A profound shift is underway in youth gender medicine across much of the developed world. Health systems that once rapidly expanded medical interventions for gender-distressed children are now pulling back, re-examining the evidence and re-asserting precaution. This change is being driven by mounting evidence on the negative impacts of hormonal and surgical interventions on a rapidly changing patient group: adolescent girls. Australia, however, remains largely anchored to earlier clinical assumptions, even as those assumptions are being reconsidered elsewhere.
Over the past decade, referral patterns to gender services have changed dramatically. What started as a largely male phenomenon when gender clinics opened in the 1980s and 1990s has now become female dominated. Today, around three-quarters of patients in the United Kingdom, Scandinavia and the Netherlands are adolescent girls, and referral numbers have increased almost exponentially. While Australia does not publish comprehensive national data, available clinic-level reporting suggests a similar trend here.
Indeed, recent reporting suggests the scale may be significant, indicating that at least 2,300 Australian children have been prescribed puberty blockers in recent years. Particularly concerning is the fact that the majority of Australian states have refused to release full figures, and Australia’s medicines regulator, the Therapeutic Goods Administration (TGA), has also warned it lacks visibility over how widely these drugs are being used for gender distress, limiting its ability to assess potential safety risks.
This matters because the medical interventions increasingly offered to girls carry serious and irreversible consequences. Cross-sex testosterone can result in permanent voice deepening, loss of fertility, sexual dysfunction, and elevated cardiovascular risks. Double mastectomies — which are performed on teenagers in Australia — permanently remove healthy breast tissue and eliminate any chance of breastfeeding. Many girls presenting to gender services also report high rates of trauma, autism, anxiety and depression, factors that complicate clinical assessment and heighten the ethical threshold for invasive treatment.
These trends have prompted a broader international reassessment. Independent systematic reviews across the United Kingdom, the United States and Scandinavia have consistently concluded that the evidence supporting puberty blockers, cross-sex hormones and surgical interventions for minors is of low or very low certainty. Long-term outcomes — including impacts on bone density, brain development, fertility and sexual function — remain incompletely studied, while robust evidence of durable mental-health benefits, including reductions in suicidality, has not been established.
In response, governments and medical authorities across the political spectrum have shifted towards a cautious approach. Between 2020 and 2023, Finland, Sweden and Norway moved away from routine medical interventions on gender-distressed youth and are instead now recommending psychosocial support as the first line of care and restricting hormonal interventions to tightly defined cases. The United Kingdom has since restructured its entire service model, while New Zealand, parts of Canada and numerous US jurisdictions have also tightened access. Many of these changes were implemented by centre-left governments, challenging claims that the reversal is part of a right-wing agenda.
Professional medical bodies are also following suit. Last month, the American Society of Plastic Surgeons revised its guidance to recommend delaying breast, chest, genital and facial surgeries until adulthood, citing weak evidence of benefit and concern about irreversibility. Other organisations, including the American Medical Association, have similarly emphasised caution where evidence remains uncertain.
Alongside these policy shifts has come a growing medico-legal reckoning. Dozens of gender clinics have closed or paused services, while malpractice lawsuits are drawing attention to alleged failures in informed consent and safeguarding. Just a month ago, the first American case concluded with the awarding of $2 million to a young woman in New York state who underwent a double mastectomy as a teenager and later detransitioned. While individual cases cannot resolve population-level policy questions, they underscore the legal and ethical stakes when irreversible interventions are provided to adolescents on uncertain evidence.
Against this backdrop, Australia’s position is increasingly anomalous. Despite one national insurer withdrawing cover for doctors prescribing cross-sex hormones to gender-distressed youth in 2023 and two women commencing legal action against Australian practitioners, only Queensland and the Northern Territory have taken steps to limit permanent medical interventions on gender-distressed youth. All other Australian jurisdictions permit the use of puberty blockers, cross-sex hormones and, in some cases, surgery for minors under existing clinical frameworks. At the same time, doctors who raise concerns about the current approach to gender distress — like Dr Jillian Spencer and Dr Andrew Amos — are being sanctioned and censored by employers and medical bodies.
The National Health and Medical Research Council’s (NHMRC) review into healthcare for trans and gender-diverse children — whose interim report on puberty blockers is due mid 2026 — therefore represents a critical decision point for Australia. The question is not whether to deny care, but whether to align clinical practices with the principles that have long guided paediatric medicine: caution, proportionality, reversibility and a high evidentiary bar — particularly where girls’ bodies and future fertility are concerned.
Much of the developed world has already begun reinstating those principles in youth gender medicine. Australia should not wait until further harm — or litigation — forces its hand.
Women’s Forum Australia is an independent think tank that undertakes research, education and public policy advocacy on issues affecting women and girls, with a particular focus on addressing behaviours and practices that are harmful and abusive to them. We are a non-partisan, non-religious, tax-deductible charity. We do not receive any government funding and rely solely on donations to make an impact. Support our work today.
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