Parents, patients, doctors weigh in on hormone freeze debate for trans kids

Every morning at kindergarten, Sarah’s middle child ran straight to the dress-up box and put on the brightest pink dress with the biggest puff sleeves, decorated with the most lace.

It became such a ritual, kindergarten teachers would have the dress out ready for when the toddler arrived.

“They knew then: ‘That’s her dress’, or ‘That’s his dress’ they would say at the time,” Sarah says.

More than a decade later, Sarah — whose name has been changed to protect her daughter’s identity — recounts the story at her home in a suburb of Logan, south of Brisbane.

It’s being retold amidst a bitter and polarising debate about transgender issues across the world.

On US President Donald Trump’s first day back in office, he issued an order questioning the very existence of trans people, declaring his government would recognise only two unchangeable sexes: male and female.

Days later in Queensland, Health Minister Tim Nicholls announced an indefinite pause on the use of puberty blockers and cross-sex hormones in new public patients under 18 years old, citing “contested evidence”.

Sources working in the sector have expressed outrage over Mr Nicholls’ lack of consultation with medical specialists treating transgender youth, and their patients, before the announcement.

Sarah speculates whether the new LNP government was motivated to act on transgender medicine in young people by what’s happening in the United States.

“They’re being encouraged, emboldened by what Trump’s doing there,” she says.

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‘I want to be a girl’

Her child is about to turn 15 and is hopeful of soon starting on cross-sex hormones — in her case oestrogen — to assist her transition into a girl.

She’s been on puberty blockers for a couple of years to avoid the unwanted changes associated with adolescence in boys, such as a deepening voice and facial hair.

The Queensland Children’s Gender Service patient has escaped the Crisafulli government’s hormone freeze, but did not hold back when she first heard about it.

“She started swearing, which we don’t do very often,” Sarah says, her fingernails painted in the colours of the trans flag — blue, pink and white.

Looking back, she realises her child has “always been a girl”.

All her friends were girls, she loved fairies and dancing, and on non-uniform days at school, she chose to dress up as a girl.

“In grade 5, she said: ‘Mum, I have a dream, and I want to be a girl,” the mother-of-three recalls.

“I’m like: ‘Oh, that’s not something we can do.'”

At the time, to her regret, Sarah had no language for transgender issues. If she did, she believes she could have acted sooner.

“We didn’t understand what it meant,” she says. 

“I still don’t always understand, but I know that we’ve got to do the right thing by our kids and by our community.

Something clicked when Sarah’s child, who had “never had behaviour issues”, was in the first year of high school and refusing to do homework centring around puberty and the differences between boys and girls.

After the school’s guidance officer became involved and told her parents their child was identifying as a girl, they supported her social transition from boy to girl.

“She’s a beautiful girl we love,” her mum says with conviction.

‘I don’t want to grow a beard’

Less than 100 kilometres away, north of Brisbane, another mum of a transgender teen struggles to sleep amid the distress caused by the Queensland government’s stance and Trump’s “body blows” on the trans community.

Under the Queensland Health directive, public patients aged 18 and under with gender dysphoria will only be able to access puberty blockers and cross-sex hormones if they had already started on a medical pathway before January 28.

Sue’s child Carly, who is almost 14, has been a patient of the Queensland Children’s Gender Service for five years.

Like Sarah’s daughter, Carly loved to dress as a girl from an early age.

“She loved wearing skirts,” Sue says. 

“She’d spin around. She loved the feel of it. She’s quite sensory.”

Carly was preparing to start puberty blockers when the pause was announced, making her ineligible for free medical treatment in the public system.

Sue will borrow money from her own mother to fund Carly’s treatment in the private sector.

But she’s “furious” at the LNP government’s decision and plans to challenge it in the courts.

“I am sick of politicians … who are looking for votes and they see my child as someone that they can attack,” Sue says.

“She’s a fairly typical teenager who just happens to inhabit a body that doesn’t fit with how she feels inside.”

Sue is also resentful of politicians interfering in her child’s healthcare.

“They’re taking it away from doctors and experts,” she says. 

“They’re taking it away from a consideration of the particular circumstances of our case, and they’re doing it for a political reason.

“It is ideology, and I’ve had enough of it.”

Sue and Carly’s names have also been changed for privacy reasons.

Contrary to what some critics suggest, Sue says the transitioning journey through the Queensland Children’s Gender Service is “not a fast process”.

“At times it’s frustratingly slow,” she says. 

“We have had a number of meetings with psychologists. There was never any particular agenda.

“I feel for those parents whose kids are on the waiting list and they haven’t even yet got to see someone.

Review didn’t find evidence of harm

Announcing the pause and a review into the evidence for giving puberty blockers and cross-sex hormones to trans young people, Mr Nicholls cited the “apparently unauthorised provision of paediatric gender services within the Cairns Sexual Health Service”.

He said this had resulted in 17 children receiving hormone therapy that “may not align with the accepted Australian treatment guidelines”.

In a statement, the Cairns and Hinterland Hospital and Health Service chief executive Leena Singh says a preliminary review in late 2024 had identified “governance issues around the delivery of paediatric gender services and where we could improve our processes”.

She says it “did not find any evidence of patient harm”.

What the research says so far

Days after the Trump and Crisafulli governments’ moves on the trans community, Federal Health Minister Mark Butler tasked the independent National Health and Medical Research Council to develop new Australian guidelines for the care of transgender youth.

A dense forest of reviews and studies into the evidence for and against prescribing puberty blockers and cross-sex hormones is available for those prepared to venture there.

In April last year, a 388-page report commissioned by England’s National Health Service (NHS) concluded “there is not a reliable evidence base upon which to make clinical decisions” regarding gender-affirming care.

Written by paediatrician Hilary Cass, who had never worked in gender services during a distinguished career, the report says: “This is an area of remarkably weak evidence”.

“Results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint,” Dr Cass writes.

As a result of the four-year Cass review, the NHS stopped prescribing puberty blockers for children and young people with gender dysphoria unless they had already started the treatment or as part of a clinical trial.

But in a perspective piece published this year in the prestigious New England Journal of Medicine, US-based lawyers Daniel Aaron and Craig Konnoth wrote: “The review calls for evidentiary standards for GAC (gender-affirming care) that are not applied elsewhere in paediatric medicine”.

They note similar calls for higher standards have not targeted girls receiving hormone therapy to treat excess hair growth or children receiving puberty blockers to treat precocious puberty — when puberty begins too early.

The Australian national youth mental health organisation Headspace has also published a recent evidence summary looking at the association between gender-affirming care — including puberty blockers and cross-sex hormones — and youth mental health and wellbeing outcomes.

It found the evidence to be “consistently and overwhelmingly positive”.

“The current review did not find any empirical research of alternative approaches to gender-affirming care that yielded positive mental health or wellbeing outcomes,” the report says.

“‘Wait-and-see’ approaches also have a negative impact on young people’s mental health and wellbeing, as studies have shown that unmet needs for gender-affirming care contribute to mental health inequities including higher rates of suicide and self-harm.”

The Queensland Children’s Gender Service has always backed the gender-affirming care it provides, telling the ABC the treatment is “safe, evidence-based and consistent with the current national and international guidelines”.

But Queensland-based academic psychiatrist Andrew Amos, who does not treat transgender children, does not hide his disdain for the use of hormones to treat gender dysphoria in young people.

“There’s a very good chance that the kids being treated under the gender-affirming care protocols are at high risk of long-term harm,” he says.

“My concern is that all of the paediatric gender clinics run in public hospitals across Australia have been set up and are now treating thousands of kids each year without actually ever having reliably demonstrated that they will improve the health of these kids.”

Dr Amos says side effects of gender-affirming care in children and adolescents can include sexual dysfunction later in life, fertility issues, osteoporosis and poor relationships with their families, particularly for those known as “detransitioners” — people who have opted to return to their birth gender.

He’s among a group of psychiatrists who argue the gender-affirming treatment model discounts underlying psychiatric issues in youths who present with gender dysphoria.

The James Cook University academic says it’s undeniable there are people who have developed gender diverse personalities where “there had definitely been a psychiatric cause”.

“There is NO reliable evidence that trans identification can be differentiated from psychosis,” he wrote on X last year.

Dr Amos says he started speaking out as an adult psychiatrist after paediatric colleagues asked him to become involved “because they were afraid to speak up”.

“Because other people weren’t speaking out, I thought it was really incumbent upon me to really make a stand and make it clear that we just don’t have the evidence to implement this form of treatment,” he says.

Dr Amos describes the Queensland government’s pause as “the right approach”.

But others, both inside and outside the health sector, oppose his view.

Royal Australian College of General Practitioners Queensland chair Cathryn Hester says that for some transgender and gender diverse young people, accessing gender-affirming medical treatments is not only crucial in improving their mental health and wellbeing, but can be a lifesaver.

Australia’s Sex Discrimination Commissioner Anna Cody says access to healthcare is a fundamental human right and gender-affirming healthcare is part of that right.

“Trans and gender diverse children and young people should feel supported to affirm their gender by the adults in their lives and healthcare providers,” Dr Cody says.

Anglican Archbishop backs trans community

Anglican Archbishop for southern Queensland Jeremy Greaves says he’s written to Mr Nicholls about the government’s pause, worried it “may put some young people at risk”.

“I wanted to share my concerns about a cohort of young people who are among the most vulnerable in our communities and to ensure that care for them is based on best practice and research and decisions are not made on the basis of politics or ideology,” he says.

“It’s a concern that if something was wrong in the clinic in Cairns, there wasn’t immediate steps to sort that out, rather than a wholesale pause on a treatment pathway that for many young people is a really important part of a bigger care plan.”

After talking to families with young people working through issues around gender dysphoria, he says he senses “a frustration that this sort of decision would be made with little consultation”.

“It seems to me that one of the missing pieces in this conversation has been the lived experience of those young people and their families, who are most impacted by the decision that’s been made,” Archbishop Greaves says.

Nearly 700 children treated last year

Since Mr Nicholls’ announcement, members of the wider trans community have wrapped their arms around the younger generation.

Drag queens have also performed to raise money for Project 491, a crowd-funding campaign, which seeks to fund gender-affirming care for trans adolescents who cannot afford private treatment.

So far, it’s raised more than $97,000 — way below the estimated amount needed, given puberty blockers cost about $3,000 a year for one trans patient.

The LNP government’s directive has put the care of hundreds of young patients in limbo.

Queensland Children’s Hospital data shows its gender service provided care for 690 children and young people in 2024, 23 prescriptions for puberty blockers were initiated and 85 young people started taking gender-affirming hormones.

As of February 25 this year, 417 children were on the service’s waitlist for an initial appointment.

Experienced general practitioner Fiona Bisshop specialises in trans medicine and mostly treats adult patients in her inner-Brisbane private practice.

She says those patients often express regret at being unable to access hormone treatments earlier.

“I have patients who’d come to me in their 60s and my oldest patient was 70-something,” Dr Bisshop says.

“They waited until all their kids had grown up. So many people wait until their parents are dead because they’d come from a generation where they just knew that it was never going to be something they could talk about.

Dr Bisshop, who has been a GP since 1999, has written to Mr Nicholls but is yet to receive a reply.

“I know heaps of other people have written to him, but we’re not getting anything back,” she says.

“It’s [as if] he says: ‘I want to protect this young group of vulnerable people, but I don’t want to talk to them or find out how my decision has affected them’.

“Please come and meet the people who are affected by this.”

Mr Nicholls has not responded to invitations to meet with affected families.

In a statement, his office says all stakeholders are encouraged to participate in the review.

Seven weeks after it was announced, the government is yet to provide information about who will lead it or the terms of reference.

Finally feeling free 

Bette Benjamin describes herself as trans feminine. 

She’s 51 and has only transitioned in the past few years after spending decades in “the closet”, having no language to describe what she was experiencing.

“No-one I knew, or had ever heard of, had ever mentioned that there could be such a thing as a transgender child,” she says.

Ms Benjamin says while suicide is described as a big issue facing trans adolescents unable to access gender-affirming medical care, another risk is having “unhappy lives that drag on for decades before finally discovering themselves”.

She says hormone treatment allows transgender people to “feel comfortable in our skins”.

“I never thought I could be this lucky as to be able to walk down the street in broad daylight, looking how I want to look, behaving how I want to behave,” Ms Benjamin says.

As the gender debate continues, Sarah’s hope is that once her “quirky girl” leaves the “brutality” of high school, she will find a supportive tribe of people that embrace her for who she is.

“I have good hope that she’ll find a group and she’ll settle in and be a confident woman in the future,” Sarah says.

As for Carly, when asked how she sees herself, she answers simply: “As a normal human”.