A ban on gender-affirming hormone treatments for trans and gender diverse young people in the Queensland and Northern Territory public healthcare systems, despite this medical care not being new or experimental. Why has healthcare been taken out of the hands of healthcare professionals and their patients?
In short:
In January 2025, the Queensland Government banned the initiation of treatment using reversible puberty blockers and gender-affirming hormones for adolescents. This appears to be in response to similar interference in the UK regarding the medical care of adolescents who identify as trans and gender diverse. When challenged, the Queensland ban was extended and immediately followed by the Northern Territory Government implementing a similar ban.
The timeline
Between December 2023 and June 2024, an external clinical service evaluation of Queensland Children’s Gender Services, that was commissioned in September 2023, found the service provides safe care consistent with evidence-based national guidelines1. There was no evidence of patients or their families being hurried into making decisions about gender affirming care, despite extensive waitlists and increasing clinical complexity1. It was acknowledged that the service did not have the resources to function as a statewide service, and a networked approach was suggested1.
On the 21st of May 2024, a Public Interest Disclosure (PID) was received by the Queensland Government regarding treatment adherence to clinical standards at the Cairns Sexual Health Service2. Consequently, there was an investigation commissioned by the Director General of Queensland Health into the establishment, governance, service delivery and complaints of public health services at the Carins Sexual Health Paediatric Gender Service3 (report released 9th January 20264).
Paediatric gender health services were provided at the Cairns Sexual Health Service from at least 2008, prior to the Queensland Children’s Gender Service being established in 20174. Once established the Cairns service did not have any formal governance in place.
On the 28th of January 2025, it was announced that a review (the Vine review) had been commissioned by Queensland Health to provide advice to the Queensland Government5. The stated intent of this review was to have a clinical and medical focus on the use of reversible puberty blockers and gender affirming hormonal treatment (GAHT) for people under 18 years of age5. The review followed a Health Service Directive declaring that Queensland public health services may not initiate puberty blockers and/or GAHT in persons under the age of 18 from the 28th January 2025 (QH-HSD-058)6. Although consultation is required by law when developing a directive7, there was no consultation with Queensland Health prior to the announcement of the Directive8.
On 31st January 2025, the Minister for Health and Aged Care Mark Butler announced the National Health and Medical Research Council (NHMRC), Australia’s expert body with statutory responsibility in health and medical research would develop new guidelines9. He requested that Minister Nicholls not continue with the Vine Review and wait for national and consistent clinical guidelines to be approved9.
The Health Service Directive (QH-HSD-058) was challenged in the Supreme Court of Queensland, where Justice Callaghan ordered it be set aside on the 28th of October 20258. However, on the same day, not waiting for the final report of the Vine review or the NHMRC guidelines, the Queensland Government issued a Ministerial Direction (QH-MD-002) to maintain the ban for the use of reversible puberty blockers and GAHT for the treatment of gender dysphoria in people under 18 years of age (to be reviewed by 28th January 2032)10.
The final report of the Vine review was delivered to the Queensland Health Director-General on the 30th of November and was released to the public, just before the Parliament Christmas break, on Friday the 19th of December 202511. On the day the report was released, the Queensland Minister for Health and Ambulance Services, Tim Nicholls,stated the ban would remain in place until the controversial National Health Service (NHS) England Pathways trial is complete in 203112 13. However, the Pathways clinical trial has not started. It was paused in February 2026 due to safety concerns raised by the Medicines and Healthcare Products Regulatory Agency14.
Two days after the extension of the Queensland government’s ban, the Northern Territory Minister for Health, Steven Edgington (Country Liberal Party), announced that access to public healthcare services for puberty blockers and GAHT for adolescents would no longer be accessible in the Northern Territory15.
Currently the NHMRC is developing new national clinical practice guidelines for the care of trans and gender diverse people under 18 with gender dysphoria16. In the middle of 2026, as requested by the Australian Government, interim advice is expected to be available16.
It is concerning that the working title of the NHMRC guidelines uses the term “gender dysphoria”. This indicates that the guidelines are unlikely to incorporate a de-pathologising informed consent model of care.
The patient group affected
This ban on medical treatment affects adolescents, from the start of puberty until the age of 18 years, seeking gender affirming care in the Queensland and Northern Territory public health systems.
Based on autonomy, the right to make one’s own decisions about medical treatment is an important legal and ethical principle17. The Queensland and Northern Territory bans on treatment completely undermine an individual young person’s rights that have been established in common law 18. In common law in Australia there is no specific age at which a person under 18 is considered competent to give a valid consent 19. Their capacity to consent, to be ‘Gillick competent’, is determined by capacity to understand the nature of the treatment for those under 16 years of age 17.
In Australia, trans and gender diverse young people have a higher frequency of mental health disorders than the general population because of how they are perceived and treated20. Of the participants aged between 14 and 25 years in the Trans Pathways study, an alarmingly high 48.1% reported attempting suicide20. Prior to the ban, trans and gender diverse young people face already faced barriers to accessing mental health and medical services due to cost, long wait lists and a lack of accessibility of gender-affirming treatments and support20.
To address the urgent need for adolescents to access suitable treatment, Project 491 is being led by the Australian Professional Association for Transgender Health (AusPATH)21. AusPATH’s principal purpose is to promote the health and well-being of all trans people.
Project 491 is an attempt to financially and clinically assist affected adolescents to access timely and appropriate medical care by alternative healthcare providers5 21. The number 491 is significant, being how many young people were waiting for this treatmentin the Queensland public healthcare systemat the time of the ban21.
The medical treatment involved in the controversy
The controversy is not about surgery22. The much-publicised controversy is about hormones.
Reversible puberty blockers are medications which delay the development of secondary sex characteristics such as breasts, facial hair and the onset of menstruation23 24. The use of these hormones prevents the formation and progression of unwanted sexual characteristics, which can be critical to prevent the worsening of negative mental health symptoms related to puberty in trans and gender diverse young people25. Further, the use of these medications can remove future hurdles for embodiment goals, if started before there are irreversible physical changes26 27.
In Australia, the medication Leuprorelin (a gonadotrophin-releasing hormone (GnRH) analogue) may be used for puberty suppression. Leuprorelin has been used since the early 1980s to suppress precocious puberty, it is considered completely reversible and can be administered from the age of two years28 29. For gender dysphoria, suppression of puberty is only a temporary measure30 24.
Gender affirming hormonal treatment (GAHT), prescribed if appropriate, is the use of hormones, generally oestrogen or testosterone, to develop secondary sex characteristics aligned with the person’s gender identity30. This treatment, like all medical care, requires informed consent to be given30.
There is inherent bias that this ban introduces into Australian healthcare. It only applies to trans and gender diverse adolescents, and not adults and cis gender young people who can still be prescribed the exact same medicines31.
Puberty blockers are reversible, but puberty is not. A wait-and-see approach, as proposed by the Vine review, does not reduce psychological distress for adolescents32 33. Trans and gender diverse people have already reported negative effects from waiting for gender-affirming care when the delay has been due to wait times and depending on how urgent the treatment was to them32 34.
The difference between gender dysphoria and gender incongruence as a diagnosis
In Australia, the evidence based International Statistical Classification of Diseases and Related Health Problems (ICD) is used for classifying patient care, and as a basis to ensure appropriate services are available 2 35.
In the current revision (ICD-11), the diagnosis of gender incongruence of Adolescence and Adulthood (HA60), “is characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex”36 (there is a further ICD-11 classification for gender incongruence of childhood for pre-pubertal children).
This ICD category has been moved from the mental and behavioural disorders into the more appropriate chapter Sexuality and Gender Identity36 37. This re-classification addresses a previous request from the European Parliament calling on the World Health Organization (WHO) “to withdraw gender identity disorders from the [ICD’s] list of mental and behavioural disorders, and to ensure a non- pathologising reclassification”38. This classification confirms transgender medical care outcomes are not an adverse consequence23 39 and may reduce the psychological harm associated with non-recognition of gender beyond rigid binary categories40.
However, under the ‘Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents’, adolescents currently need to have a diagnosis of gender dysphoria to qualify for access to puberty blockers or GAHT30.
The term gender dysphoria comes from the American Psychiatric Association DSM-541. For adolescents, this is defined as “a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration,” and “is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning” (F64.0)41.
The current need for this DSM-5 mental health diagnosis to access treatment is controversial.
The need for a diagnosis pathologises people for being trans or gender diverse, and an individual may not meet the clinical criteria for a psychiatric disorder because of not experiencing gender dysphoria17 23 20. This practice instils within the healthcare system the ‘doctor’ as the authority and trans and gender diverse young people not trusted to know themselves, leading to psychiatrists being seen as gate keepers, either preventing gender-affirming care or delaying it42. Being trans or gender diverse is not a disorder that requires a cure43.
In addition, this pathologising approach to medical care comes at a greater financial cost for the Australian healthcare system44. Trans and gender diverse people who access gender affirming medical care, have reduced future demand for mental health services, which translates to significantly lower total Medicare costs over time44. Further, without access to puberty blockers, surgical procedures to remove sex characteristics developed through puberty, such as breasts and a prominent Adam’s apple, will be costly and not without risks for trans adults17 27.
Identifying as trans or gender diverse is not new or experimental
Terminology has changed, but identifying as a different gender to the one assigned at birth is not a new or “trendy” modern phenomenon45 46.
In 2021, there was a peak in referrals to the three tertiary gender clinics in Victoria47. This may have been due to an increase in visibility, representation, knowledge and access to health care48. Referral numbers have since plateaued and declined, with a likely shift in where services are provided47.
In Western healthcare, it has been almost 50 years since the WHO added ‘Extreme gender variance in children’ to the ICD37. This later became ‘gender identity disorder of childhood’ in the ICD-9 (302.6)49 (this edition also included homosexuality (302.0) in the same chapter). This is relatively recent compared to historical documentation describing gender-nonconformity, some of which are more than 4000 years old46 50 51.
Further, the World Professional Association for Transgender Health (WPATH) has produced evidence-based clinical International Standards of Care for transgender individuals since 197952 (version 8 is currently available23). Version 8 of the clinical guidance for healthcare professionals in the WPATH Standards of Care was produced through a rigorous review of existing evidence and consensus by a multidisciplinary team of clinicians, researchers and stakeholders53.
In Australia, different fundamentally from the UK, sex is changeable and not a traditional narrow binary concept (2013 Amendments to The sex discrimination Act 1984)54.
The value of the Vine Review for Australian healthcare?
The Queensland Government did not wait for the advice reported in the Vine review before reinstating the ban on the initiation of treatment using reversible puberty blockers and gender-affirming hormones for adolescents in Queensland’s public hospital system11.
The Review’s narrow terms of reference favours the DSM-5 terminology to the exclusion of the more Australian culturally appropriate, less pathologising standard for classifying patient care in the ICD-115 35. This is despite both terms being used in the evidence provided in the Vine review’s systematic review: “the literature and evidence base considered by this Review use both ‘gender dysphoria’ and ‘gender incongruence’” (page 27), and an acknowledgement that “ICD-11’s gender incongruence dominates newer and affirming frameworks” (page 34)5.
The Vine review considered a very limited selection of five jurisdictions for guidance on pharmacological management(page 15)5. The two specified countries, to the exclusion of all others except Australia, have a current approach of governments stepping in to restrict medical care for trans and gender diverse adolescents (Finland55 and the UK56).
The Vine review, like the conclusions in the Cass review, removed the healthcare professionals expertise from the research by placing minimal value on published evidence-based guidelines from long-term professional consensus and instead focused on infeasible “golden standard” randomised control studies39 56 57 58.
Additionally, the inclusion of the therapy-first outlier Gender Exploratory Therapy Association (GETA) within the pharmacological management guidance is questionable. This association espouses mandatory talk therapy, which has been described as a form of conversion practice59.
There is no empirical research that shows that discouragement of cross-gender behaviour leads to desistence of gender incongruence in childhood 42. On the contrary, as far back as the 1960s there was evidence from John Hopkins and UCLA in the US demonstrating that the conversion therapies they were trying were not working60.
Conversion therapy is psychologically harmful and is not endorsed by the American Psychological Association (APA)42 or Australian clinical guidelines 30 61.
Conclusions
The ban in the Queensland and Northern Territory public hospital systems appears to be politically motivated and is a backwards step for the necessary healthcare of trans and gender diverse adolescents.
It is hoped that the NHMRC national clinical practice guidelines (for the care of trans and gender diverse people under 18 with gender dysphoria), which are currentlybeing developed,will recommend healthcare that is guided by the knowledge and best evidence based clinical practices of healthcare professionals and not by politicians.
Acknowledgements
Thank you for feedback on early draft
Tara Nipe
Michelle McNamara
Mel Carron
Resources
• QLife – Free phone and online LGBTIQ+ peer counselling for LGBTIQ+ people across Australia. Available 3pm to Midnight, 7 days a week. 1800 184 527 and webchat.
• 13 YARN – National crisis support line for mob. Available 24 hours, 7 days a week. 13 92 76 (13 YARN).
TransHub crisis support – National resource hub for trans people, loved ones, allies and clinicians.
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One Response
Pheona van Huizen’s thoughtful paper raises questions that extend well beyond gender medicine. It asks us to consider how we regulate clinical risk, how diagnostic language shapes access to care, how evidence is evaluated, and how clinical decision-making should be shared between health professionals, patients and governments.
The existence of clinical risk is not a reason to prohibit care. Risk is inherent across healthcare. The appropriate response is careful assessment, informed consent, specialist oversight, monitoring, and transparent guideline development. If the same medications can be prescribed for cisgender young people or for other endocrine indications, we must ask why equivalent pharmacological risks are being regulated differently for trans and gender diverse young people.
The paper also highlights the importance of diagnostic language. The distinction between gender dysphoria and gender incongruence is more than semantic. It shapes whether care is framed through pathology or recognition, gatekeeping or informed clinical decision-making. Diagnostic terminology should facilitate respectful, evidence-informed care—not become a barrier to it.
One of the most important questions this paper raises is not whether evidence matters, but how evidence is evaluated. Evidence-based practice has never been synonymous with randomised controlled trials alone. Rather, it is the integration of the best available research evidence, clinical expertise, and the values and preferences of the person receiving care.
Randomised controlled trials are extraordinarily powerful when they are feasible and ethical, but they have never been the sole determinant of good clinical practice. Across healthcare we also rely on observational and longitudinal research, qualitative studies, patient-reported outcomes, implementation science, pharmacological and physiological science, and evidence-informed clinical guidelines. Different research methods answer different clinical questions. The hierarchy of evidence is not a hierarchy of worth, but of fitness for purpose.
The question raised by this paper, therefore, is not whether gender-affirming care should be evidence-based. It absolutely should. The more fundamental question is whether the evidence informing this area of practice is being evaluated according to the same principles we apply elsewhere in healthcare.
Healthcare has an ethical obligation to ensure it never becomes an instrument through which discrimination is enacted or reinforced. Discrimination is not only a social injustice; it is a determinant of health. Reasonable people will continue to disagree about aspects of gender-affirming care. But uncertainty should invite intellectual humility rather than political certainty. It should encourage better research, respectful clinical dialogue, and careful attention to the voices of those most directly affected. Healthcare is at its best when scientific integrity, compassion, and respect for self-determination remain at the centre of care.