Puberty blockers paused in one state
Queensland has put a temporary hold on children accessing puberty blockers after concerns were raised over a young child accessing the service.
Health minister Tim Nicholls confirmed an independent review into puberty blockers will be carried out after a 12-year-old was prescribe a puberty blocker by the Cairns Sexual Health Service in May 2024.
Mr Nicholls said there were concerns with clinical decision making, including the lack of multidisciplinary consultation, which must be held for all young people 14 years and under who seek to commence treatment with puberty blockers as best practice.
A preliminary review found the service of Stage 1 hormone therapy, known as puberty blockers, and Stage 2 hormone therapy, known as gender affirming hormones, were being administered in a way that might not have a aligned with Australian guidelines.
'The Cairns Sexual Health Service delivered an apparently unauthorised pediatric gender service without an agreed model of care,' Mr Nicholls said.
'The service was delivered to 42 pediatric gender services clients, 17 of whom were prescribed Stage 1 or Stage 2 hormone therapy.
'A recent internal review undertaken of the CSHS identified deficiencies relating to credentialing and scope of practice and medico legal concerns relating to patient and parental consent.
'Clinical variation and delay was identified, including delayed blood tests or bone mineral density tests in some patients.
'The client records did not meet minimum standards for documentation around multidisciplinary team discussions or consensus. 'Reference to fertility discussions and referral to private fertility specialists was inconsistent.
'In short, assessment, diagnosis and treatment may not have aligned with Australian treatment guidelines.'
The clinic was ordered to suspend any intake of clients under the age of 18 in November.
The government confirmed on Tuesday it the clinic will now be subjected to an investigation and further clinical review, after it received advice regarding the next steps to be taken in relation to disclosure to patients and families regarding consent matters and clinical concerns.
'The Part 6 clinical review will focus on the health services delivered to patients through the service,' Mr Nicholls said.
'It's critical that children and adolescents with gender dysphoria receive appropriate diagnosis, care and treatment.
'The Part 9 health service investigation will examine the governance framework and pathways of clinical care processes for paediatric gender services.
'The findings of the investigation and clinical review will be used in the assessment of pediatric gender services across Queensland, not just for the Cairns and Hinterland HHS.'
Equality Australia CEO Anna Brown said the decision to put a pause on hormone treatment would be detrimental to the health of young people.
'This will be catastrophic for young trans people and their families when the evidence on the benefits of hormone treatments is clear and well established,' Ms Brown said.
'This move is at odds with the current evidence base, expert consensus, health services in all other Australian states and territories and the majority of clinical guidelines around the world.
'Only last year a review in Queensland found that practices in the state's gender clinics were safe and evidence based, recommending increased funding and capacity to reach regional areas.
'Governments should stay out of these deeply personal decisions and leave it to young people, their parents and the expert doctors treating them.'
The service has had 547 children and adolescents actively receiving care as of June 2024.
Mr Nicholls said the review will assist in ensuring the correct medical support is given to children across the state.
'There is contested evidence surrounding the benefits of Stage 1 and Stage 2 hormone therapy for children and adolescents with gender dysphoria emerging from studies throughout the world,' he said.
'France, Finland, Norway, Denmark and Sweden have all tightened regulations around prescribing hormone therapy to children and adolescents.
'More recently, the Government of the United Kingdom has changed legislation to restrict the prescription and supply of puberty blockers to children.
'The Queensland Government has already announced on 4 January 2025 that it does not support expansion of the Queensland Children's Gender Service (QCGS) and it has paused further delivery of the evaluation recommendations, pending further consideration by government.
'Queensland has not yet undertaken its own review of the evidence for Stage 1 and Stage 2 hormone therapy.
'There is a need to maintain confidence in public health services, particularly those delivered by Queensland Health for children.
'The Director-General will also issue a Health Service Directive to pause the intake of new patients under the age of 18 years for Stage 1 and Stage 2 hormone therapy in Queensland Health facilities.
'Patients who are already on a treatment plan with QCGS would be exempt, similar to the steps implemented in the UK.'
But Australian Professional Association for Trans Health (AusPATH) chief executive Eloise Brook said medical practitioners followed guidelines established through research and clinical evidence to ensure clients receive the best care.
'Hormone treatments for the small number of young people who need them are essential health care,' she said.
'The evidence shows that denying access to this care will cause young people immeasurable trauma, contributing to depression, anxiety and in some cases self-harm.'
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