Damning review of Australian gender clinic: 12-year-olds given puberty blockers without proper assessment

A long-awaited review of the paediatric gender clinic in Cairns, Australia, describes precisely the kind of shortcomings that critics of the affirmative treatment model have been warning about for years: children given puberty blockers without proper assessment, patient files lacking consent documentation, and a culture in which access to treatment took precedence over safety. Commissioned by Queensland Health Director-General David Rosengren and published after more than a year of investigation, the 213-page report refers to a “negative patient safety culture” within the service.

Twelve-year-olds without proper assessment

The investigation found that children as young as twelve were prescribed puberty blockers without an appropriate assessment beforehand. Staff reported that young people with developmental impairments were given medication “despite lacking the capacity to understand treatment information”. In some cases, patients went from an initial psychological consultation to hormone treatment within just a few weeks, without a clear protocol for family involvement or education. Whether a child can understand the implications of such treatment is the subject of an article on informed consent at puberteitsblokkers.nl.

Files without consent, medication outside guidelines

A December 2024 sample of seventeen patient files revealed “major deficiencies”: incomplete notes, missing test results, no consent documentation, and little input from mental health professionals. In May 2024, a clinician reported that staff had attempted to prescribe the puberty blocker Lucrin outside the state guidelines—the pharmacy refused to dispense it. Only two months later did it become mandatory for every child to be assessed first by the Queensland Children’s Gender Service in Brisbane before puberty blockers could be started.

Earlier warning signs ignored

As early as 2018, anecdotal reports emerged of misdiagnoses—gender dysphoria being diagnosed when the underlying issue was actually mental health problems—but these warning signs were never escalated or investigated. The review also describes administrative instability, a culture of fear among staff, poor communication, and clinical duties being delegated to non-clinical staff who lacked the expertise required to provide hormone treatment to children and adolescents.

21 recommendations: stop self-diagnosing

The report makes 21 recommendations, including that the Cairns clinic stop assessing and diagnosing gender dysphoria in patients under eighteen on its own. It also recommends an audit of all patients with gender dysphoria who were under eighteen between 2018 and 2021. Specific complaints have been referred to the state’s Health Ombudsman, and Rosengren said he accepted the recommendations “in principle”.

The case does not stand alone: the pause Queensland introduced in early 2025, coinciding with the start of this investigation, on new puberty blockers and cross-sex hormones for minors remains in effect. The article on gender care in Australia describes this shift in policy at state level; at the federal level, a national review of the puberty blocker guidelines is also under way. Like the United Kingdom following the Cass Review, Queensland is awaiting the outcome of long-term follow-up research—including a British study whose results are not expected before 2031.