Every year hundreds of children in New South Wales are prescribed puberty blockers, powerful drugs which stop natural development of their bodies, possibly make them infertile, and launch them into a lifetime of transgender medication.
The NSW minister for health Ryan Park has given this treatment his tick of approval. At the Legislative Council’s budget estimates hearing on 2 March, he insisted the policy is “very evidence-based”.
“We are constantly looking at the evidence,” he said. “We are constantly looking at what is happening overseas, and … my expectation is that that [kind of] healthcare, like all healthcare, is evidence-based and is delivered in a way that is tailored, best practice; it’s multidisciplinary; it’s age appropriate; and it’s evidence based.”
How many of these kids are taking puberty blockers is uncertain, as it’s mum’s-the-word with the NSW health department and the state’s gender clinics.
Greg Donnelly, an upper house MP with an interest in the issue, had to prise the figures out of them with freedom-of-information requests. It was like squeezing blood from a stone.
With good reason, perhaps, because the evidence base for treating “gender dysphoria” with puberty blockers is looking shonkier and shonkier all the time. Perhaps it’s a case of the less the public knows, the better.
In January last year, Queensland minister for health Tim Nicholls announced his state would immediately pause Stage 1 (puberty suppression with puberty blockers) and Stage 2 (gender-affirming hormones) hormone therapies.
“There is contested evidence surrounding the benefits of Stage 1 and Stage 2 hormone therapy for children and adolescents with gender dysphoria emerging from studies throughout the world,” Nicholls said at the time.
“France, Finland, Norway, Denmark and Sweden have all tightened regulations around prescribing hormone therapy to children and adolescents.
“More recently, the Government of the United Kingdom has changed legislation to restrict the prescription and supply of puberty blockers to children.”
A number of doctors in Australia also have serious reservations about puberty blockers.
Gary Geelhoed – who has served as the WA president of the Australian Medical Association, the WA’s chief medical officer, and assistant director-general for the WA Department of Health – told The Australian recently that it was “one of the worst medical scandals for a long, long time”.
He even said it might end up being worse than the notorious lobotomy scandal of the 1940s and 50s. Doctors had claimed that they could cure mental disorders ranging from depression to schizophrenia with brain surgery. Tens of thousands were performed in the United States alone.
The results? Often they were devastating – epilepsy, dramatic personality changes, brain abscesses, dementia, and death. Yet many doctors championed it and Portuguese neurologist António Egas Moniz won the 1949 Nobel Prize for “one of the most important discoveries ever made in psychiatric therapy.”
Sometimes doctors are dead wrong.
Park and his minions in the health department are trying to ignore an ever-growing pile of evidence that puberty blockers and cross-sex hormones are dangerous and do not resolve children’s underlying psychological problems.
The most comprehensive and forceful report to date is a 2024 review of the evidence by Professor Hilary Cass, a former president of the Royal College of Paediatrics and Child Health. It found that “systematic evidence reviews [have] demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.”
It also was sceptical of the need for puberty blockers: “The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.”
The impact of the thoroughly researched and carefully argued Cass Review was so powerful that the British government immediately reversed course. It closed government gender clinics and banned puberty blockers.
Park is aware of the Cass Review – which makes his intransigence less excusable – and told the budget estimates committee that a local review by the Sax Institute (which is largely funded by the NSW Government) found that hormone therapy was safe, beneficial and reversible. But that review had ignored Professor Cass’s report – in other words, it was completely out of date.
Since 2024, there have been even more developments which undermine the credibility of trans and gender diverse healthcare.
Just last month, the American Society of Plastic Surgeons openly expressed scepticism about the effectiveness of youth gender medicine. “Because the evidence base for this care pathway is very low/low certainty and increasingly suggestive of potential harm and long-term complications, downstream surgical decision-making carries heightened ethical, clinical, and legal risk,” it said.
The American Medical Association, the largest medical group in the US, immediately agreed. “The evidence for gender-affirming surgical intervention in minors is insufficient.”
As Leor Sapir, a senior fellow at the Manhattan Institute, said on X (formerly Twitter): “If the AMA was wrong about surgeries, could it also have been wrong about hormones?”
And talking of legal risk, if Minister Park won’t listen to doctors, doctors will undoubtedly listen to lawyers.
A young woman, Fox Varian, has just won US$2 million in damages from doctors who removed her healthy breasts when she was 16 to make her a trans man. A score of other detransitioners have filed lawsuits in the US. “Observers believe the damages, all told, could run into hundreds of millions of dollars,” says The Economist.
Is Minister Park putting the NSW government at risk of being sued for wilful negligence?
