A sociologist who surveyed more than 100 young transgender people and their parents following a puberty blocker ban in the UK has warned similar bans in Australia and New Zealand will lead to youth suicides.
Dr Natacha Kennedy from Goldsmiths, University of London, analysed the impact of the UK ban that was first implemented in March 2024, and extended indefinitely last December.
The ban followed the Cass review, a non-peer reviewed, independent assessment of gender identity services for children and young people, commissioned by England’s National Health Service and led by paediatrician Dr Hilary Cass.
The review proposed restrictions to youth accessing gender-affirming care, but has since faced extensive peer-reviewed criticism for methodological problems and insufficient engagement with those with lived experience – including trans people and clinical experts working in gender affirming care.
According to Kennedy, the review also disregarded the level of harm caused by denying youth with gender dysphoria access to puberty blockers and hormone therapy. Her research found “the harm the UK puberty-blocker ban has caused is truly appalling”.
“These are young people living in abject misery and severe distress, unable to lead normal lives and socialise with their peers at a crucial time as they are developing into adults,” Kennedy told Guardian Australia.
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“The psychological harm they were experiencing was very significant and included extreme levels of stress, anxiety, fear, trauma and increased suicidal ideation.”
Her study, published in the Journal of Gender Studies in June, found that these harms were constant, pervasive and all-encompassing.
After bans were introduced in Queensland and New Zealand, Kennedy said her “initial response was of absolute horror”.
“This ban will harm trans children,” she said.
“Not might, may or could. Will.
“Some … will take their own lives. They [politicians and policymakers] may choose to ignore this inconvenient fact, but their actions will be directly responsible for harming children.”
The Queensland situation
Asked about the Cass review in 2024, Queensland’s then health minister, Shannon Fentiman, described the state’s Children’s Gender Service as “one of the best in the country” and said “all trans young people deserve access to high-quality and timely healthcare”.
But after defeating her Labor party at an election later that year, the Liberal National government issued a directive blocking doctors in the public system from prescribing puberty blockers or hormones for gender dysphoria in new young patients.
Then, in November, the New Zealand government announced a similar ban, only to delay its introduction pending a judicial review.
Rachel Hinds is the chief executive of the Open Doors Youth Service, which offers mental health support and help accessing healthcare to the LGBTQ+ community. She said was given no notice ahead of Queensland’s puberty blocker ban.
“We’re now supporting a number of families who have their young people on suicide watch,” Hinds said.
“I was talking to one mum after the pause on puberty blockers, who was just was sobbing down the phone to me and saying: ‘The goalposts have changed for us now. We just need to keep her alive’.
“It is taking an incredible toll.”
Puberty blockers pause the onset of puberty and prevent the development of associated physical characteristics. This is fully reversible and gives adolescents time to explore their gender identity before any further steps are taken.
Gender-affirming hormones such as oestrogen or testosterone, which produce physical changes aligned with the young person’s gender identity, may also be prescribed. Some effects of hormone treatment are irreversible without surgical intervention.
Governments implementing bans have cited concerns over the quality of evidence regarding long-term effects of puberty blockers, adopting a precautionary approach.
A spokesperson for Queensland’s health minister, Tim Nicholls, said that “in light of the divergent and inconclusive evidence around the world”, the government had appointed psychiatrist Dr Ruth Vine “to lead an independent team to investigate and report on the evidence and to provide policy advice for consideration”.
Despite Vine finding that with proper and cautious oversight, standards and appropriate reporting, “there can be benefit for a young person in being able to access puberty blockers,” Nicholls extended the ban until 2031.
‘Evidence’ limitations
What the Cass review – and governments in the UK, Queensland and New Zealand – appear to have ignored is that most paediatric medicine operates on a low to moderate-quality evidence base, according to the paediatrician and biomedical researcher, associate professor Ken Pang.
This is because conducting large studies in children is often impossible, unethical or unfeasible – in part because there may not be enough children with a certain condition.
“Those of us working in the field readily acknowledge the need for more high-quality evidence to continue to strengthen care further,” said Pang, from the Melbourne Children’s Research Institute.
“But it’s important to realise that the quality of evidence in this field is similar to that of most other areas of child health.
“This continual focus on the evidence completely disregards the other two pillars of evidence-based medicine, which are patient values and clinical expertise.
“If politicians and policymakers are interested in families’ best interests and in promoting best practice health care, then they need to up-lift the voices of the young people, parents and clinicians with knowledge and direct experience in this field.”
Pang is a member of the National Health and Medical Research Council’s gender guidelines development committee, which is drafting recommendations for the care of trans and gender diverse children with gender dysphoria. He said he was commenting based on his clinical experience, and that his views do not necessarily reflect those of the committee.
“Many of the people who criticise gender-affirming care have never actually worked with transgender young people, but that doesn’t stop them from claiming to be experts in the area,” Pang said.
“I know that if I was diagnosed with cancer, then I’d be seeking advice from an oncologist, not listening to some other random doctor.”
This has led to misinformation, including that providing access to puberty blocking and hormone medications to gender-questioning children is a standard form of treatment and “too easy” to access, Pang said.
But documents released under freedom of information laws from the Australian department of health show that puberty blocker prescriptions are not routine treatments for youth with gender dysphoria or incongruence.
The documents cite an independent review of Queensland’s gender clinic, which found out of the total cohort of children and adolescents who attended an initial session at the clinic between February 2023 and April 2023, most (71%) had not been prescribed gender-affirming hormone treatment and puberty blockers at least 12 months later.
The review also found the service to be safe, evidence-based and consistent with national and international guidelines.
Similarly, only 23% of those attending a large clinic in Victoria over a 10-year period had started puberty blockers.
The documents note that the UK’s Commission on Human Medicines recommended ongoing restrictions on prescribing puberty blockers due to insufficient evidence for this specific use, not because of any new safety concerns.
The medicines themselves remain safely used in for conditions such as precocious puberty, endometriosis and fertility preservation during cancer treatment, the commission found.
“There are now trans people in their late 40s who were prescribed puberty blockers [as children], so if there were any significant long-term harm caused, we would know about it by now,” Kennedy said.
Politicisation fears
Research has also found fast access to gender-affirming care is crucial for those who need it.
But in recent years, healthcare for gender-questioning youth has become increasingly politicised, and misinformation is rampant, making it more difficult for youth to access care when they need it, said Dr Ronita Nath, the vice-president of research at the Trevor Project.
The organisation is the leading nonprofit for LGBTQ+ youth mental health in the US. In 2024, a first-of-its kind study co-authored by Nath found state-level anti-transgender laws in the US had led to a direct increase in recent suicide attempts among a sample of more than 61,000 youths.
“It’s understandable to have questions,” Nath said.
“However, stripping young people of this life-saving care only results in causing them harm.
“It is deeply disappointing to see lawmakers, in any country or community, take action to prevent transgender and non-binary young people from receiving access to best-practice medical care.”
In Australia, the crisis support service Lifeline is 13 11 14. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. Other international helplines can be found at befrienders.org
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