The gender clinic at the Perth Children’s Hospital enables double mastectomies for its teenage female patients who identify as boys, according to an internal document the West Australian Cook Labor government tried to keep secret. The four-year-old model of care document – abruptly tabled in state parliament in November after months of refusals to disclose it – reveals that the gender clinic will connect interested under-18 patients with private surgeons for “top surgery”, or mastectomy, while stressing the “personal responsibility” of the girl and her family for the choice. The office of WA Health Minister Meredith Hammat did not reply to media requests for comment, including data on transgender surgery referrals and the clinic’s fast track to puberty blockers for very young patients. There is no accurate public data on the extent of under-18 transgender mastectomy in Australia. Knowing the very idea is strongly opposed by mainstream opinion, activists downplay it or outright deny it happens, despite this surgery being documented in Family Court rulings.
In September 2016, a year after its formal start, the Perth gender clinic had 14 legal minors – patients aged under 18 – on puberty blockers. This number rose to 71 in the same month last year, an increase of 407 per cent. These figures were obtained under Freedom of Information law; the clinic does not publish regular treatment data. On media estimates, the per capita use of puberty blockers in WA in 2024 is 19.2 cases per 100,000 in the 10-19 age group, significantly higher than the rate of 1.9 for every 100,000 at the UK Tavistock gender clinic, the world’s largest such service before its 2024 closure as a consequence of the landmark review led by British pediatrician Hilary Cass. Although the Perth Children’s Hospital gender clinic enables double mastectomies and a fast track to puberty blockers for younger minors “with a strong wish” to stop their natural puberty, the model of care is at pains to say it does not offer “extended or intensive counselling or psychotherapy”, nor formal diagnosis of autism or ADHD.
The Tavistock clinic claimed to offer a multidisciplinary approach, but Dr Cass concluded that its focus on trans identity, puberty blockers and cross-sex hormone drugs risked “overshadowing” other potential causes of gender distress among these patients, such as neurodiverse conditions or mental health issues. The 2021 WA model of care cites a low-quality anonymous online survey from the Kids Research Institute Australia, which makes the alarming claim that 48 per cent of “trans youth” will attempt suicide. The “transition or suicide” narrative has been debunked by the Cass review and robust research from Finland. In state parliament in November, Australian Christians MP Maryka Groenewald, whose requests for a copy of the model of care had been stonewalled for six months, foreshadowed a motion to compel the government to release the document. The model of care was tabled at the last minute. “What is the possible reasoning for withholding critical information on how children and young people are treated?” Ms. Groenewald asked during the debate on an amended motion critical of the government’s reluctant transparency.
She said the WA model of care was heavy on references from “advocacy groups” – meaning low-quality gender-affirming treatment guidelines and trans rights advocacy research. And she said the document was “very outdated by medical standards”, and “includes no evidence or research to justify the specific clinical practices of this model of care”. “Is it possible that perhaps the Health Minister did not know what was in these documents? Is it possible that these documents have not had the proper review and scrutiny to perhaps even revisit some of those references and that updated research?” she said. In response, Ms Hammat’s parliamentary secretary, Pierre Yang, claimed the government had resisted disclosure for “the wellbeing of patients”, implying a risk of self-harm. “The document contains clinical frameworks and treatment pathways that, if misrepresented or politicised, would cause confusion, distress and harm,” he said.
The typical “gender-affirming” treatment trajectory of early puberty blockers followed by cross-sex hormone drugs brings potential harms such as sterilisation, sexual dysfunction, cardiovascular disorders, and as yet unknown long-term disorders during a lifetime of medicalisation. The Australian can reveal that the version of the 2021 model of care tabled by the government has some legally defensive measures influenced by litigation against the London-based Tavistock clinic, which was at the heart of the Cass review. The WA government, which has not informed the public of its own legal concerns arising from detransitioner Keira Bell’s initial 2020 court victory over the Tavistock, has dismissed the Cass review as “not applicable to the WA context”. The 2020-24 Cass review was the world’s most thorough inquiry into the internationally shared evidence base for hormonal treatment of gender-distressed minors and made specific criticisms of low-quality clinical practice guidelines and a puberty blocker fast track used by Australian gender clinics.
One of WA’s most distinguished physicians, Gary Geelhoed – who served as the state’s chief medical officer and assistant director-general for the WA Department of Health – told The Australian he believed it was “unethical” for female minors to be referred for mastectomies. “They can’t possibly be consenting, because they can’t possibly be fully acknowledging what that means for their lifetime,” said Professor Geelhoed, a retired pediatrician and researcher who for 22 years ran the emergency department of the Princess Margaret Hospital for Children, which was succeeded by the Perth Children’s Hospital. “Children can’t vote, they can’t drive a car, they can’t fight for their country, they can’t do all these things, and yet they’re allowed to consent to lifelong medications and mutilating surgery. It is just wrong, really. “How does a 13-year-old understand the loss of fertility, the loss of sexual function, a shortened lifespan? There’s no way they could.”
Professor Geelhoed, who also served as WA president of the Australian Medical Association, urged the medical profession to advocate for an Australia-wide ban on puberty blockers, cross-sex hormones and surgery for gender-confused minors. He said it was “one of the worst medical scandals for a long, long time”, perhaps worse than the post-war lobotomy scandal, because gender medicalisation was affecting an exponentially increasing number of the very young around the world. “If the child thinks they’re in the wrong body, then we as doctors are supposed to go along with that. Now, I just think that is so fundamentally wrong. We don’t do that in any other area of medicine,” he said. “We know that many of these young people have other problems or challenges, like autism. Many of them are same-sex attracted and so on, which clearly makes it much more confusing trying to navigate the difficulties of puberty.” Professor Geelhoed said scientific data proving beneficial outcomes for the hormonal and surgical interventions of children’s hospital gender clinics was “sorely lacking” but the evidence of potential “lifelong harms is very real and growing”.
He said what was happening in these clinics went “under the radar” or was misunderstood by the public, who were inclined to a mistaken acceptance of these treatments because they conflated trans medicalisation with non-discrimination towards LGB people. From his many years running the emergency department at Princess Margaret Hospital for Children, Professor Geelhoed recalled very rare cases, typically pre-adolescent girls, who would turn up with “the most bizarre symptoms – you know, that they went blind, they couldn’t talk, they couldn’t move, they had extreme pain”. “And I always thought, this is just their reaction to the onset of adulthood, puberty. They want to opt out,” he said. But with support, understanding and family reassurance, “the vast majority of those symptoms would resolve in a matter of weeks”. Now, coinciding with the rise of social media, there had been an unprecedented surge in chiefly female adolescents – a group especially prone to socially adopted psychological symptoms – declaring themselves the opposite sex and seeking hormone drugs falsely said to be necessary to prevent suicide, he said.
If this “horrific” suicide narrative were true, he said, there would have been thousands and thousands of deaths among young girls “going back through the mists of time” before, say, 2010, when these hormonal treatments for minors were still vanishingly rare. And now, Professor Geelhoed said, the gender-affirming treatment model took as gospel a minor’s self-declared identity and offered an “assembly line” of medicalisation, rather than properly exploring underlying issues such as autism, family trauma or awkward same-sex attraction, he said. He said that for the government to have hidden the WA model of care from the public would have run counter to the contemporary medical practice to share such information with health consumers. WA opposition health spokeswoman Libby Mettam called for an urgent review and suspension of the 2021 gender clinic model of care, which she said was “harmful and outdated”.
“The seminal independent UK research presented in the 2024 Cass review has quickly led an international response to the treatment of child gender diversity in the UK, the US and many European countries as well as New Zealand,” she said. “They have responded to the evidence that puberty blockers administered to children can have life-altering consequences, including sterility, sexual dysfunction and a lifetime of medication dependence. “This evidence has not yet prompted our government to react.” Under the WA model of care, the treatment at the Perth Children’s Hospital gender clinic appears chiefly medical, with an emphasis on an under-18 patient’s “wish” for puberty blockers and cross-sex hormones as treatment, and an explicit disclaimer that its staff psychiatrist or clinical psychologists do not offer “extended or intensive counselling or psychotherapy”. Exploratory psychotherapy, which might lead a confused child to re-embrace his or her biological sex and healthy body, is often portrayed by trans activists as “conversion therapy” akin to the long-abandoned use of cruel aversion treatment seeking to “cure” homosexuality.
The WA model of care also states that the Perth gender clinic does not carry out formal diagnosis of autism or ADHD, both of which are potential underlying factors that may better explain a child’s gender distress or confusion than the theory of an in-born transgender identity. A 2019 study at the Perth clinic found that 18.3 per cent of a group of 104 patients showed severe autism traits on a screening measure. Under the model of care, the clinic is to “work with” minors to find “a safer option” for those who are “self-medicating with irregularly obtained hormone medication”, presumably meaning synthetic hormone drugs bought online with no prescription and potentially against the law. The document boasts of the clinic’s collaboration with Transfolk WA and other “advocacy” groups that called on the WA government last year to “reject the findings” of the Cass review. The revelations in the 13-page WA model of care undercut the Cook government’s assurances that the gender clinic follows a cautious and considered multidisciplinary model of care in which medical intervention is just one treatment option.
The Perth clinic offers an “urgent pathway” to puberty blockers for younger patients “with a strong wish” to suppress their natural development at times when demand at the clinic is high and the wait for “full assessment” may be lengthy. The rationale appears to be that for a child to progress in a normally timed puberty constitutes “disproportionate harm”. This fast-track triage system used by three Australian children’s hospital gender clinics was criticised in research commissioned by the Cass review for its lack of safety data and exposure of young patients to longer periods on potentially harmful puberty blocker drugs. The onset of puberty, the trigger for blockers, may begin as early as eight in girls and nine in boys, meaning chemical suppression of a child’s natural sex hormones at the Perth clinic may run for several years before synthetic cross-sex hormones start. Asked about the Cass review during budget estimates, Ms Hammat responded with a written answer dismissing it as UK-focused and “not applicable to the WA context”. Her answer claimed the Cass recommendations “did not address specific treatments or clinical guidelines for care”.
In fact, apart from the UK review’s specific criticism of the Australian fast track to puberty blockers, Dr Cass found that the internationally shared evidence base for puberty blockers and cross-sex hormones was “remarkably weak”. And she also commissioned a peer-reviewed evaluation of clinical guidelines around the world, including Australia’s de facto national guidelines issued by the Royal Children’s Hospital Melbourne. Those RCH guidelines, a key influence on the Perth gender clinic, were rated as low quality and not recommended for use. The version of the 2021 model of care tabled by the government followed an unpublished review of the gender clinic influenced by the English High Court’s 2020 ruling in favour of detransitioner Keira Bell, who was given puberty blockers and cross-sex hormones at the Tavistock clinic and went on to have a double mastectomy as a young adult. Some language and procedures in the WA model of care document appear calculated to protect the clinic and the state government from future lawsuits by former patients who decide medical transition was a mistake.
Under the WA document, children at the Perth gender clinic are to be given strong warnings on treatment-inflicted harm to health, such as sterilisation. Even “peri-pubertal” children as young as eight or nine and their parents are to be told – and expected to understand – “the possibility of regret related to future reduced or lost fertility” and “potential long-term adverse health consequences, unknowns, and the possibility of disappointment or regret and detransition”. The term detransition does not appear in the RCH standards. The WA model of care does not repeat the RCH document’s claim that puberty blockers are reversible, a claim still used by activists to reassure parents and the public about such early medicalisation. And the WA model acknowledges that “most” children who begin on puberty blockers will seek cross-sex hormones, although it frames this as simply a “continued wish” for hormones. There is no mention of longstanding concerns, amplified in Dr Cass’s 2024 report, that blockers may lock in gender distress that would otherwise resolve naturally and create trans-medicalised heterosexuals from children who would otherwise emerge as gay or bisexual adults.
The WA model of care tabled in parliament suggests tension between the legally defensive measures of the State Solicitor’s Office and the radical medical treatments of the gender-affirming model. On double mastectomies, listed under “Ongoing care”, the tabled WA document is careful not to create the impression that the gender clinicians themselves vouch for the private surgeons whose procedures they enable. Rather, the clinic is to provide its willing patients with details of “experienced, specialised private surgeons recommended by the local and national trans community”. And the clinic does so “while emphasising the young person and family’s personal responsibility for making an informed choice”. At a time when the female patient seeking amputation of her breasts is still in its care, the clinic also provides “documentation of gender diagnosis and treatment history to accompany GP referrals to a surgeon”. And the clinic passes on information about the girl’s “capacity to consent to surgeons when requested”. The model of care draws the line at referral to overseas surgeons.
Source: Compiled by APN from media reports
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