Over the last 10 to 15 years, the number of children and adolescents seeking medical help for gender dysphoria has rapidly increased in Australia. In the context of uncertainty over how to respond to this phenomenon, the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (ASOCTG) was developed by an interdisciplinary team of physicians and researchers at the Royal Children’s Hospital Melbourne, and published in 2018.
The development of these guidelines contributed to the widespread adoption of what is called “gender-affirming care” across state medical bodies — as well as by the Australian Professional Association for Trans Health (AusPATH), which defines it as follows:
Gender affirming healthcare emphasises affirming language, psychological and peer support, support for social affirmation, and/or medical affirmation (e.g. puberty blockers for young adolescents, or feminising or masculinising hormones and/or surgery for older clients), as medically necessary and clinically relevant.
t is important to note, however, ASOCTG was not endorsed by the National Health and Medical Research Council (NHMRC), which has been asked by the federal government “to develop new national guidelines for the care of trans and gender diverse people under 18 with gender dysphoria”. These proposed national guidelines will not be finalised until March 2028. In the interim, medical bodies in Australia have an opportunity to reconsider the evidentiary basis for the gender-affirming model of care.
This comes at the same time that, due to growing evidence of harms, several European countries — including Finland, Sweden, Norway, Denmark and the UK — recommended that aspects of the practice of gender-affirming care be restricted. As recently as 1 May 2025, the United States Department of Health and Human Services released its “umbrella review” evaluating “the direct evidence regarding the benefits and harms of treatment for children and adolescents with gender dysphoria”, which concluded that:
many U.S. medical professionals and associations have fallen short of their duty to prioritize the health interests of young patients. First, there was a rapid expansion and implementation of a clinical protocol that lacked sufficient scientific and ethical justification. Second, when confronted with compelling evidence that this protocol did not deliver the health benefits it promised, and that other countries were changing their policies appropriately, U.S. medical professionals and associations failed to reconsider the “gender-affirming” approach. Third, conflicting evidence — evidence that challenged the foundational assumptions of the protocol and the professional standing of its advocates — was mischaracterized or insufficiently acknowledged. Finally, dissenting perspectives were marginalized, and those who voiced them were disparaged.
The ideological premises of gender-affirming care are that, irrespective of age: children know their gender and healthcare needs; their gender identity will remain stable; affirmation (social, medical and surgical) is necessary to assist mental well-being; incongruence between gender identity and biological sexed reality is normal; and any distress experienced by youth is the result of intersectional vulnerabilities and prejudice.
Recommendations to support distressed children with a psychotherapy first-line — what is sometimes called “watchful waiting” — are, in turn, criticised by some activists as “medical gatekeeping”, despite there being evidence that a normally timed puberty leads to resolution of symptoms in 85 per cent of children with gender dysphoria.
Moreover, medical transition can cause potentially serious physical complications — including bone density loss (osteoporosis), sexual dysfunction (anorgasmia), metabolic and cardiovascular complications, thromboembolic (stroke) risk, mood changes, pelvic floor dysfunction and surgical complications. There is also evidence that puberty blockers can interfere with pubertal hormonal changes necessary for brain development. The risks of infertility and permanent sterility require children to decide upon ethically challenging fertility preservation at a time in their lives when many have not experienced their first romantic relationship.
The assertion that medical transition is “life-saving” and urgently required is a frequently made claim that can have the effect of coercing parents, policy makers and institutions to suppress some of their questions and deeper concerns.
And yet an independent review of data on rates of suicide among young gender dysphoria patients of the Tavistock and Portman NHS Foundation Trust, following the 2020 restriction of puberty blocking drugs, suggests that medical transition is unlikely to mitigate suicide risk among trans-identified youth. On the contrary, a large Finnish study concluded that it is other co-occurring mental health conditions that are associated with suicide — as a result, the authors stressed the need for professionals to treat other conditions, such as trauma or autism, rather than rush to provide medical transition or surgery.
Despite the clear need for holistic care, scientific reviews, an independent service review and a recent Family Court finding have all demonstrated that some Australian specialist gender clinics do not, in fact, offer the comprehensive treatment — including for that of co-occurring conditions — they promise.