Nine objections to the QLD ban

Objections to the ministerial directive banning gender-affirming hormone treatments for young people through the Queensland public health system:

1. The Health Minister claims the new directive is in the public interest, but offers no evidence as to why that might be the case. The closest he gets is to namedrop the Cass Review, but the Cass Review cites no new evidence of harms attributed to puberty blockers. The one side-effect it does cite has been well-known to treating physicians for decades: possible reductions in Z-value bone density. However, as Dr Simona Giordano testified before the UK Women and Equalities Committee regarding the UK’s ban on blockers, “In the literature, there is no reported case of complaint around loss of mineral density from the cohort of children treated since the mid-1990s. There is no report in the literature, no litigation, no complaint through clinical authorities from patients.” In short, there is no evidence of long-term harm, which would explain why the Health Minister does not appear to be worried about cisgender young people accessing the same treatment.
2. In fact, the only treatment for gender dysphoria shown to do harm in any of the hard evidence cited by the Cass Review is cognitive behavioural therapy. Likewise, the only treatment for dysphoria for which Cass’s team found no evidence at all was psychotherapy, which is now both (a) recommended by the Cass Review as the first-line treatment for dysphoria, and (b) the only treatment available through the Queensland Children’s Gender Service since the QLD ban took effect. How is it in the public interest to ban a treatment which has been used without incident for 30 years and replace it with a treatment for which there is no supporting evidence at all?
3. “The Review, and the UK Government, have taken the position that GAMT, an established treatment with observational evidence of early and medium term benefits and acceptable safety, should be actively withheld from trans adolescents due to lack of high-certainty evidence of very long term efficacy and safety. Few treatments for any condition meet this criterion, and it is difficult to name another field in which regulators impose such a benchmark. Much health care in other areas of medicine is guided by evidence of similar or lesser strength.” (Moore et al. Cass Review does not guide care for trans young people. Medical Journal of Australia (2025). https://www.mja.com.au/journal/2025/223/7/cass-review-does-not-guide-care-trans-young-people)
4. The Cass Review claims the evidence for prescribing puberty blockers is “weak” since it does not reliably show that blockers improve mental health or relieve gender dysphoria. But as Dr Cal Horton says, “Puberty blockers are not expected to resolve gender dysphoria. They are not expected to lead to an improvement in mental health and well-being. They are intended to prevent the catastrophic decline in mental health and well-being that is known to occur when trans youth are forced through a puberty they find intolerable.” A study presented at WPATH 2024 highlighted the different mental health trajectories of trans youth. It emphasised that for trans youth with family support, low levels of minority stress, and good mental health from childhood, puberty blocker treatment would not lead to an improvement in mental health but a retention and protection of that good mental health. Similarly, for trans youth facing lack of support and higher rates of minority stress, gender-affirmative healthcare is not expected to eradicate mental health challenges. (Chen et al. Not yet published. Presented at WPATH 2024.)
5. Far from protecting young people, the Minister’s directive puts young people at risk. As Turban et al (2020) found using a survey of over 20,000 transgender adults, “There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment.” (Turban et al. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics (2020). https://pmc.ncbi.nlm.nih.gov/articles/PMC7073269/)
6. Qualitative studies of puberty blockers show (1) the heightened anxiety in trans children as puberty approaches; (2) information on blockers providing reassurance for trans pre-adolescents; (3) the harms caused by delays; and (4) the relief obtained when trans adolescents have their puberty blocked. (Horton, C. Experiences of Puberty and Puberty Blockers: Insights From Trans Children, Trans Adolescents, and Their Parents. Journal of Adolescent Research (2022). https://doi.org/10.1177/07435584221100591)
7. In addition, likely harms arising from the QLD ban will affect all trans young people, not just those directly denied healthcare. Lee et al (2024), using a sample of over 60,000 young people surveyed from 2018-2022 in the USA, found “a very sharp and statistically significant rise in suicide attempt rates” after the enactment of anti-trans laws. A small rise was seen in a state soon after laws were enacted, followed by a sharper rise two or three years later. Among 13-17 year olds, two years after a law took effect, the likelihood of a past-year suicide attempt was 72% higher than it was before that law‘s passage. (Lee, Hobbs, Hobaica, et al. State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Natural Human Behaviour (2024). https://doi.org/10.1038/s41562-024-01979-5)
8. More generally, the Cass Review has received widespread criticism both among peak medical bodies and in peer-reviewed literature. Writing in the New England Journal of Medicine, Aaron & Konnoth (2025) note that “the Review transgresses medical law, policy, and practice”; “lacks peer review, transparency of authorship, and equitable selection of nonauthor contributors”; and contains “unacceptable departures from medical law and policy”. They note “evidence of antitransgender bias in invitations to oversee and participate in the report” and that “a third of health professionals whom the authors [of the Cass review] chose to interview agreed that ‘there is no such thing as a trans child.’” They also note that “the Review (and associated studies) misrepresented the data behind its conclusions” and “had both a high risk of bias according to the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) and a ‘substandard level of scientific rigor’”. The Cass Review was not peer-reviewed. (Daniel G. Aaron and Craig Konnoth. The Future of Gender-Affirming Care — A Law and Policy Perspective on the Cass Review. New England Journal of Medicine (2025). https://www.nejm.org/doi/full/10.1056/NEJMp2413747)
9. The Cass Review showed no evidence of harm, and justified the bulk of its recommendations with speculation. Of so-called “detransitioners”, for eg, Cass wrote “there is suggestion that numbers are increasing.” Of the supposed dangers of social transition she wrote that it “may lock in a transgender identity”. No citations for either of these claims were given. Hilary Cass theorised, again with no evidence, that porn usage may cause transness. As the UK’s Trans Safety Network said, “We believe there to be systemic biases in the ways that the review prioritises speculative and hearsay evidence to advance its own recommendations while using highly stringent evidence standards to exclude empirical and observational data on actual patients.”