicians. Again, this was an activist consensus.
Since 2020, in jurisdictions as various as Finland, Florida, England and Sweden, independent systematic reviews – the gold standard for assessing the quality of research data for a health intervention – have concluded that the evidence for the mental health benefits of blockers and hormones is very weak. Gender clinicians have no firm basis to claim these hormonal treatments are “lifesaving”. No wonder they want to change the subject to politics.
The re Kelvin case had a distinctive feature. The court put its faith in a new Australian treatment guideline for youth gender dysphoria. In draft form, this was the document issued the following year by the gender clinic of the Royal Children’s Hospital Melbourne. That guideline helped accelerate the gender medicalisation of minors across Australia.
In the UK, Cass commissioned a study of the rigour and influence of international treatment guidelines, including the “Australian standards” document from RCH Melbourne, which was rated as low quality. Cass’s 2024 report highlighted a pattern of mutual referencing within the cosy fraternity of gender-affirming treatment guidelines. “The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor,” she wrote. And she noted that “most of the guidelines described insufficient evidence about the risks and benefits of medical treatment in adolescents, particularly in relation to long-term outcomes. Despite this, many then went on to cite this same evidence to recommend medical treatments.”
In Australia, the focus now turns to the National Health and Medical Research Council, commissioned by Health Minister Mark Butler to review RCH Melbourne’s de facto “Australian standards” and develop new guidelines for treatment of gender-distressed minors. The council must resolve a contradiction. The new guideline process is supposed to be “driven by evidence”, using the international system GRADE to rate the quality of the research data. Yet the NHMRC and the wider health bureaucracy are steeped in gender identity ideology and potentially wide open to lobbying by gender-affirming activists. If, yet again, a false consensus prevails, the price may be further harm inflicted on vulnerable young people.
Bernard Lane publishes Gender Clinic News.
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Puberty blockers are still being promoted as safe and reversible; a no-regrets option. Their unwanted puberty suppressed by these drugs, children have time to explore a “gender identity” at odds with their birth sex before the supposedly separate and more momentous decision to proceed to lifelong cross-sex hormones. Or so we have been told by children’s hospital gender clinics and many media outlets, especially the ABC.