Former Family Court chief justice Diana Bryant has issued an extraordinary intervention in the trans medicine debate. The judge who led Australia’s Family Court when it green-lit liberalised access of puberty blockers to gender-distressed children in 2013 has revealed she now has doubts about the landmark ruling, in an extraordinary intervention into the trans medicine debate. Former Family Court chief justice Diana Bryant says it may be better for parliaments to step in now and regulate the field of pediatric gender medicine rather than rely on whatever disputes come before judges. Ms. Bryant earlier this year chaired the World Congress on Family Law and Children’s Rights in Cambridge, England, where she was struck by a presentation on teenagers, their immature brains and risky decision-making. But it was under her leadership just over a decade ago that the Family Court accepted expert evidence that puberty blockers were reversible, safe and a no-regrets option to give children time to explore their gender identity.
In the 2013 case involving a 10-year-old boy known as Jamie – who had long identified as a girl and was well advanced in male puberty – Ms. Bryant wrote the key decision abolishing the rule that, even if parents agree, court approval is necessary before a child with gender dysphoria can start on puberty blockers. This was hailed as a human right victory at a time when the transgender movement was taking off in Australia and the rest of the developed world. The Re Jamie ruling has been the law ever since. Ms Bryant, as Chief Justice, wrote the key decision. But the senior jurist has now said that the evidence of Jamie’s treating endocrinologist, “Dr G” – that blockers were fully reversible and without side-effects – did seem “misleading” and “overconfident” in hindsight. “Things have absolutely moved on since 2013,” Ms Bryant said. “So, if I were deciding the (2013 Re Jamie) case now and had the evidence that’s now becoming available, I certainly doubt that I would have come to the conclusion that we should move to the general view that (court) approval wasn’t needed for puberty blockers.”
Ms. Bryant stressed that she is talking about the principle of court approval, not the specific facts going to Jamie’s best interests at the time, nor any future case that might come to the court “with compelling evidence”. The former Family Court chief justice also said she sees a contradiction between the norms of medicine and the notion that “gender-affirming care” is child-driven. “If a child, for example, has cancer and there is to be treatment, you’d certainly hope that they’d be involved (in the decision), but it’s highly unlikely that their parents are going to give them complete autonomy to decide what to do,” she said. Linda Dessau heard the 2011 Family Court case and later went on to become governor of Victoria in 2015. When Jamie’s case first went to the Family Court in 2011, Justice Linda Dessau drew on an expert report by “Dr MW” and remarked that as puberty blockers were “fully reversible, without long-term effects on fertility, the child will be free to change her mind at a later date, when she is more cognitively able to grasp the long-term implications of the decision”.
In the ensuing 2013 appeal case, the court accepted an argument by the Australian Human Rights Commission that the risk of a child being wrongly prescribed blockers was not too serious because anonymised experts in the proceedings had asserted the drugs were “fully reversible” and had “no side-effects”. This “time to think” rationale has been discredited by international data showing that the vast majority of children started on blockers proceed to cross-sex hormones, an experimental lifelong treatment path with risks including sterility, sexual dysfunction and cardiovascular problems. At the Cambridge family law conference chaired by Ms. Bryant in July, Sallie Baxendale, professor of clinical neuropsychology at UCL, pointed out that adolescents and young adults are more prone to impulsive, peer group-pleasing decisions because of fear of social exclusion and an imbalance between the reward centres and inhibition circuits of the brain, which does not fully develop until the mid to late 20s.
Professor Baxendale got drawn into the hot-button topic of puberty blockers because she was startled to hear the implausible claim by gender clinicians that these hormone-suppression drugs, given to children as young as eight or nine, are “fully reversible”. She knew that the natural sex hormones of puberty are potentially crucial not just for secondary sex characteristics and healthy bone density but for development of the brain and its complex structure. The concern is that critical windows in cognitive development may be missed if sex hormones are blocked. Professor Baxendale’s presentation at the UK conference was just one influence on Ms Bryant’s change of position. Ms Bryant also cited the UK’s 2024 Cass report, which undermines the confident claim of beneficial outcomes by gender clinics; the unprecedented surge in chiefly female teenage patients with the possibility of peer pressure, and, concerns that a minor’s rejection of birth sex may be driven by overlooked factors such as poor mental health, autism or awkward same-sex attraction.
Ms Bryant’s rethink is significant because her written reasons in Re Jamie are the most detailed and give the clearest insight into the judicial mindset in the mid-2010s, which was the trans tipping point in Australia and the rest of the developed world. In her decision, Ms. Bryant invoked then recent changes to the federal Sex Discrimination Act – the subjective concept of gender identity unrelated to biological sex was added under Australia’s first female prime minister, Julia Gillard – as a sign that “those who are transgendered are an identifiable group in our society and their right to live as a member of the sex with which they feel compatible is to be respected”. The UK’s 2024 Cass report, which undermines the confident claim of beneficial outcomes by gender clinic, was just one influence on Ms Bryant’s change of position. The court noted that Jamie “generally presented as a very attractive young girl with blonde hair”. Rejecting the idea that an opposite-sex identity is abnormal, Ms Bryant observed in her decision.
“Once it is accepted that there is no normative state, at least not in every person, then the absolute necessity of aligning the self-identity and the physical characteristics becomes apparent.” Bryant said. Although Justice Dessau had imposed strict suppression orders in 2011, saying “it could only be damaging for Jamie to be identified”, the court waived this four years later – and Neighbours star Georgie Stone emerged as a role model for trans youth and an “ambassador” for the Royal Children’s Hospital Melbourne (RCH) gender clinic with its offer of puberty blockers and cross-sex hormones. The clinic had just begun to experience a dramatic increase in patient numbers under Dr Michelle Telfer. Stone starred in a 2016 ABC Australian Story episode entitled About A Girl, with an emotive introduction by Victoria’s then Labor premier, Dan Andrews. Alongside Dr Telfer, she appeared in publicity material for the RCH Melbourne Foundation, which has used alarming but misleading suicide statistics to raise money for the gender clinic”.
Gender clinics use puberty blockers “off-label” – without regulatory approval – to suppress the normally timed development of a child who identifies as the opposite sex or “non-binary” and is distressed at the prospect of the “wrong puberty”. Although the Family Court still supervises these medical treatment decisions for minors when parents disagree, Ms. Bryant said hormone drugs are reportedly available online beyond the control of judges and “it probably would be better” for state parliaments to codify consent rules. She said the capacity of children to give informed consent appears to have been “assumed”, rather than determined, in most of the gender dysphoria treatment cases heard by the court, which, until recently, had the reputation of always giving the green light for these contentious hormonal and surgical interventions. A pivotal moment came in April when the court’s Justice Andrew Strum dealt a series of hammer blows to the foundations of “gender-affirming care” and made orders protecting “Devin”, a 12-year-old gender-nonconforming boy, from puberty blockers at an anonymised gender service later identified as the clinic at the Royal Children’s Hospital Melbourne.
Following a public interest application by The Australian newspaper, that clinic’s former director, Dr Telfer, was identified as the anonymous “Associate Professor L” rebuked by Justice Strum for failing in her duty to give objective expert evidence to the court and for presenting a misleading account of the Cass review of gender dysphoria treatment. Justice Strum noted that Devin’s psychologist, Dr N, could not recall a single case in which puberty blockers were not given if the child and parents wanted them. Concern about puberty blockers is widespread and growing. Nordic countries have led the way with systematic evidence reviews and more cautious treatment policy since 2020. The UK has a politically bipartisan indefinite ban on routine prescription of blockers. In Australia, the National Health and Medical Research Council is due to issue interim advice on the evidence for blockers next year. And in Queensland’s public health sector, there is a pause on any new hormonal treatment pending an independent review of the evidence scheduled to report to the Crisafulli government by the end of this month.
In June, former Family Court justice Steven Strickland said it was now clear that contemporary medical evidence contradicted the position in Re Jamie 12 years ago that puberty blockers involve no risk. In that case, Justice Strickland and Mary Finn were the two other judges who handed down the full court’s 3-0 ruling in favour of freeing up access to these drugs. Caitlyn Jenner, the transgender Olympic champion formerly known as Bruce, unveiled her new name and look in a Vanity Fair cover shoot. In 2015, soon after the trans-trend moment of Annie Leibovitz shooting former male athlete Caitlyn Jenner for the cover of Vanity Fair, Dr Telfer was the go-to expert for Australian men’s magazine GQ, where she gave an upbeat, reassuring account of paediatric gender medicine. Puberty blockers, she insisted, “don’t stop growth generally, or your brain maturing emotionally and cognitively, they just stop the sexual characteristics from developing”.
Talking to RCH alumni three years later, Dr Telfer bracketed Stone’s story with Jenner and other US celebrity trans figures including Jazz Jennings, of reality TV fame, and the gender-bending children of Angelina Jolie and Brad Pitt. But some basic fact-checking would have blunted the media-amplified message of the Telfer clinic and its legal reform campaign, which began with Re Jamie and culminated in a similarly celebrated liberalisation of cross-sex hormones in 2017 case Re Kelvin. A common thread encouraging the court to trust clinicians and parents was the claim of a new-found expert consensus and advances in science favouring an early medical response to gender dysphoria. There was no treatment alternative, nothing other than callously ignoring the distress of children highly likely to harm themselves, and no clinical case for waiting – or so the judges were told by experts promoting what would euphemistically become known as “gender-affirming care”.
It is true that new research and commentary have only deepened concerns about what’s going on in gender clinics, but this doesn’t represent the unravelling of a genuine consensus that justified the Family Court’s more permissive stance on puberty blockers, cross-sex hormones and trans surgery for minors. In Re Jamie, the Human Rights Commission urged the judges to place their confidence in the “international consensus” encoded in a new 2009 treatment guideline from the US-based Endocrine Society invoked by Dr G. That document claimed blockers to be “fully reversible”. What neither the commission nor Dr G told the court was that the guideline conceded its treatment advice was based on low-quality and very low-quality evidence. It was the case that some centres around the world were at this time adopting the puberty blocker-driven “Dutch protocol”, which clinicians in the Netherlands hoped would allow “juvenile transsexuals” to pass better as the opposite sex and thereby be spared the poor mental health outcomes documented in adults, especially males, who transitioned after puberty.
But there was great doubt and disagreement about this radical new approach, which was based on one methodologically flawed study of 70 minors, and, to their credit, Dutch researchers set out to document and analyse the state of expert opinion in 2013-14. The result of their interviews with 36 health professionals in the field across 10 countries, published in 2015, highlighted seven points of profound disagreement about puberty suppression. These included the potential for harm to cognitive and brain development, the fear that early medical intervention might stop natural resolution of gender dysphoria, the risk of wrong treatment decisions, and doubts about the capacity of children to consent. “As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment,” said the authors, among them psychologist Peggy Cohen-Kettenis, the Dutch protocol pioneer.
Sex Discrimination Commissioner Anna Cody argued that Queensland’s pause in puberty blockers, not the drugs themselves, could ‘harm the physical and mental wellbeing of children’. Two attempts, in the UK and US, to replicate the original 2011 Dutch finding that puberty blockers brought mental health benefits both failed. The image of a new scientific consensus presented to Australia’s Family Court judges has proved to be a mirage. In Australia, where RCH Melbourne has arguably sponsored a more aggressive medicalised approach than the original Dutch protocol, we are still waiting for longitudinal data on local treatment outcomes, which six years ago RCH researchers said was “urgently needed”. In 2022, the Melbourne clinic acknowledged that the effects of puberty blockers on the still-developing adolescent brain are in fact unknown. But this belated advice was issued in a newsletter to patients and parents, without any public explanation.
In the same opaque manner, the clinic late last year quietly abandoned the long-unqualified claim on its website that puberty blockers “are reversible in their effects”. The claim now is that blockers are “largely reversible”. Which aspects are reversible, which are not? The website has nothing to add. Yet the clinic’s treatment guideline – the de facto national standards of care developed in part to assure the Family Court that judicial oversight could safely be wound back – still asserts the unqualified reversibility of these drugs. Page three of this document shows a glamorous photo of Stone as the clinic’s ambassador. Earlier this year, Sex Discrimination Commissioner Anna Cody argued that Queensland’s pause in puberty blockers – not the drugs themselves – could “harm the physical and mental wellbeing of children”. Asked if the commission stood by its Re Jamie position that blockers are reversible, a spokeswoman said: “The evidence at first instance, accepted by the primary judge (Dessau), was that the suppression of puberty as a result of taking (the puberty blocker) Zoladex lasts only while it is being given.” The commission did not reply when asked about RCH quietly backtracking on its once confident claims about puberty blockers.
Source: Compiled by APN from media reports