It is a shame that the case of a 12-year-old in Queensland who was prescribed puberty blockers without parental consent is what finally triggered an inquiry into such an ethically fraught treatment.
While puberty blockers are often touted as a “pause button” that allows children time to “work through their issues” related to gender distress, the reality is far more complicated.
Puberty blockers do not simply offer a temporary reprieve for children to sort out their gender identity issues. Rather, they perpetuate and prolong their distress. This approach does not alleviate the underlying psychological distress associated with gender dysphoria or merely give them time to decide if they want to transition; instead, it traps children in a state of suspended development, both physically and emotionally.
A study conducted by The Children’s Hospital at Westmead in 2023 found 88 per cent of young people with gender dysphoria had significant mental health concerns or comorbid diagnoses, such as anxiety, depression and autism, that often go unaddressed while the focus remains on gender identity. This can prolong their distress.
It is important to recognise there are two distinct groups of young people presenting with gender distress: those whose concerns are evident from an early age without any other significant mental health history, and those who develop issues around puberty or adolescence. Gender confusion in the latter tends to emerge suddenly, subsequent to other mental health conditions such as anxiety, autism spectrum disorder and trauma. In many cases gender issues are linked to these conditions and are alleviated by addressing the underlying problem.
The distress transgender people face in navigating their gender identity is real, and the process of transitioning is a deeply challenging and often traumatic experience that comes with significantly higher rates of depression, anxiety and suicidality. But problems arise when we expand medical interventions – such as puberty blockers – to a much larger portion of the young people, particularly to those who are still in the process of developing their gender identity and who may be dealing with other, often unaddressed, mental health concerns.
One of the most concerning aspects of the medical approach is the assumption that treating gender dysphoria with medical interventions such as puberty blockers or cross-sex hormones resolves the mental health condition.
According to the DSM-5, gender dysphoria is a mental health condition characterised by significant distress due to the incongruence between a person’s assigned gender and their experienced gender. The assumption is that transitioning alleviates that distress. But many studies, including those referenced in the Westmead study, indicate while transitioning may alleviate gender-related distress, it does not necessarily resolve underlying mental health issues these individuals face. Physical treatment is not a cure for a psychological issue.
As a professional who has clinically treated several young people referred for puberty blockers by other clinicians, I can attest to the complexity of this issue. In many cases, parents – who were not transphobic, far right or religious zealots – brought their children to me as a last-ditch attempt before signing off on life-changing medical interventions. These were parents who had supported their children through longstanding issues such as generalised anxiety, trauma and autism. They had not seen years of persistent gender distress in their child; rather, this issue seemed to have appeared suddenly with medical professionals supporting their child in seeking medical interventions.
Do you know what I did as a professional? Nothing. I did not argue with the young person that their feelings were “all in their head” and attempt to convince them they were actually their biological gender. As anyone who has tried to dismiss a pre-pubescent child or teenager’s sense of self can attest, this simply does not work. As a psychologist, my role is to listen with empathy. So, I agreed to refer to the young person by their preferred name, but we parked the gender issue and moved on to address other pressing issues – peer relationships, school refusal, bullying, self-esteem, family conflict, screen addiction, learning disorders, substance abuse.
And you know what happened? Over the months, and sometimes years, of working with these young people, the gender distress faded into the background. I never went back to the young person and brought it up, nor did I say, “See, you were wrong”. I instructed the parents not to raise the issue either. Every one of these clients is now a happy young adult, having gone through puberty and living confidently in the sex they were born.
The case in Queensland has revealed a significant gap in our approach to the treatment of gender dysphoria in children. I have concerns that, in the face of international evidence and multiple countries pausing or banning gender-affirming therapy, the Australian Psychological Society continues to endorse gender-affirming care as the gold standard in treating gender distress in children and young people.
We need a national inquiry into the use of puberty blockers in children. We must examine the true impacts of these treatments, taking into account the full developmental context of children, the psychological consequences of early medical interventions, and the complex interplay of gender distress and mental health. Otherwise, we will need to answer to a generation of experimented-on young adults who will require more than just our empathy to explain what we allowed to be done to them.
Clare Rowe is a psychologist in private practice in Sydney.
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