National guidelines on puberty blockers are coming as fraught debate continues
Tue 28 Jul 2026 at 4:40am
Reflecting on the awkwardness of early adolescence is uncomfortable for many, but for 16-year-old trans girl Kassie it has been particularly challenging.
For Kassie the prospect of puberty — and the aspects of male development that come with it — was incredibly distressing.
"I really didn't like having broad shoulders or a masculine silhouette … I didn't want to experience those things, I was really scared of having to go through that, and having to see that and remind myself when I look into a mirror," she said.
When Kassie was 12 she was formally diagnosed with gender dysphoria, which refers to the feelings of distress when a person's gender identity is different to their sex assigned at birth.
At times Kassie's distress was so great she struggled to even wash herself.
Her mother Marianne recalls covering the mirrors in the bathroom, turning off the lights, putting on music and burning incense and candles to distract Kassie while she bathed.
"She was increasingly realising that she was not comfortable in her skin,"Marianne said.
"It was really hard for her to shower … I think being surrounded by mirrors and getting naked for any of us sometimes is a bit confronting but especially I think if you're not feeling like how you feel in yourself, is not the way you look."
For two years, from the age of 13, Kassie was on medication known as gonadotropin-releasing hormone analogues (GnRHa) or puberty blockers, injections that pause aspects of physical development by suppressing sex hormones.
The medication is a form of medical intervention prescribed to trans children, however generally patients cannot access other medication, like hormones oestrogen or testosterone, until after they turn 16, while gender-affirming surgery is usually only available for adults.
Marianne said the process behind Kassie starting the medication was rigorous, taking more than a year and involving multiple consultations with health professionals including paediatricians and psychologists.
"So that they're very clear, that over this prolonged period of time, that they feel confident that you're continuing to present in a certain way … and that they are clear that informed consent was able to occur and that Kassie understood the good, the bad, the ugly, the pros, the cons, the whole picture," she said.
"I have absolutely no doubt that we made the right decision because I've got my happy, cheerful child back."
Advocates argue pausing puberty temporarily — for months or a few years — buys patients time to decide if they want to take the next steps towards transitioning with hormones.
But critics claim the medication is experimental and potentially dangerous, with questions over whether children have capacity to consent to the treatment.
As a result, people like Kassie have found themselves at the centre of an increasingly fraught area of medicine that is polarising the community and politicians around the world.
Puberty blockers generate fierce debate
US President Donald Trump last year signed an executive order to end federal funding for gender-affirming care for children under the age of 19, including puberty blockers.
He later declared he had "stopped the mutilation of children".
More than half of US states now have policies banning or restricting the treatment for minors.
Other countries like the UK, Finland and New Zealand have also restricted the use of puberty blockers.
The UK's ban for new patients followed the Cass review into gender-affirming care offered by the National Health Service (NHS) in England, which called for sweeping changes to the treatment of young people with gender dysphoria.
Conducted by paediatrician Hilary Cass, the review found the evidence base for treatments like puberty blockers was "weak" with insufficient evidence about the effects of the medication on fertility.
It also found bone health may be compromised during treatment.
A clinical trial known as PATHWAYS was planned to gather further data, but it has been delayed because of safety concerns and legal challenges.
In Australia, politicians are divided.
Queensland last year became the first state in Australia to restrict public access to puberty blockers for children with gender dysphoria who were not already on them.
The Northern Territory followed suit.
As it paused access to the medication, Queensland ordered an independent review by psychiatrist Ruth Vine.
The review found overall that the evidence base about the use of puberty blockers for gender dysphoria was limited.
On the issue of the impact of the treatment on fertility, it also found the evidence was limited.
Based on the available research it found there was evidence that puberty blockers "impact bone health in the short to medium-term".
The review found that while the long-term physical, mental health and social impacts of prescribing puberty blockers had not been settled, the risks should be balanced with an emerging trend of evidence suggesting potential psychosocial benefit.
It stated the "effects of [puberty blockers] are reversible" and with proper oversight … "there can be benefit for a young person" in accessing the medication.
The review put forward three options for the Queensland government.
The first banned puberty blockers or hormone treatment for gender dysphoria in the public system for children under the age of 18, an option it said carried "inherent risks" including treatment being provided privately without multidisciplinary care.
The second would return Queensland to the situation before the ban, where treatment was provided through the Queensland Children's Gender Service. The review said this option may be beneficial for young people but also carried risks, including a limited evidence base for the medication.
The third would allow the treatment to be delivered within a public statewide system of care, with additional safety measures to help ensure and monitor quality of care and mitigate risks. The review said that option would "support more robust research and reporting to inform the evidence base".
The Queensland government stopped short of fully implementing the first option, instead choosing to continue the pause until 2031, while awaiting the results of the upcoming UK clinical trial.
That decision went "beyond" the review, according to professor of endocrinology at the University of Melbourne, Ada Cheung, who supports the use of puberty blockers where appropriate.
"The Vine Review did not advocate for restricting care," she said.
"The Vine Review put forward three options and the government chose the option that provided no benefit but significant risk, which is concerning."
Ethical dilemmas
A complicated combination of ethical and practical limitations around the way research is conducted means puberty blockers are caught in a conflict of methodology.
The gold standard of scientific studies is known as the randomised controlled trial, which compares two groups randomly selected. One is given the treatment and the other is given something else, like a placebo, or even the same treatment at a different time.
In the case of puberty blockers, that approach raises ethical concerns, because it can mean delaying or withholding treatment for children.
When neither the participants nor the researchers know who is in which group, that is called a double-blind trial — a method used to prevent bias.
However, because the drugs stop physical changes like menstruation or voice deepening, patients and doctors can guess if they are in the group receiving treatment, so double-blind trials are not possible with puberty blockers.
That has left a reliance on so-called observational studies, where scientists observe and track individuals without manipulating the environment.
These studies are not considered to be as high quality as randomised controlled trials because without comparison, researchers cannot be sure what impact the treatment itself has had.
In addition, because only a small proportion of the population is trans or gender dysphoric, the available studies have small sample sizes.
The available evidence is interpreted differently by each side of the debate.
Professor Cheung argues that a burden of proof has been put on puberty blockers that has not been placed on other forms of healthcare.
"This level of evidence is very common for other areas of paediatrics and for surgery and so it's the norm, not the exception … and it's not dissimilar to other areas of health like, for example, ADHD," she said.
"There are many areas of medicine where we may not have the highest quality of evidence, but it doesn't mean an absence of evidence, and it doesn't mean evidence of harm."
However Gold Coast paediatrician Dylan Wilson says he does not believe the benefits outweigh the risks.
"The fact that this has been subjected to systematic reviews shows that the evidence at the moment is poor," he said.
"That doesn't mean that because other treatments don't have that same standard that we should continue with this treatment."
'Pulled the rug out from under them'
Queensland's effective ban has led many children with gender dysphoria to Brisbane GP Fiona Bisshop.
Dr Bisshop, a past president of the Australian Professional Association for Trans Health, now administers puberty blockers to patients paying about $3,000 a year to purchase the medication privately.
She says the impact of the ban was profound and immediate.
"Our phone lines were ringing off the hook with worried parents," she said.
"There were many young people who were about to start puberty blockers through the clinic, and it pulled the rug out from under them.
"For many of them, they don't know where else to go. So there are definitely going to be people out there who are missing out."
Dr Bisshop says puberty blockers have been used since the 1980s to treat young children who go through puberty early, which is also known as precocious puberty.
"It is a double standard to say that you can use this treatment for one condition of childhood but not for another … transphobic discrimination is what it is,"she said.
Dr Bisshop says puberty blockers have benefits that outweigh the risks for many young people, and minimise the need for future medical intervention for those who decide to continue with their gender-affirming care.
"My adult trans patients who never had puberty blockers, they are now undergoing surgeries," she said.
"Some of them are undergoing top surgery to remove breast tissue. Some of them are undergoing surgery to get rid of their Adam's apple to try and change their voice and make it lighter and higher.
"These things — the voice, the hair — are key identifying features out in society. So if you walk down the street and you've got a deep voice and facial hair, people are immediately going to gender you as male, it doesn't matter what you're wearing and how you present yourself.
"These are the sorts of things that we can prevent. And the ultimate saving in mental health and in costs to our patients is enormous."
Queensland Health Minister Tim Nicholls defended his government's decision.
"We owe it to children to ensure health care is based on robust evidence and delivered with caution to ensure their safety and wellbeing," he said in a statement to 7.30.
How many children on puberty blockers?
Clinicians prescribing puberty blockers argue only a small portion of patients referred to gender clinics go on to puberty blockers.
However, finding out exactly how many children are on puberty blockers for gender dysphoria is difficult, and has meant people are debating an issue without relevant data.
7.30 contacted every state and territory for the figures, however most declined to provide the information citing privacy concerns, even though the data could be provided without naming individual children.
Perth Children's Hospital's Gender Diversity Service is treating 58 children on puberty blo
