How the gender affirming care model failed our families
For years, the gender-affirming care model has shaped the treatment of kids presenting with gender dysphoria – no questions asked. Now, these parents want answers.
It was in early April that Richard*, a dad from NSW’s Hunter Valley, first heard about a 58,000-word judgment handed down by Justice Andrew Strum in the Family Court. The judge made headlines by ruling that a mother should be stripped of custody of her child (a biologically male 12-year-old known as Devin*), effectively blocking the child from accessing medical treatment known as “puberty blockers”, and giving custody to the father. Devin’s mother believed her child was gender dysphoric – a term given to those experiencing distress brought on by feeling their gender identity doesn’t match their biological sex. She believed Devin should be prescribed the medication, which works by suppressing hormones that trigger puberty. The child’s father wanted to hold off treatment and “let the child be the child” – and Justice Strum agreed.
In his bombshell ruling, the judge blew a hole in Australia’s gender-affirming treatment guidelines for children, which accept the wish of young people to assume their preferred gender identity and offer therapies that reinforce their plans to transition gender. He also referenced a 2024 UK report known as the Cass Review, which dramatically altered care for gender dysphoric youth in that country, moving away from gender affirmation and banning the use of puberty blockers in favour of a more holistic, therapy-based model of treatment and care.
Justice Strum criticised the approach of Australian hospitals to “affirm unreservedly” children who questioned their gender, and was critical of an anonymised medical expert who he said had given “concerning” evidence in support of Devin’s mother. The expert was later revealed to be Michelle Telfer, chief author of the Australian Standards of Care and Treatment Guidelines (ASCTG) for trans and gender diverse children and adolescents, and the chief of medicine at the Royal Children’s Hospital in Melbourne, where Devin had been treated. Justice Strum said the court was “not concerned ‘in what the community thinks’ or ideologies, but only what, on the evidence, is in the child’s best interests”; he ruled that the ASCTG did “not have the approval or imprimatur of the Commonwealth or any state or territory government”.
Justice Strum’s words hit Richard hard. Only four months earlier, he too had been in the Family Court, battling his ex-wife and medical experts from a NSW Health clinic offering gender-affirming medical services. Richard spent $150,000 arguing to retain his parental rights over his biologically female teenage daughter, known as Ash, and prevent her from taking testosterone to transition from female to male.
For Richard, the final outcome had been very different. Family Court Judge Peter Tree ruled in favour of Ash’s mother, who obtained sole parental responsibility over the 16-year-old in order to approve the administration of hormones. “I have earnestly tried to ascertain what is best for Ash,” ruled Justice Tree, who also wrote that he had given “great weight” to the ASCTG – “because they are models of care arrived at by consensus of the relevant professional bodies”.
When I speak with Richard in May it is clear he is still angry. “It didn’t matter what experts spoke in favour of letting my child just be a child and wait until they were older,” says the father of two. “It’s scary when the fate of your child is in the hands of another person, making judgment without understanding anything of our family relations.”
Richard is unsure where to direct his anger. “It’s like fighting invisible spooks,” he says. “All I’m trying to do is protect my child from harm. I was saying, ‘Hold on a second, we need to slow things down a bit’.” But nobody was listening.
In 2016, Richard attended an appointment at a gender clinic and was asked to consent to his daughter being prescribed medications, including testosterone, to hasten gender transition.
“I was very concerned. The moment I started questioning what the clinic was saying, they shut me down and wouldn’t answer my questions,” he says. “They expected me to just consent to my daughter’s medicalisation … without any facts.”
Clinic staff told him that if he didn’t consent to the proposed treatment, Ash would be at a heightened risk of suicide. “Everything to do with the trans [medical movement] comes with a threat,” Richard says. “If you don’t go along with what they say, it comes with a threat that your child will self-harm or suicide.”
In the past decade, Richard points out, it’s been common for parents of trans kids to be silenced or minimised after voicing concerns about their child’s medicalisation and mental health. At every turn, the voices of trans support groups and lobbyists, the medical fraternity, health departments, education departments and ministers instead put their children on a path to gender transition – no questions asked.
But with Justice Strum’s judgment, is the pendulum about to swing back the other way? Richard certainly hopes so. And so does Perth mum Tess Hackett.
Tess was cooking dinner one evening in 2016 when her daughter announced she had something important to say. “What’s up?” Tess asked, as she dollied between the chopping board and the hotplates. At first she thought she had misheard when her daughter, then aged 16, said: “Mum. I’m a man trapped inside a woman’s body.”
“She knew I’d always have her back. She knew she could trust me, and used to tell me everything,” Tess says through tears. But in the intervening nine years, the relationship between her and Veronica* fractured as they were swept into the world of gender clinics, gender-affirming care, puberty blockers and cross-sex hormones. They entered this world together, but it’s not how they would leave.
In the early and mid-2010s, states across Australia opened specialist gender services for young people with a flurry. A significant rise in children seeking gender-related care put pressure on existing services, and state governments identified the need for specialist medical intervention as a priority. It was deemed a public health priority, one that mirrored the demand in other Western nations.
Melbourne’s Royal Children’s Hospital gender service was established in 2012. In NSW, Sydney’s Westmead Children’s Hospital and Newcastle’s John Hunter Children’s Hospital added similar services in 2013. By 2015, Perth Children’s Hospital Gender Diversity Service was operational. It had been decided by figures in the medical fraternity – and consolidated by support from administrators – that these clinics were the best model to treat Australian kids experiencing gender dysphoria.
So when Tess took Veronica to their GP in 2016, he wasted no time referring her to Perth Children’s Hospital. While waiting for their appointment, scheduled for March 2017, Tess says Veronica slipped further into trans-affiliated online communities and chat rooms. And one day that summer, there came a knock at the door. A well-dressed man announced he was there to take Tess’s son, who he believed was in danger. Tess says she was bewildered – obviously, there had been a mistake. She assumed firstly that the man was from the WA Department of Family Services, and secondly that he was referring to Veronica’s younger brother. When she asked him for identification, he revealed that he was actually a representative of TransFolk of WA, a support service for the transgender community, and that he was a transgender man. He was here for Veronica. Tess says he pushed past the threshold, entered Veronica’s bedroom and collected armloads of her clothes. Tess called the police, but was told because Veronica was 16 there was nothing officers could do to prevent her from leaving.
The situation devolved. Tess tells me she pushed the man out her front door. He tripped and fell to the ground. He called the police. They arrived shortly after.
Police officers spoke with Veronica, who told them she was suicidal, and they took her to hospital for psychiatric evaluation. It was here, Tess said, that she first heard a phrase similar to the one Richard had heard in Newcastle. A psychiatrist informed Tess and her husband that from this point forward, they should affirm their daughter as a boy. “It’s better to have a live son,” the psychiatrist told them, “than a dead daughter.” Veronica was sent home, and Tess was given a list of instructions, including to allow her daughter full access to digital devices and to remove from display any photos that showed Veronica as a girl.
In due course, Veronica attended the long-awaited appointment at the Perth Children’s Hospital gender clinic with Tess in tow. Tess welcomed the chance to speak with professionals. At an absolute minimum, she says, she expected her daughter’s state of mind to be assessed. Veronica had been through a terrible trauma only a year before, which Tess believed she had never recovered from. She had been sexually assaulted by a boy from her school. It was an experience Tess says shattered her daughter’s worldview; she went from being a happy and vibrant girl to somebody who needed real help.
“I realised very quickly the gender clinic was not our friend,” Tess recalls. After a 25-minute consultation with a nurse, during which Veronica filled out a questionnaire and a consent form, Veronica was told: “Let’s get you started on puberty blockers.”
“This was before we’d even seen a doctor,” Tess says. “I told them, ‘She’s 16, she’s already been through puberty’. It was just so surreal.”
The nurse acknowledged Veronica had indeed been through puberty and revised her advice: Tess’s “son” should skip the puberty blockers and instead begin taking testosterone. Any associated risks, Tess insists, were “skimmed over”. According to her, the failure to address the psychological effects of what she described as Veronica’s “rape trauma” in this first consultation was pivotal. It set Tess and Veronica at odds. As soon as her mother began to ask questions, Veronica bristled. “It was all ideology,” Tess says. “I couldn’t believe I was in a hospital getting this non-medical, non-researched dribble.”
Furious about not being allowed to get testosterone, Veronica ran away a few months later, leaving a note saying she wanted her mother to acknowledge she’d given birth to two boys. Veronica spent a couple of weeks living with a TransFolk representative before moving into a homeless shelter. At 18, she began testosterone injections. Transfolk of WA did not respond to questions submitted by this magazine.
In 2017, shortly after Veronica moved out, Tess Hackett took the first step to connect with others like her – people who were disillusioned with the system of gender-affirming care and had concerns over the use of puberty blockers and testosterone. These parents were not convinced the medical fraternity had got it right. “Everyone, even medical professionals, thought I was insane when I tried to talk about [my experience],” Tess says. “I felt completely isolated.” The group, Parents of Rapid Onset Gender Dysphoria Kids, now has several hundred members, Tess says. She’s one of only a few people willing to put her face and name to the cause. Others remain fearful of the power of transgender activists, while many more are trying to maintain a relationship with their children.
“It’s called the trans train. You get on at thestation and there are no stops until the end when the body is destroyed,” says Dianna Kenny, a Professor of Psychology at the University of Sydney. For seven years Kenny has been working with “gender declaring” children and their families, and studying the rapid rise of minors identifying as transgender. She says kids are first “imbued with the trans philosophy” through their peers, institutions or online, and “once they are hooked into the cult, they get a lot of reinforcement from going through to the next stage and the next stage… it becomes a self-reinforcing loop”.
Kenny firmly believes the rise of transgenderism in youth is a social contagion. Last year she published a book titled Gender Ideology, Social Contagion and the Making of a Transgender Generation, in which she makes the case for dismantling the “mythology and misinformation around transgenderism” and reports on the findings of her work with young patients.
“It became obvious that other forces were operating – some family dysfunction, or the child wasn’t coping in some area of their life – and the gender dysphoria was a cry for help,” she says. “I found the gender dysphoria would dissolve spontaneously if the other problems were addressed.” Kenny says children are susceptible to the “transgender pandemic” and once the social contagion takes hold it can affect multiple children at the same school, or peer groups who connect via social media or via online gaming groups and communities.
Kenny, who treats patients in Australia, New Zealand and the US, says the trans lobby vehemently denies the concept of social contagion, and its lobbying has left parents feeling ostracised. “Everywhere we turn, there has been collusion of the medical profession, the education department, the legal profession and the government. [They’ve] all jumped on board and fallen in line with the trans lobby, who are so powerful that they can do people a lot of harm if they don’t agree,” Kenny says.
“The parents who search me out are desperate for sanity. They don’t want to take their children to gender clinics to automatically be affirmed.”
Dr Jillian Spencer became a lightning rod in the gender wars when she first spoke out against affirmative care models in 2022. Spencer worked as a psychiatrist at the Queensland Children’s Hospital until April 2023, when she was suspended from clinical duties after she raised concerns about the safety of the model and a patient made a complaint of transphobia.
Like Kenny, Spencer says she’s swamped with parents reaching out to her looking for a more critical approach to care. During her work in the hospital’s mental health wards, emergency department and paediatric wards, Spencer says she saw “teenage girls with very complex, long-term emotional problems being prescribed puberty blockers and cross-sex hormones”, she reveals. “I saw 14-year-old boys being put on oestrogen. This is very concerning because oestrogen is destructive to the testicles and causes lifelong infertility after about 12 months. The parents were often frantic because they’d been blindsided by their child suddenly identifying as trans in adolescence. The [child] would be seen by a gender clinic and then the parents were told their child is trans and had hidden their gender non-conformity from them for years.”
Spencer said it was confusing for parents who’d watched their child grow up happily engaging in activities and wearing clothes that stereotypically suited their biological sex. Parents were routinely told they must affirm their child’s newly claimed gender identity or risk losing them to suicide. “We were required to think that transition is the best outcome for children with gender distress. To think otherwise was considered ‘transphobic’,” Spencer explains.
Public gender clinics don’t release official numbers of patients seen or treated; the only information available has come via Freedom of Information (FOI) requests, which show a significant increase in children seeking treatment. Responses to FOI requests, published by psychiatrist Dr Andrew Amos, a lecturer at James Cook University, reveal that in 2014 there were just 56 children under the age of 18 treated for gender dysphoria at public gender clinics. By 2022, this number had jumped to 3231.
“The number of patients being affected is increasing, the resources being put in are increasing, and the political influence on the public paediatric gender clinics is increasing,” says Amos. He believes the rapid expansion of clinical resources devoted to gender medicine is driven by political lobbying, and the lack of transparency is a deliberate strategy to avoid scrutiny and satisfy the LGBTQ+ community.
Amos says the principle of the gender-affirming model of care is that clinicians have an ethical responsibility not to question or evaluate patient-reported gender identity, even when it’s unstable, changes rapidly or is co-morbid with severe mental illness. “The primary goal of gender-affirming care is not the treatment of a medical condition, it’s literally the affirmation of a gender identity – which is a political goal, not a medical treatment,” he says. “Under a Labor government in Queensland the gender services were going to be increased, and under a Liberal government they are being restricted, which highlights that they are being driven by political considerations rather than medical considerations.”
Professor John Whitehall, foundation chair of Paediatrics and Child Health at Western Sydney University, says he was at a medical conference in Cairns in 2016 when he attended a presentation by Telfer on treating minors with gender dysphoria. He says at the time, over his almost 50 years of working in medicine, not a single parent had come to him “and said, ‘Willy thinks he’s a girl’.”
Whitehall’s criticism of gender-affirming care is well documented and he has written widely on the subject. Chief among his concerns is “the clinics’ mantra that puberty blockers are safe and reversible”, he says. “There is a huge amount of research proof that ought to slow people up when giving [puberty blockers] to the developing brain of a human. It’s unregulated experimentation on children.”
In a statement, the Royal Children’s Hospital told this masthead it stood by the reputation of both the hospital’s “world-leading” gender clinic, as well as Telfer.
“Our Gender Service is underpinned by both national and international research methodology,” it reads. “We always have and will continue to support and provide an evidence-based approach that puts our young people’s health and wellbeing first.
“(Telfer’s) leadership has been instrumental in improving the research and clinical care of all children, in particular trans or gender diverse children and adolescents and those experiencing gender dysphoria. With the utmost consideration, empathy and care for her patients, (she) believes children and families are best placed to make informed decisions about their own health care. Simply put, the work Assoc. Prof. Telfer leads saves lives.”
There is one group who areover-represented in gender clinics: autistic youth. Autism Spectrum Australia cites a 2018 study that found 22.5 per cent of transgender adolescents had a diagnosis of autism, compared to 2.5 per cent of all Australians. Researchers worldwide acknowledge this correlation and have called for more investigation.
Melbourne father-of-three Scott* describes his eldest son John* – a 16-year-old with severe level two autism – as a square peg in a round hole. “He has trouble making friends. He suffers from social anxiety, depression and phobias. He’s emotionally much younger than his years,” says Scott, an IT expert.
John’s overwhelming drive to make friendships led him online, where Scott says he found a community of other autistic children, many of whom were trans identifying. John joined groups and threads on online communities such as Reddit and Discord, and struck up a relationship with an AI-generated gender therapist on CharacterAI.com
“Kids like my boy, [who are] not grounded in their own physicality, are more than happy to consider different genders,” Scott says. “He was 15 when he came to me and said, ‘Dad, I think I’m trans, I think I’m a girl’. There was no indication of this before. It just came out of the blue. His depth of understanding is at the level of memes he’s found online, and he will repeat back to me word for word what he’s read on a website. It’s terrifying.”
Even more terrifying, Scott says, are his son’s physical outbursts. On multiple occasions, while struggling to regulate his emotions, John has attacked his parents. “We’ve had the police in the house three or four times,” Scott says. After John threatened his father with violence while both were on school grounds, a report was made to child protection services, who turned up at their home. What did they want to talk about? “They wanted to discuss our unwillingness to affirm his gender. They left him with brochures of LGBTQA+ youth groups he could contact.
“The violence has broken me. I’m able to have this conversation now without breaking down in tears, but three months ago I was a mess,” he says. “It has been traumatising and confusing for his siblings. My 13-year-old son will go to his room and my 11-year-old daughter has been in tears hiding under the table.”
When Scott sought the help of John’s paediatrician to resolve the violent episodes, he says his concerns were ignored as soon as the issue of gender arose. The specialist instead referred John to a gender clinic.
John’s long-term occupational therapist, too, began to affirm his declared gender, calling him by a female name without Scott’s knowledge. “She gave him information on how to contact a gender clinic, and how to find a GP who’d give him a referral,” he says. “It was a horrible betrayal and explicitly avoided parental engagement.” He says he arrived after one session to find John dressed as a girl, wearing a blonde wig.
It didn’t stop with health practitioners, either. At one of their regular student support group meetings at school, Scott and his wife were confronted by six people – including teachers, the school nurse and vice principal – who insisted on discussing John’s gender identity and advised Scott to take him to both a gender clinic and an LGBTQA+ youth group. The meeting left John in such a state of distress he ended up on the floor curled into the fetal position.
“If we’d got into a gender clinic, he [John] would now be on puberty blockers, if not cross-sex hormones. It’s our job as parents to keep him safe. As his parents we will love this child forever – there is nothing we will not do for him, and that’s a commitment for the rest of my life. The paediatrician and gender clinic, they don’t care. Once he’s out of their sight they won’t give him another thought, or care what happens to him in five years.”
Scott says resisting the gender-affirming guidelines and refusing to take his son to a gender clinic has been an isolating experience. Some close friends and family have been sympathetic to his position, while others have written him off as a transphobe.
Gender-affirming care originated in the Netherlands in 1998 and although the model has not been without its critics, it was not until last year that it was brought under extreme scrutiny.
Referrals to youth gender identity services in the UK had increased 100-fold over a decade; since 2011, thousands of British children have received puberty blockers on the National Health Service. But in April 2024, a review conducted by paediatrician Hilary Cass found there was no good evidence to support the practice of prescribing hormones to under-18s to halt puberty or transition to the opposite sex. Her final report, now referred to as the Cass Review, moved treatment away from puberty blockers.
“For most young people, a medical pathway will not be the best way to manage their gender-related distress,” Cass said, adding that children must be seen “as a whole person and not just through the lens of their gender identity”. She said it was vital services take into account the high rates of autism and mental health problems in children identifying as transgender.
In the wake of her report, the NHS committed itself to overhauling its gender identity services for children, which included a ban on the use of puberty blockers for under-16s. In Australia, puberty blockers remain available to children in every state except Queensland. Queensland Health Minister Tim Nicholls announced in January the suspension of hormone treatment for patients under the age of 18 following reports an unauthorised paediatric gender health service had been provided by the Cairns Sexual Health Service. Nicholls ordered an independent review into the use of puberty blockers and the final report is expected to be delivered to the Director-General of Queensland Health by November 30.
Around the world – in Norway, Sweden, Finland and France – the use of gender-affirming care and puberty blockers has also been wound back. In the US, 18 states have placed bans on puberty blockers, and last month, the US Supreme Court knocked down a legal challenge that argued a ban on prescribing puberty blockers to minors introduced in Tennessee had been discriminatory and should be overturned.
In January, the Albanese Government ordered a review of the Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents, and federal health minister Mark Butler instructed the National Health and Medical Research Council (NHMRC) to develop new guidelines for the care of young people with gender dysphoria. The NHMRC says it is developing the guidelines using an “expert committee” that includes people with “lived experience”, and the guidelines would be informed by public consultation and international research.
“These guidelines will ensure Australia has the most appropriate national guidelines of clinical practice and that families have the utmost confidence in the healthcare young Australians receive.” A spokesman for the minister confirmed interim advice on the use of puberty blockers will be available mid-2026, and the full guidelines are expected to be finalised and available in 2028.
Tess, Richard and Scott hope their voices, long diminished, will reach the ears of those making decisions on the new national guidelines. Two years ago Tess started the organisation Active Watching and Waiting, which she hopes will give parents more power to lobby without being shouted down, sidelined or attacked. “Australia is too captured” by the supporters of gender-affirmative care, she says. “Hopefully the changes happening overseas will trickle down here.”
* Names have been changed. Lifeline 13 11 14; beyondblue.org.au; samaritans.org.au
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