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Young people’s access to gender-affirming medical care has been making headlines this week.

Today, federal Health Minister Mark Butler announced a review into health care for trans and gender-diverse children and adolescents. The National Health and Medical Research Council will conduct the review.

Yesterday, The Australian published an open letter to Prime Minister Anthony Albanese calling for a federal inquiry, and a nationwide pause on puberty blockers and hormone therapy for minors.

This followed Queensland Health Minister Tim Nicholls earlier this week announcing an immediate pause on access to puberty blockers and hormone therapies for new patients under 18 in the state’s public health system, pending a review.

In the United States, President Donald Trump signed an executive order this week directing federal agencies to restrict access to gender-affirming care for anyone under 19.

This recent wave of political attention might imply gender-affirming care for young people is risky, controversial, perhaps even new.

But Australian courts have already extensively tested questions about its legitimacy, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.

What are puberty blockers?

Puberty blockers suppress the release of oestrogen and testosterone, which are primarily responsible for the physical changes associated with puberty. They are generally safe and used in paediatric medicine for various conditions, including precocious (early) puberty, hormone disorders and some hormone-sensitive cancers.

International and domestic standards of care state that puberty blockers are reversible, non-harmful, and can prevent young people from experiencing the distress of undergoing a puberty that does not align with their gender identity. They also give young people time to develop the maturity needed to make informed decisions about more permanent medical interventions further down the line.

Puberty blockers are one type of gender-affirming care. This care includes medical, psychological and social interventions to support transgender, gender-diverse and, in some cases, intersex people.

Young people in Australia need a medical diagnosis of gender dysphoria to receive this care. Gender dysphoria is defined as the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth. This diagnosis is only granted after an exhaustive and often onerous medical assessment.

After a diagnosis, treatment may involve hormones such as oestrogen or testosterone and/or puberty-blocking medications.

Hormone therapies involving oestrogen and testosterone are only prescribed in Australia once a young person has been deemed capable of giving informed consent, usually around the age of 16. For puberty blockers, parents can consent at a younger age.

In the United States, President Donald Trump signed an executive order this week directing federal agencies to restrict access to gender-affirming care for anyone under 19.

This recent wave of political attention might imply gender-affirming care for young people is risky, controversial, perhaps even new.

But Australian courts have already extensively tested questions about its legitimacy, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.

What are puberty blockers?

Puberty blockers suppress the release of oestrogen and testosterone, which are primarily responsible for the physical changes associated with puberty. They are generally safe and used in paediatric medicine for various conditions, including precocious (early) puberty, hormone disorders and some hormone-sensitive cancers.

International and domestic standards of care state that puberty blockers are reversible, non-harmful, and can prevent young people from experiencing the distress of undergoing a puberty that does not align with their gender identity. They also give young people time to develop the maturity needed to make informed decisions about more permanent medical interventions further down the line.

Puberty blockers are one type of gender-affirming care. This care includes medical, psychological and social interventions to support transgender, gender-diverse and, in some cases, intersex people.

Young people in Australia need a medical diagnosis of gender dysphoria to receive this care. Gender dysphoria is defined as the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth. This diagnosis is only granted after an exhaustive and often onerous medical assessment.

After a diagnosis, treatment may involve hormones such as oestrogen or testosterone and/or puberty-blocking medications.

Hormone therapies involving oestrogen and testosterone are only prescribed in Australia once a young person has been deemed capable of giving informed consent, usually around the age of 16. For puberty blockers, parents can consent at a younger age.

Can a child legally access puberty blockers?

Gender-affirming care has been the subject of extensive debate in the Family Court of Australia (now the Federal Circuit and Family Court).

Between 2004 and 2017, every minor who wanted to access gender-affirming care had to apply for a judge to approve it. However, medical professionals, human rights organisations and some judges condemned this process.

In research for my forthcoming book, I found the Family Court has heard at least 99 cases about a young person’s gender-affirming care since 2004. Across these cases, the court examined the potential risks of gender-affirming treatment and considered whether parents should have the authority to consent on their child’s behalf.

When determining whether parents can consent to a particular medical procedure for their child, the court must consider whether the treatment is “therapeutic” and whether there is a significant risk of a wrong decision being made.

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