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Gender care in Australia
Australia has long been, together with the Netherlands, one of the most explicitly gender-affirmative countries in paediatric gender care. Since 2024 that picture is shifting. Queensland suspended new referrals for puberty blockers and hormones for minors in 2025 pending the completion of a national review. The New South Wales health service has announced its own evaluation, and the Australian Government Department of Health began a national review at the end of 2024, led by the National Health and Medical Research Council (NHMRC). The Cass Review has thereby found a clear echo in Australia too.
Historical context: Family Court case law
Until 2013 judicial approval was required in Australia for both puberty blockers ("Stage 1") and cross-sex hormones ("Stage 2") in minors — a unique system that grew out of the Re Jamie case. In 2017 the Full Court of the Family Court ruled in Re Kelvin that judicial approval for cross-sex hormones is no longer required when the young person, parents and care providers agree. That simplified the pathway and led to a sharp rise in the number of referrals.
Royal Children's Hospital Melbourne
The Royal Children's Hospital (RCH) in Melbourne developed the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (2018) and has been a leading centre for years. The RCH guideline explicitly embraces the gender-affirmative model and is followed by many Australian clinics. Since 2023, however, the guideline has been under pressure: critics within Australia point out that the RCH approach is at odds with the Northern European reorientation and with the findings of the Cass Review.
The change of course in Queensland (2025)
Queensland Health published the outcome of an internal evaluation of the Queensland Children's Gender Service in Brisbane in 2024. The evaluation was critical: diagnostic standards had not been consistently applied, co-morbid problems were insufficiently investigated and the informed consent procedure fell short. In early 2025 the state of Queensland suspended new referrals for puberty blockers and cross-sex hormones for minors pending the completion of a national review. It is thereby the first Australian state to effectively adopt the Cass recommendations.
Other states
As in the US, considerable variation by state exists in Australia. New South Wales announced its own review of its paediatric gender care in 2024. South Australia has taken restrictive measures. Victoria and the capital Canberra (ACT) still follow the older RCH model with broadly accessible gender-affirmative care.
National review (NHMRC, 2024-)
The Australian federal government announced a national evaluation at the end of 2024 via the National Health and Medical Research Council. The NHMRC is working on new national guidelines for paediatric gender care, with input from systematic evidence reviews and consultation with patients, parents, clinicians and detransitioners. The outcome is expected in 2026 and is expected to replace the old RCH guideline.
Critical voices from the Australian profession
A growing number of Australian paediatricians, psychiatrists and endocrinologists — united among others in the Society for Evidence-based Gender Medicine (SEGM) and the National Association of Practising Psychiatrists — have publicly advocated a more cautious, evidence-based approach. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) published a statement in 2021 in which restraint and the necessity of extensive differential diagnostics were emphasised — a strikingly different position from the affirmative main line in other Australian professional organisations.