Overview

Three linked developments put Australia's youth gender services under scrutiny between 2023 and 2026. In Queensland, child and adolescent psychiatrist Dr Jillian Spencer was stood down in April 2023 after criticising the gender-affirming model used at the Queensland Children's Hospital, and the dispute ended in a confidential settlement in July 2026. In January 2025 the Queensland government paused new puberty blocker and hormone treatment for under-18s in public hospitals. After an independent review, a Supreme Court defeat and a ministerial direction, that pause now runs until results from the UK's PATHWAYS trial of puberty blockers are available, expected around 2031. In Victoria, an April 2025 Family Court judgment, Re Devin, sharply criticised expert evidence given by Dr Michelle Telfer, a senior paediatrician at the Royal Children's Hospital Melbourne (RCH) and lead author of Australia's national treatment guideline. Nationally, the federal government asked the National Health and Medical Research Council (NHMRC) in January 2025 to write new guidelines. Interim advice on puberty blockers is scheduled for public consultation in November–December 2026.

This page is part of the gender medicine scandals hub. For the international evidence picture see evidence reviews. For how other countries regulate youth transition see law around the world. For the drugs themselves see puberty blockers.

Background

Australia's public youth gender services are run by the states and territories. The largest are the RCH Gender Service in Melbourne, which describes itself as a Victorian statewide service, and the Queensland Children's Gender Service (QCGS) in Brisbane, which opened in 2017. Since 2018 clinical practice has followed the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (ASOCTG), written at the RCH with Dr Telfer as first author. They endorse a gender-affirming approach. Under the 2017 Family Court decision Re Kelvin, parents no longer need court approval for hormone treatment when parents and doctors agree. Courts still decide when parents disagree, and Re Devin was one of those cases.

Demand rose sharply. In mid-2024 an external evaluation commissioned by Children's Health Queensland (CHQ) reported that the QCGS had 547 children and adolescents in active care and 491 more on the waitlist. Median waits for the lowest-priority referrals were 577 days (CHQ External Clinical Service Evaluation 2024).

Australia's caution came later than several European countries'. England's Cass Review (2024), and earlier changes in Finland, Sweden and Norway, concluded that the evidence for medical transition in minors was weak. Queensland's own January 2025 announcement cited these countries. The Tavistock GIDS (England's former national youth gender clinic) and Karolinska pages cover those cases.

What was alleged and revealed

Jillian Spencer and the Queensland Children's Hospital

Dr Spencer was a senior staff specialist psychiatrist at the Queensland Children's Hospital. She did not work in the gender clinic. She raised concerns internally about the clinic's assessments and treatment model, then spoke publicly. The Australian Broadcasting Corporation (ABC) reported that she was suspended in April 2023 after criticising the service over its use of puberty blockers and cross-sex hormones (ABC 2026). Medical trade outlet AusDoc reported that she was stood down after a transgender patient reportedly accused her of transphobia, and that the hospital began misconduct proceedings (AusDoc 2026). The hospital's specific allegations were never published, and this page does not try to reconstruct them.

In September 2025 Queensland Health issued her a termination notice. She challenged it by judicial review in the Supreme Court, and the dismissal was put on hold. A separate political-discrimination claim was run in the Queensland Industrial Relations Commission by the Human Rights Law Alliance, a Christian legal advocacy group (HRLA 2025). She also faced notifications to the health regulator Ahpra over her social media posts. LGBTQ+ outlet Star Observer reported one in April 2026, based on a complaint that a post "criticised gender affirming care and encouraged followers to petition against it" (Star Observer 2026).

Dr Spencer also co-wrote a peer-reviewed critique of the 2024 QCGS external evaluation. It argued that the evaluation should have asked whether the service's model and treatments were "safe and appropriate", and that it ignored the Cass Review's evidence findings (Spencer, Amos & Clarke 2025). The evaluation itself had found clinical practice "consistent with the current national and international guidelines" and "no evidence of children, adolescents or their families being hurried or coerced" (CHQ 2024). Each side read the other as having avoided the central question.

The Cairns service and the January 2025 pause

On 28 January 2025 Health Minister Tim Nicholls announced an immediate pause on new patients under 18 starting puberty blockers (Stage 1) or cross-sex hormones (Stage 2) in Queensland public hospitals. Patients already on treatment could continue. He also announced an independent evidence review. The trigger was clinical governance concerns at the Cairns Sexual Health Service, and the minister said there was "contested evidence surrounding the benefits" of these treatments (Queensland Government 2025).

The Cairns investigation reported in February 2026. It found that the service had treated under-18s for gender dysphoria "from at least 2008" without ever being formally established or overseen by the hospital board. It found that clinical governance put "access … over safety", that it was "undermined by a negative patient safety culture", and that incident reporting and audit were "either absent or inconsistently applied" (Queensland Health investigation report 2026). The ABC's summary of the attached clinical review reported that treatment in some cases began before formal consent was obtained (ABC 2026). Queensland Health accepted all 21 recommendations "in principle" and referred concerns about individual clinicians to the Office of the Health Ombudsman (Director-General response 2026).

The Vine review

The review was led by psychiatrist Professor Ruth Vine with a seven-member panel and released on 19 December 2025 (Queensland Health). Its terms of reference asked for advice, not recommendations. On the evidence, the panel agreed "with the near consensus among international reviews that the evidence base … is limited". It also found ("PB" and "GAHT" are the review's abbreviations for puberty blockers and gender-affirming hormone therapy):

• "low quality preliminary evidence increasingly suggests" that blockers and hormones, "when used appropriately", can relieve gender dysphoric distress;
• "there is evidence that PB impact bone health in the short to medium term";
• "there is evidence that fertility is negatively impacted by GAHT";
• "there is a paucity of evidence about other long term risks or benefits" (Vine review 2025).

The panel set out three options. Option 1 was no initiation of treatment in the public system. Option 2 was a return to the QCGS's pre-pause practice. Option 3 was treatment within a statewide public system with "compliance-based oversight and monitoring". It concluded that "no overall positive risk-benefit decision" could be made for every young person, and it flagged Option 1's risks, including treatment "outside the specialist multidisciplinary teams" and inequity by income or location. If treatment continued, it said a DSM-5-TR diagnosis should be required, blockers should start only at Tanner stage 2 (the first physical signs of puberty) or later "where co-occurring problems that may be contributing to distress have been addressed", and a national clinical registry should be set up.

Re Devin and the Royal Children's Hospital

Re Devin [2025] FedCFamC1F 211 was a parenting dispute. The mother wanted her son, then 11, to start puberty blockers at the RCH Gender Service. The father opposed it. Justice Andrew Strum of the Federal Circuit and Family Court ruled against the treatment in April 2025. The parties and witnesses were initially given pseudonyms. On 5 June 2025, on an application by The Australian's publisher Nationwide News, the judge allowed the hospital and Dr Telfer (pseudonymised as "Associate Professor L") to be named (Gender Clinic News 2025).

The reported findings include:

• On the child's capacity. As quoted in the Vine review, the judge wrote: "I am not satisfied on the evidence that no matter how mature this 11-year-old child (or, indeed, any 11 year-old-child) might be, such a child could properly discuss, and understand, the ramifications of treatment with puberty blocker" (Vine review 2025, Schedule 6, p. 197).
• On diagnosis and risk. A law blog reproduces paragraph [131]: the court "was not satisfied that the mother had proved, on the balance of probabilities, that the child is, in fact, gender incongruent or gender dysphoric". It also reproduces part of paragraph [187]: the judge was "not satisfied that … the purported benefits of puberty blockers outweigh the identified risks thereof" (Maddens 2025). The Australian reported that the RCH did not give the child a formal diagnosis until the proceedings had begun, despite treating him for six years (as reproduced by Daily Declaration 2025, Christian outlet).
• On the guideline. As reported by The Australian, the judge wrote: "It is concerning that an oddly binary approach is adopted in relation to children … to affirm unreservedly those who present with concerns regarding their gender, brooking no questioning thereof" (reproduced by Feminist Legal Clinic, gender-critical). The same report said he "did not offer general comment on the treatment model adopted by the RCH" but considered its impact on this child relevant.
• On Dr Telfer's evidence. Gender Clinic News, a newsletter critical of youth gender medicine, reported that the judge criticised her for letting her self-described role as an "advocate for trans rights" override her duty as an expert witness. He agreed with the Independent Children's Lawyer that her commentary on the Cass Review "was misleading or omitted findings/material that detracted from her opinion". He also found she could not "point to any empirical or substantive basis" for her view that a child's gender identity is immutable (Gender Clinic News 2025). She had linked scrutiny of youth gender medicine to a history of persecution beginning with the Nazis. The judge said that comparison had "no place whatsoever in the independent evidence that should be expected of such an expert" (as reproduced by Daily Declaration 2025).
• Orders. The father was given sole parental responsibility (Peleg 2025), and the child was not to be seen at the gender clinic (summarised by Society for Evidence-Based Gender Medicine (SEGM) 2025, gender-critical evidence group).

Sources differ on some details. Most outlets give the child's age as 12, which was his age by the June naming ruling, while the judgment as quoted by the Vine review refers to "this 11-year-old child". Advocacy summaries also describe the evidence list at paragraph [178] (sterility, loss of sexual function and so on) in their own words. We have not reproduced that list here because we could not check it against the judgment.

Responses

Children's Health Queensland. Its settlement statement of 17 July 2026 said the parties had been in dispute "since 2022". It acknowledged that "these are matters of legitimate professional and public debate". It stated that "CHQ HHS accepts that Dr Spencer's concerns were grounded in her training and background as an experienced child and adolescent psychiatrist", and that "health practitioners must take a clinical approach … that focuses on the best available research and the child's best interests rather than directing a child down a pre-determined treatment pathway". It confirmed that "all disciplinary proceedings against Dr Spencer have been discontinued", that her employment had ended, and that the terms are confidential (CHQ statement 2026). The statement neither admitted nor denied any specific allegation from 2023.

Dr Spencer. She told the ABC she felt "vindicated" and that she "never did anything wrong by speaking out" (ABC 2026).

Queensland Government. When it released the Vine review, the government kept the pause "until 2031" pending the PATHWAYS trial. The minister cited the review's finding that "there is a paucity of evidence about other long-term risks or benefits" (Queensland Government 2025). The Director-General's February 2026 response describes the pause as "pending review by 2032" (Director-General response 2026). The two official documents give different end years.

Royal Children's Hospital. About a week after Dr Telfer was named, the RCH issued a statement calling her "a highly respected paediatrician, expert in adolescent medicine, and fierce advocate for the health and wellbeing of all children and young people" (as quoted by Gender Clinic News 2025). Its Gender Service page states that it "always has and will continue to support an evidence-based approach" and that it continues to see new referrals (RCH). We found no public statement from Dr Telfer about the judgment.

Federal Government. On 31 January 2025, Health Minister Mark Butler asked the NHMRC to "undertake a comprehensive review" of the ASOCTG "and to develop new national guidelines" (Butler 2025).

Investigations, legal and regulatory outcomes

In AB, Justice Callaghan stressed that the case did "not involve any review of the directive's merits". He found that the Director-General had in effect issued the directive for the minister: "Section 44 of that statute gives the Minister direct power to issue directives. He may not do so indirectly, through the chief executive's use of s 47. That is, essentially, what happened here." He added that "the Minister could not have been more open about his intentions" (AB v Chief Executive of Queensland Health [2025] QSC 277, [6], [70], [72]). The minister then used that direct power. The outcome of the December 2025 "new patient" application is not reported in the sources we found.

The Daily Declaration, a Christian outlet, reported in July 2026 that Ahpra had told Dr Spencer it was taking "no further action" on its investigation of her posts (Daily Declaration 2026). We could not confirm this from an Ahpra source.

The NHMRC process. As of October 2026 the NHMRC timetable runs as follows: interim advice on puberty suppressants drafted February–October 2026, public consultation November–December 2026, full draft guidelines for consultation September–November 2027, and final guidelines in April 2028. The NHMRC says the guidelines follow the GRADE method (the standard system for rating how certain evidence is) and that the timeline is "subject to change" (NHMRC). This is later than the minister's original estimate of "the middle of 2026" for the interim advice. The ABC reported that the federal guidelines "will likely not have the power to override state decisions" (ABC 2026).

Significance and wider impact

• First Australian state to pause. Queensland was the first Australian jurisdiction to stop starting minors on blockers and hormones in its public system. It tied the length of the pause to a randomised trial abroad rather than to a domestic review.
• Two reviews, different readings. The 2024 QCGS evaluation found the service consistent with guidelines and found no coercion. The 2026 Cairns investigation found serious governance failures at a regional service. The 2025 Vine review agreed the evidence was limited but advised against a blanket ban. Supporters and critics of the pause each draw on different parts of this record.
• The national guideline was questioned in court. The Australian described Re Devin as the first time a sitting judge had directly questioned the ASOCTG. The Vine review notes that Re Devin and an earlier case, Re Ash, "came to very different conclusions" about hormone treatment. It says the two cases show "how evidence may be differently presented and accepted/rejected".
• Whistleblower protection. The Spencer case is one of several in which a clinician who questioned youth gender medicine faced discipline. Compare Jamie Reed at the WashU Transgender Center and the GIDS staff. Exploratory approaches are discussed on the gender-exploratory therapy page.

Criticisms of how the case has been framed

Of the Queensland pause. The Sex Discrimination Commissioner, Dr Anna Cody, said the government was "ignoring the findings of their own review", which "does not recommend a blanket ban". She said Stage 1 and 2 treatments are "supported by Australia's leading medical bodies, including the Australian Medical Association, AusPATH" (the Australian Professional Association for Trans Health) (Australian Human Rights Commission 2025). Opposition health spokesperson Shannon Fentiman called the extension ideological, and Parents of Trans Kids Speak Out said families would face hardship (ABC 2025). The Vine review itself warned that a public-system ban could push treatment into private or interstate settings "without state mandated safety standards". The pause does not apply to private practice.

Of Re Devin. Associate Professor Noam Peleg of the University of New South Wales's Australian Human Rights Institute argued that the judgment gave "no weight" to the child's wishes and reflected an "anti-gender and anti-children's rights ideology" (Peleg 2025). In Medical Republic, a GP (general practitioner) disputed parts of the judge's medical reasoning (Medical Republic 2025). Family Court judgments decide one child's best interests and do not rule on a treatment model in general. The judge said as much: "This is a case about a child … not one about the cause of transgender people" (para [382], via Maddens 2025). According to Gender Clinic News, Ahpra found Dr Telfer to be "meeting accepted standards of practice" (Gender Clinic News 2025). Much of the most detailed coverage of the judgment came from outlets and groups that campaign against youth transition. Readers should weigh that.

Of the Spencer case. Most coverage of the settlement came from Christian and gender-critical outlets, which present it as vindication. The settlement terms are confidential. The CHQ statement accepts that her concerns were professionally grounded, but it does not say the 2023 allegations were false or that the gender service acted wrongly.

What detransitioners say

Few r/detrans posts mention specific Australian clinics, so this section uses Australian commenters where they say they are in Australia. These are individual accounts. They do not describe any particular service. Across ~3,100 r/detrans stories analysed by detrans.ai, 57% of those with a known age began transitioning before 18 (n = 1,089). The sample is self-selected and coded by AI (detrans.ai stats).

Some Australian commenters describe a fast route through youth care:

Puberty blockers at 14, testosterone at 15, and top surgery at 17.

Australia. —dogyuck, detrans female

Another commenter, who was about 24 at the time and so an adult, describes the kind of minimal assessment the Cairns investigation found in its own records:

…for me in Australia, I had a brief intake with a nurse or something, I expressed pretty clearly that I wasn't intending on being on T for more than a year or two … and he and the prescribing doctor I saw the same day were both like immediately yep totally here you go (after a blood test)!!! … thinking back it's really crazy that no one paused to think like hey maybe this person should talk to someone first to make sure? —Melodic-Hyena-5375, detrans female

The Vine review and the CHQ settlement both stress that co-occurring problems should be assessed before medical treatment. Commenters elsewhere describe what happened when they were not. This commenter does not say which country she was in:

I was so worried that they would be concerned about the fact that I was literally testifying in court against someone who raped me, had an eating disorder, had a history of depression and suicide attempts, had severe lifelong anxiety and panic attacks but they weren't concerned about these things at all. —Admirable_Treacle_97, detrans female

Some Australian detransitioners describe cost and isolation afterwards:

I've talked to my GP about it and he said that it's basically impossible to get it covered by Medicare because it was considered an elective surgery. —cinder_garden, detrans female

I think I'm missing that connection with people in my life that are from Australia, because I know 0 other detrans Aussies. It feels isolating and I feel quite alone not knowing anyone else going through this. —cinder_garden, detrans female

Others describe being glad a clinician made them wait, which is the approach Dr Spencer argued for:

That was exactly the point of my therapist back in 2013. I am so grateful for making me wait and address my mental health first. —meteorpuppy, desisted female

For support options in Australia and elsewhere, see the support directory. Related experiences are collected under transition regret and informed consent critique.

Trans perspectives

Trans commenters in Australia mostly describe the Queensland pause as a loss of access. Many point out that it covers only public hospitals:

As others have said, the QLD HRT for minors ban only affects the public system and not private practice (which may include GPs), nor does it affect other states that offer telehealth. —Bedrock2375, trans woman (MTF)

Others describe long waits before the pause:

Basically here in Australia you will be on wait lists and appointments for a year to a year and a half (With maple leaf house nsw atleast) and if your a minor with unsupportive parents you're fucked. —Ashtxns, trans man (FTM)

These accounts support the Vine review's warning that a public ban can move treatment into less-regulated settings. Supporters of the pause would answer that the Cairns findings show what weak oversight looks like inside the public system. For trans young people who are content with their care, the Queensland pause does not affect treatment already under way.

Related pages

• Gender medicine scandals and whistleblowers
• Evidence reviews
• Puberty blockers
• Law around the world
• Tavistock GIDS and Keira Bell v Tavistock
• Fertility harms
• Backlash against detransitioners
• Study archive

References

• AB v Chief Executive of Queensland Health [2025] QSC 277 (28 October 2025). Supreme Court of Queensland.
• Re Devin [2025] FedCFamC1F 211 (Federal Circuit and Family Court of Australia, April 2025). Published on AustLII; not directly accessed. Quoted via the sources below.
• Queensland Government (2025). Media statement: Independent Review into puberty blockers (28 January 2025). source.
• Queensland Government (2025). Independent Review into puberty blockers released (19 December 2025). source.
• Vine R et al. (2025). Independent review of Stage 1 and Stage 2 hormone therapies in Queensland's public paediatric gender services: Advice Report. Queensland Health. report; review page.
• Queensland Health (2026). Health Service Investigation into Paediatric Gender Health Services at Cairns and Hinterland HHS: final report. source.
• Rosengren D (2026). Response to recommendations from the investigation into paediatric gender services, Cairns and Hinterland HHS (12 February 2026). source.
• Children's Health Queensland (2024). Queensland Children's Gender Service – External Clinical Service Evaluation. source.
• Children's Health Queensland (2026). Statement from Children's Health Queensland Hospital and Health Service (17 July 2026). source.
• Spencer J, Amos AJ, Clarke PHJ (2025). Recommendations of the Queensland children's gender service external evaluation and their implications for health policy in Australia. Australasian Psychiatry 33(2):265–272. doi.
• Butler M (2025). Health care for trans and gender diverse Australian children and adolescents (31 January 2025). source.
• NHMRC (2026). National clinical practice guidelines for the care of trans and gender diverse people under 18 with gender dysphoria. overview; timeline.
• Australian Human Rights Commission (2025). Concerns Queensland's call on gender-affirming healthcare will cause harm and distress (19 December 2025). source.
• Royal Children's Hospital Melbourne. Gender Service (update February 2025). source.
• Cass H (2024). Independent review of gender identity services for children and young people: Final report. study page.
• ABC News (2025–2026): minister reinstates ban; fresh legal challenge; pause to continue; Cairns review; Spencer settlement; national guidelines.
• AusDoc (2026). Hospital bosses drop misconduct claims against Dr Jillian Spencer. source.
• Star Observer (2026). Dismissed psychiatrist Jillian Spencer under investigation by health regulator over social media posts (LGBTQ+ outlet). source.
• Lane B (2025). Top gender doctor faces complaint; Unequal verdicts. Gender Clinic News (critical of youth gender medicine). source; source.
• Peleg N (2025). Trans healthcare decisions denote concerning anti-children's rights ideology. Australian Human Rights Institute, UNSW. source.
• Medical Republic (2025). Two views: puberty blockers. Part 1: A judge and gender-affirming care. source.
• Maddens B (2025). Medical: Gender incongruence / dysphoria & best interests of the child (law blog reproducing judgment paragraphs). source.
• Partisan or advocacy sources used for specific attributed details: Feminist Legal Clinic and LGB Alliance Australia (gender-critical; FLC, LGBA); SEGM (gender-critical evidence group; digest); Daily Declaration (Christian; 2025, 2026); Human Rights Law Alliance (Christian legal advocacy; source); QNews (LGBTQ outlet; source).
• detrans.ai (2026). Detransition statistics from /r/detrans stories. stats page.