Kids’ public hospital gender care ban extended despite ‘inherent risks’

Queensland’s ban on gender-affirming care for transgender children will continue until at least 2031 despite the extension being the riskiest of three options outlined by a long-awaited report.

The opposition and other stakeholders have reiterated accusations the cabinet-approved ban was, and remains, an ideological decision despite external evaluation viewing the Queensland Children’s Gender Service favourably.

The Crisafulli government halted new public hospital hormone treatments for children under 18 in January, after a three-page document with allegations of “apparently unauthorised” services to 42 patients in Cairns.

As part of its “pause”, the government ordered an independent clinical review of all services to be conducted by a panel led by Victoria’s former chief psychiatrist Professor Ruth Vine. Its report was handed to government on November 28.

The review’s terms of reference did not allow it to make recommendations. Instead, it offered advice, which Nicholls did not describe in detail, but said was carefully considered by cabinet over the past fortnight before the decision announced today.

The review, which was not available publicly before Nicholls media conference, laid out three options.

The first, essentially a continuation of the ban, was described as carrying “inherent risks” in legal, ethical and social terms, risks around not further building evidence, and risked of pushing people to access treatments through less regulated and expensive private sector practitioners, overseas, or illegally.

A second option, essentially returning to the pre-ban arrangements, would allow some beneficial outcomes for young people and continued research, but would also carry legal, ethical and social risks.

The third option, to return the services statewide with extra compliance-based oversight and monitoring, was said to offer beneficial outcomes, address or balance risks, and even help strengthen systems and monitoring of quality of care.

Nicholls said the government’s decision would extend the stage one and two hormone therapy ban for new patients until the end of the United Kingdom’s Pathways trial in 2031, in line with an approach also taken by New Zealand.

Stage one therapies refers to the use of puberty blockers, medications that temporarily stop a young person’s body developing physical characteristics. Stage two therapies include hormone replacement therapy (HRT) such as estrogen or testosterone.

Puberty blockers were banned outside research settings in the United Kingdom last year, but the three-year Pathways clinical trial, involving more than 200 young people, was set up to find evidence about the risks and benefits of the drugs.

The report agrees with a “near consensus among international reviews” that the evidence base for the use of the drugs is limited, particularly regarding the use of puberty blockers before starting stage-two therapies and other long-term risks or benefits.

“Low quality preliminary evidence increasingly suggests” both stages of care, used appropriately, can help ease gender dysphoric distress and have beneficial psychosocial impacts, the report said. But there was also evidence of short-term impacts on bone health and fertility.

“We’re prepared to observe and watch and wait what happens in the United Kingdom,” Nicholls said, noting that existing public-sector patients would continue to receive treatment and all children would continue to have access to mental health and wellbeing support.

“In Queensland, we’re not prepared to go down that pathway of trialling unproven drugs on children.

“When that [UK] trial is completed, that will then be an opportunity for the government, at that time, to reconsider the pause.

Senior Labor opposition figure Shannon Fentiman said the review did not support the government’s approach which she described as an “ideological” and “heartless” decision, calling for Nicholls to withdraw his ministerially directed ban.

“This should be about health care. This should be a decision that families make with their doctor,” Fentiman told journalists at a later media conference.

Greens Maiwar MP Michael Berkman said in a statement that the government had “completely ignored the findings of their own review, and vulnerable children will suffer as a result”.

“We now have two reviews in as many years that show gender-affirming treatment is not only appropriate, but life-saving.”

Jackie Turner of the Trans Justice Project, in a statement released with four other community and expert stakeholders criticising the government’s decision, said the move was a “cynical” attempt to “appeal to a small, hateful minority who don’t want our young people to have the freedom to be themselves”.

One motion debated at the LNP state convention in August sought a ban on all gender-affirming surgical or medical treatment for children.

The state policy may conflict with recommendations from the Australian government, which is also reviewing care and treatment guidelines for trans and gender diverse children, and planned to release interim advice on the use of puberty blockers by mid-2026.

Nicholls also used his media conference to announce the release of a “harrowing” review into the services provided at Wolston Park Hospital from 1950 to 2000, and a review of the implementation of calls from a report into heart and lung transplant services at the Prince Charles Hospital.

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