Is There medical consensus on Gender Affirming Care?
There is no medical consensus on the efficacy, safety, or ethics of gender affirming treatments (such as puberty blockers, cross-sex hormones or surgeries) particularly when they are provided to people under 18.
This timeline displays a selection of the many concerns and warnings issued by Australian and international health bodies and experts about the risks and uncertainties of youth medical transition procedures.
April 2026: Australia's NHMRC interim advice on puberty suppression remained unpublished. Commentary in The Spectator Australia criticised the pace of the federal process, noting that final national guidelines were not due until 2028. Interim advice on puberty suppression is promised by mid-2026.
March 2026: Alberta became the first Canadian province with legally operative restrictions on youth gender medicine to take full effect. After Premier Danielle Smith invoked the constitutional notwithstanding clause in November 2025 to force through Bill 9, the legislation prohibited clinicians from initiating puberty blockers or cross-sex hormones for anyone under 16 with gender incongruence, and banned sex-reassignment surgeries for all minors.
February 2026: Queensland Health released its investigation into the Cairns Sexual Health Service, the unauthorised paediatric gender service whose discovery triggered the state's 2025 pause. As reported by the ABC, the investigation found a "negative patient safety culture," puberty blockers prescribed to children as young as 12 without adequate evaluation, treatment given to young people with developmental disabilities who lacked the capacity to understand it, and informed consent that "did not align with best practices." Concerns about clinicians "misdiagnosing patients with gender dysphoria when they in fact had mental health issues" had been raised internally as early as 2018 but were not pursued.
3 February 2026: The American Society of Plastic Surgeons (ASPS), the largest US professional body for plastic surgeons, issued a position statement recommending that surgeons delay all gender-related surgery until a patient is at least 19. The statement declined to endorse the guidelines of WPATH, the Endocrine Society or the AAP, citing "low certainty" evidence:
"ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old."
20 February 2026: The UK's Medicines and Healthcare products Regulatory Agency (MHRA) paused the PATHWAYS trial — the only sanctioned route to puberty blockers in England — citing fresh safety and ethical concerns. The regulator warned:
"Identified risks include but [are] not limited to, effects on fertility preservation, bone mineral accrual, fracture risk, cognitive development and sexual function, which require monitoring… many of these outcomes will only become measurable in adulthood."
21 December 2025: The Northern Territory Government ceased public funding for puberty blockers and gender-affirming hormones for under-18s, one day after Queensland's announcement. Health Minister Steve Edgington — who had earlier in 2025 dismissed similar calls — said:
"Kids in the Territory should be able to grow up without these harmful, ideologically motivated practices that have irreversible effects."
19 December 2025: The Queensland Government released the independent Vine Review and extended its ban on puberty blockers and gender-affirming hormones for new under-18 patients until at least 2031, pending the outcome of the UK's PATHWAYS trial. The Review found the evidence base "limited," with "a paucity of evidence about other long-term risks or benefits."
19 December 2025: New Zealand's regulations banning new prescriptions of puberty blockers for gender incongruence in under-18s came into force, Health Minister Simeon Brown having cited a Ministry of Health review finding "a lack of high-quality evidence demonstrating the benefits or risks." The High Court granted interim relief on 17 December pending a judicial review, though the regulations remained technically in force.
26 November 2025: The Australian Doctors Federation (ADF) urged all Australian political leaders to ban gender treatments for under-18s immediately and called on the federal government to abandon the NHMRC review, which it said was compromised by conflicts of interest:
"We request that in every state in Australia 'gender treatments' — including puberty blockers, cross-sex hormones and surgery — are banned for those under 18 years of age immediately."
21 November 2025: The Australian Medical Professional Society (AMPS) and the Nurses Professional Association of Australia wrote an open letter to Health Minister Mark Butler calling for the NHMRC guidelines process to be discontinued in favour of a Royal Commission, describing current practices as systemic malpractice:
"Current practices lack scientific and medical credibility and do not meet accepted standards of evidence-based medicine. They amount to systemic malpractice, enabled by flawed governance structures."
November 2025: Alberta's Premier invoked a notwithstanding clause to pass Bill 9, prohibiting puberty blockers and cross-sex hormones for under-16s and banning sex-reassignment surgery for all minors — bypassing anticipated constitutional challenges.
September 2025: Scotland closed its only young people's gender service. The Sandyford Young People's Gender Service in Glasgow was replaced with a network of paediatric services, with puberty blockers available only through the UK-wide clinical trial. The Scottish Government stated that gender healthcare for youth "should not be conducted in an adult sexual health environment… but rather in pediatric clinical settings."
18 July 2025: France's National Authority for Health (HAS) published its first national guidelines (English translation) on gender transition care — but limited them to adults, explicitly excluding minors, citing insufficient evidence:
"In the absence of sufficiently robust data and consensus, the HAS has chosen to address the issue of individuals under the age of 18 separately."
8 June 2025: The Australian National Association of Practising Psychiatrists (NAPP) published an updated guide characterising youth gender medicine as "a contested area of medical practice" and recommending psychosocial interventions as first-line treatment:
"There is no consensus that medical treatments such as the use of puberty-blocking drugs, cross-sex hormones or sexual reassignment surgery led to better future psycho-social adjustment."
March 2025: The medical directors of Norway's four regional health authorities called on the Directorate of Health to revise the country's 2020 guidelines to clearly state the experimental nature of hormonal and surgical treatments and to restrict them to clinical trial settings.
12 March 2025: The Australian Doctors Federation issued a medicolegal update advising doctors against prescribing puberty blockers, cross-sex hormones, or referring under-18s to gender clinics, noting that Australian treatment guidelines reviewed by the Cass investigators "scored 19/100 for rigour of development and were judged 'untrustworthy' by Prof Gordon Guyatt a pioneer of evidence-based medicine."
February 2025: The Australian Doctors Federation (ADF) released a statement requesting that gender reassignment treatment, including puberty blockers, cross-sex hormones, and surgery, be banned for people under 18 years in every Australian state. The ADF called for a more cautious approach, emphasizing the need for thorough assessment, psychological support, and careful consideration of the risks and benefits of medical interventions. The statement also warned:
"Gender clinics in Australia are providing harmful treatment to children and adolescents and should be closed. Practitioners need to be able to provide supportive evidence-based psychological care to children and adolescents with complex mental health issues including gender uncertainty or confusion."
February 2025: Argentina's President Javier Milei announced a ban on gender-affirming care for people under 18. In a decree, the Argentine Government reportedly cited an unpublished technical report from Argentina's National Directorate for Comprehensive Mental Health, which raised concerns about the limited understanding of the long-term consequences of hormonal treatments, and also cautioned that people under 18,
"…have not yet completed their neurobiological and psychic maturity to fully understand the importance of the decision"
January 2025:The Australian Federal Minister for Health announced that the National Health and Medical Research Council (NHMRC) will review the self-styled Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents, and will also develop Australia's first national guidelines. Current guidelines did not meet the standards necessary to qualify for assessment by the NHMRC when they were first published in 2018. The new guidelines will be created using the NHMRC's Standards for Guidelines and the international GRADE approach.
January 2025:The Queensland State Government announced an investigation into paediatric gender health services and a pause on new hormone therapies for patients under 18 in the public health system. A media release from the QLD Health Minister, Tim Nicholls, stated,
"A recent internal review undertaken of the CSHS identified deficiencies relating to credentialling and scope of practice and medicolegal concerns relating to patient and parental consent."
November 2024:An evidence brief released by New Zealand's Ministry of Health found that evidence for the impact of puberty blockers on clinical and mental health and wellbeing outcomes was scarce and that available evidence was "largely of poor quality." The brief was accompanied by a position statement stating that:
"…there is insufficient basis to say that puberty blockers are safe or reversible (or not) for use as an intervention for gender dysphoria in adolescents."
And,
"Noting that the Government has signalled an intent to consider regulating puberty blocker prescribing in gender-affirming care, clinicians should exercise caution in prescribing."
November 2024: Italy's National Bioethics Committee (CNB) recommended restricting puberty blockers for gender dysphoria in minors to independent clinical trials only. The CNB noted the lack of international consensus on the safety of puberty blockers, the inadequacy of available research and the need to analyse outcomes by sex.
English Translation (provided by SEGM)
September 2024: 46 doctors signed an open letter calling for an 'Evidence Check' into Gender Affirming Care commissioned by the NSW Government to be "publicly retracted as false/and or misleading." The open letter stated that the 'Evidence Check' contained "scientifically unsupported assertions that puberty blockers are reversible", and "did not include the highly relevant systematic reviews and finding of the Cass Review."
September 2024: According to media reports, the Chilean Ministry of Health recommended that public and private care providers cease to initiate new prescriptions of puberty blockers and cross hormones for children and adolescents, pending the development of expert-reviewed guidance.
June 2024: The American College of Pediatricians authored the Doctors Protecting Children Declaration, calling on prominent American medical institutions to halt current harmful protocols promoted for children and adolescents who express discomfort with their biological sex. The declaration has been co-signed by medical and health organizations from across the U.S.
May 2024: The German Medical Assembly, representing 17 medical associations, passed a resolution calling on the Federal Government to restrict puberty blockers, cross-sex hormones, and transition surgeries for under-18s to controlled clinical trials. The resolution cited the absence of reliable evidence for youth transitions and the long-term health risks of transition, including impaired reproductive function.
May 2024: The UK Government introduced emergency legislation placing an indefinite ban on new prescriptions of puberty blockers for minors. In addition, the National Health Service announced that henceforth, puberty blockers would only be available to children participating in approved clinical research studies.
April 2024: Scotland's only gender clinic announced a pause on referrals of prescriptions for puberty blockers and cross-sex hormones to people under 18. In a statement, the clinic said the change was in response to research from NHS England and the Cass Review, both of which found little evidence supporting the treatments.
April 2024: The European Society for Child & Adolescent Psychiatry (ESCAP) advised that recent reviews of gender affirming medicine highlighted that the evidence for the benefits of these treatments is very limited. In a communication, ESCAP went on to say:
"ESCAP calls for healthcare providers not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and, therefore, to adhere to the "primum-nil-nocere" (first, do no harm) principle."
April 2024: The Cass Review, an independent review of the UK's gender identity services for children and young people, found that gender medicine was an area of "remarkably weak evidence" that had been exceptionalised to the detriment of children treated at gender clinics:
"Some practitioners abandoned normal clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations. They deserve very much better."
March 2024: England's National Health Service confirmed that children will no longer routinely be prescribed puberty blockers at gender identity clinics. The NHS issued a new policy stating:
"We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [Puberty suppressing hormones] to make the treatment routinely available at this time."
March 2024: Leaked internal files from global transgender healthcare body WPATH lent support to widely-held doubts about the ethical and scientific basis for the medical transitioning of children. The leaked documents included:
- Transcripts in which WPATH members acknowledge that children have difficulty giving informed consent to affirming procedures because it is, "out of their developmental range to understand the extent to which some of these medical interventions are impacting them."
- Reports of patients feeling "brainwashed" into transitioning, and frequent occurrences of regret.
March 2024: Medical directors representing Norway's four regional health authorities found that puberty blockers and cross-sex hormones for minors should be classified as experimental treatments. The directors also called for a revision of existing 2020 treatment guidelines, and for puberty blockers to only be prescribed to minors within the context of clinical trials.
January 2024: A World Health Organisation FAQ into the development of guidelines on the health of trans and gender diverse people reported, "on review, the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care…"
December 2023: The Royal Australian and New Zealand College of Psychiatrist's updated position statement recognised the lack of evidence for the medical transitioning of minors and stressed the importance of exploratory therapy:
"Distress associated with gender may in some situations be related to a range of psychosocial issues or mental health conditions."
November 2023: Over 35 psychiatrists, psychologists, and doctors wrote an open letter to NSW parliamentarians expressing "serious professional concerns" about the state's gender affirming framework and its recommendations for the use of puberty blockers and hormones:
"This flawed framework disregards the more cautious model of treating childhood and youth gender dysphoria adopted by countries such as the United Kingdom, Sweden, Norway, Finland and France...the framework also makes claims in support of puberty blockers and cross-sex hormones for children and young people that have been disputed or have a weak evidence base."
October 2023: Dr Riittakerttu Kaltiala, an adolescent psychiatrist who pioneered the establishment of an early clinic for gender-distressed youth in Finland, was interviewed for the article, Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It. In it, Dr Kaltiala said:
"It is devastating to speak to patients who say they were naive and misguided about what transition would mean for them, and who now feel it was a terrible mistake. Mainly these patients tell me they were so convinced they needed to transition that they concealed information or lied in the assessment process."
September 2023: New Zealand's Ministry of Health removed a claim from its website stating that puberty-blocking drugs are "safe and fully reversible." Journalist Bernard Lane reported that the change was made to the website after two separate articles were published in New Zealand media outlets, both of which highlighted international concerns about the safety of the drugs.
August 2023: The Journal of the Danish Medical Association confirmed that the country had shifted away from prescribing puberty blockers and cross-sex hormones to minors. The Association noted a lack of evidence supporting the model and the rates of detransition:
"The Danish clinicians are now concerned that the basis for gender-transition of large numbers of minors with diverse presentations of gender dysphoria is a single short-term Dutch study based in a different population and which has failed replication outside the Netherlands." (SEGM Summary)
July 2023: The Medical Director of Child and Youth Mental Health Services, Children's Health Queensland, Dr Stephen Stathis told a conference that he had changed his mind about the use of puberty blockers for minors and that the evidence base for their use was of "low quality".
July 2023: Australian medical indemnity insurer MDA announced it would restrict coverage for private doctors who perform gender-affirming hormones on minors. In a press release explaining its decision, MDA cited growing criticism of current treatment practices, the risk of "high-value claims arising from irreversible treatments", and the possibility that doctors may be held liable for influencing patient decisions:
"…there is growing criticism globally of the research that underpins medical and surgical transition of children in response to gender dysphoria."
June 2023: Dr Jillian Spencer, a child and adolescent psychiatrist, warned that most clinicians held serious concerns about the Affirmation Model but are being "forced to affirm the social transition of all children."
"I would say that the vast majority of child and adolescent psychiatrists hold very serious concerns about the affirmation model but to speak up in the current climate or even to take a more cautious clinical approach puts their employment at risk, their AHPRA registration is at risk and they fear criminal sanctions under the conversion therapy legislation."
March 2023: The Norwegian Healthcare Investigation Board recommended restricting the use of puberty blockers, cross-sex hormones and transition-related surgery to clinical research settings (note: these were recommendations, not a formal ban). The board also recommended that these treatments should be defined as experimental.
February 2023: A former employee of the Washington University Pediatric Transgender Center filed an affidavit alleging serious medical negligence and harm to patients. In a 23-page testimony, the employee alleged:
"I personally witnessed Center healthcare providers lie to the public and to parents of patients about the treatment, or lack of treatment, and the effects of treatment provided to children at the Center. I witnessed staff at the Center provide puberty blockers and cross-sex hormones to children without complete informed parental consent and without an appropriate or accurate assessment of the needs of the child. I witnessed children experience shocking injuries from the medication the Center prescribed. And I saw the Center make no attempt or effort to track adverse outcomes of patients after they left the Center."
January 2023: The Italian Psychoanalytic Society wrote to the Italian Prime Minister Giorgia Meloni expressing serious concerns about the use of puberty blockers on children. In an open letter, the IPS also warned that a diagnosis of gender dysphoria in pre-pubescent children is based on self-reporting, cannot be thoroughly evaluated, and that only a minority of children who claim to not identify with their biological sex maintain this position after puberty.
January 2023: A study of adolescent patients conducted at Westmead Children's Hospital's gender clinic found that the evidence base for the Gender Affirming medical pathway was "sparse" and that clinicians feel under pressure to affirm patients:
"For the young people who may regret their choice of pathway at a future point in time, the risks for potential harm are significant."
December 2022: Patrick Parkinson AM told a Queensland Government inquiry that he feared that the practice of gender medicine would emerge as the biggest medical scandal in Australia in 100 years:
"My knowledge of what is going on gives me no reason for confidence that the prescription of powerful and life-altering drugs is occurring only after rigorous assessment or careful evaluation of the reasons why the child or young person may be wanting to embark upon this lifelong medical treatment pathway."
July 2022: The London Tavistock Clinic announced it would close after an independent review found "significant gaps in the research and evidence base."
"[In the UK] the clinical approach has not been subjected to some of the usual control measures that are typically applied when new or innovative treatments are introduced."
— The Cass Review, Interim Report
The President of the Australian National Association of Practicing Psychiatrists spoke to Sky News about the UK's more cautious approach.
May 2022: Queensland paediatrician Dr Dylan Wilson publicly urged other doctors not to refer young patients to gender clinics:
"...there exists a service at my local children's hospital, and at other hospitals around the country, to which I will never refer a child. I believe this service is not appropriate for children, and is actively doing harm...I am talking about the paediatric gender service at my local children's hospital."
March 2022: The Australian National Association of Practicing Psychiatrist's guide for Managing Gender Dysphoria/Incongruence in Young People cautioned that treatments with puberty blockers and cross-sex hormones aren't fully reversible and that there is a lack of consensus that they lead to better outcomes:
"...there is no consensus that medical treatments such as the use of puberty-blocking drugs, cross-sex hormones or sexual reassignment surgery lead to better future psycho-social adjustment"
February 2022: The French National Academy of Medicine noted that there was a risk of "over-diagnosis" in gender-affirming practice and urged caution in prescribing cross-sex hormones and puberty blockers to minors.
February 2022: Sweden's National Board of Health and Welfare found that the risks of hormonal treatments outweigh the benefits for most young people. The Board decided that moving forward, access to hormonal interventions for minors would be tightly restricted and treatment eligibility would be provided on the basis of distress, not 'identity'. In 2024, a certified translation of Sweden's new guidelines revealed that puberty blockers had been restricted to clinical trials.
August 2021: The Royal Australian and New Zealand College of Psychiatrists acknowledged that evidence and professional opinion was divided on whether the gender-affirming model is suitable for children:
"Gender Dysphoria is an emerging field of research and, at present, there is a paucity of evidence."
July 2021: The Society for Evidence based Gender Medicine (SEGM) conducted an independent inspection of the references supporting AusPATH's Public Statement on Gender Affirming Health Care, including for trans youth. SEGM found:
"AusPATH relies on poor quality research, fails to highlight the methodological limitations of most studies and at times misrepresents or exaggerates the research findings and conclusions. AusPATH also mischaracterises psychotherapy for gender dysphoria as potentially harmful."
March 2021: Clinical psychologist Dr Sandra Pertot questioned Gender Affirming Care on a podcast for the Australian Psychological Society. She told The Age that she had seen a marked uptick in patients presenting with sudden, late-onset dysphoria:
"While some described a long history of distress with their bodies, others had only come to the belief in recent months that they experienced gender dysphoria, after learning about it online. In some cases a parent attended a consultation and said this had taken them by surprise as there had been no indications that their child had any confusion about their gender identity."
March 2021: The Australian National Health and Medical Research Council told The Australian that the 2018 RCH guidelines were not of a high enough quality to be considered for inclusion in its Australian Clinical Practice Guidelines:
"It was determined that the guideline did not include a funding statement, an evidence base for the recommendations or information about conflict of interest, and that it would not meet the portal selection criteria, so a full assessment was not carried out."
— Reported by Bernard Lane for The Australian
July 2020: A Finnish health advisory body found in young patients with both gender dysphoria and significant psychiatric comorbidities that "no conclusions can be drawn on the stability of the gender identity of the child." It also said:
"The reliability of the existing studies with no control groups is highly uncertain, and because of this uncertainty, no decisions should be made that can permanently alter a still-maturing minor's mental and physical development."
And,
"It is not known how the hormonal suppression of puberty affects young people's judgement and decision-making." (SEGM Translation).
New guidelines recommended psychotherapy as the first-line treatment for gender-dysphoric youth and tightly restricted the criteria for administering puberty blockers.
June 2020: Over 70 medical professionals signed a letter to the Federal Health Minister warning that current treatment practices lacked an evidence base, were experimental, and posed medico-legal risks:
"We believe that major interventions with uncertain harms and damage on the basis of poor evidence and doubtful capacity regarding the provision of informed consent, amounts to medical experimentation"
"We warn that the experimental nature of 'affirmation therapy' with its withholding of publicised side effects renders Ministers of Health medico-legally vulnerable noting the High Court of Australia's ruling in Rogers v Whitaker [1992] HCA 58."
May 2020: The Australian Medical Association Queensland called for practitioners to come together to write new national treatment guidelines in a submission to the Queensland government:
"AMA Queensland would suggest that more research is needed across all the domains of care for children and adolescents who present with gender dysphoria"
January 2020: Dr Cary Breakey, Child, Adolescent & Family Psychiatrist, submitted to the Queensland Health Legislation Amendment Bill that he held grave concerns for children rushed onto hormonal treatment and that other diagnoses were being overlooked under the current medical model:
"For almost all of the Gender Identity Disorder/Gender Dysphoria patients I have seen, there were clear (but different in each) family issues which made choice of the opposite gender an understandable response. Problems ranged from relatively uncomplicated sibling "favouritism" to risks of sexual abuse, (real and perceived). In many, there was a strong history of inter-generational sexual abuse, domestic violence, and/or high occurrences of tragedy for either males or females in the family. Dealing with these issues with the patient and family members both resolved the gender issues, and improved family functioning."
September 2019: Over 200 Australian medical practitioners signed a letter from Professor John Whitehall demanding a Federal Parliamentary Inquiry into child social and medical transitioning.
"It is my view that lack of evidence for effect and denial of side effects renders the Medical Pathway of treatment of childhood gender dysphoria experimental"
November 2019: The Medical Affairs Committee of the Endocrine Society of Australia (a sub-specialty college of the Royal Australasian College of Physicians) opposed an endorsement of the 2018 RCH Guidelines. In a letter to the RACP, the ESA wrote:
"This is a complex area, the evidence base is limited and the RCH document largely reflects the authors' opinion because, as the authors themselves state, 'the published evidence on the topic prohibited the assessment of level (and quality) of evidence for these recommendations'."
— Reported by Natasha Robinson for The Australian
October 2019: The Australian National Association of Practicing Psychiatrists (NAPP) called for a federal parliamentary inquiry into the treatment of child gender dysphoria. A statement from the NAPP identified several areas of concern, including:
"...the child's capacity for informed consent, and the medical risks, known and unknown, of treatment with puberty blocking drugs, sex hormones and surgery before the age of 18 years."
December 2018: Following the release of the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents by the Royal Children's Hospital, a response published in The Lancet critiqued the guidelines. The authors of the critique argued,
"The health of transgender children is addressed with imprecise language and overplayed empirical evidence in new Australian guidelines."
And,
"The guideline does not consider longer-term effects, including the difficult issue of detransition."