Letter sent to Dr Arya on the 22.12.25
Dear Dr Dinesh Arya,
Re: Urgent need for review of puberty blocker use and safeguarding standards for gender-distressed minors in Tasmania
We are writing to express our deep concern about the ongoing use of puberty blockers and cross-sex hormones in the treatment of gender-distressed children and adolescents in Tasmania.
Recent disclosures from Queensland highlight significant clinical and ethical issues surrounding the so-called “gender-affirming” model currently in practice. Documents obtained under Right to Information reveal that in August 2023, Queensland’s Chief Psychiatrist, Dr John Reilly, was formally warned by a fellow psychiatrist that the treatment model at the Queensland Children’s Gender Service (QCGS) carried a “reasonably high chance of causing resultant permanent sterility in children.”
That same correspondence also raised concerns that psychiatry, as the discipline responsible for diagnostic confirmation, cannot “disavow responsibility for the treatment model provided at the hospital and any future consequences that may flow from it.”
In January 2025, the Queensland Government responded by pausing new hormonal treatments for minors in public health settings, pending an independent review to report by November 30. This action reflects growing recognition that the evidence base supporting these interventions remains weak and that long-term harms — including irreversible infertility and loss of sexual function — have not been properly evaluated.
The Queensland letter also questioned whether informed consent is being obtained adequately, particularly where parents consent on behalf of minors deemed not capable of fully understanding the consequences. International data show that more than 95% of children placed on puberty blockers progress to cross-sex hormones, raising legitimate questions about whether these drugs are truly “reversible” or merely the first step in a medical pathway leading to lifelong dependence on synthetic hormones.
In response to these concerns, the Queensland Government commissioned an independent review led by Dr Vine. The Vine Review found that the evidence base for puberty blockers and cross-sex hormones in minors is limited and uncertain, that long-term outcomes remain inadequately studied, and that existing clinical governance and safeguarding arrangements were insufficient.
The review recommended a precautionary approach, stronger clinical oversight, and a clear prioritisation of psychosocial and mental health support over medical intervention. On the basis of these findings, Queensland has continued its pause on the initiation of puberty blockers and cross-sex hormones for minors in public health settings. This reflects a growing recognition that the potential for irreversible harms, including infertility and loss of sexual function, has not been adequately balanced against the claimed benefits of these interventions.
Similar action has now been taken in the Northern Territory, where the government has also moved to restrict access to puberty blockers and cross-sex hormones for minors. These decisions demonstrate that Australian jurisdictions are increasingly acknowledging the need to place child safeguarding, clinical caution, and evidence-based practice ahead of ideology or political pressure.
We believe Tasmania must now act to ensure that no child is exposed to irreversible medical harm under a model of care that is increasingly under scrutiny across Australia and internationally. In the United Kingdom, the Cass Review has likewise concluded that the evidence base for these interventions is weak and has called for a decisive shift toward comprehensive mental health assessment and psychosocial support.
Given your statutory responsibilities under the Mental Health Act (Tasmania) to provide clinical leadership and oversight of psychiatric services, we respectfully urge you to:
- Initiate and lead a clinical governance review of the assessment, referral, and treatment pathways for gender-distressed minors within Tasmanian public mental health services, and formally advise the Department of Health and the Minister for Health on the findings and any identified risks.
- Issue formal clinical advice and risk guidance to Tasmanian public mental health services recommending a precautionary pause on the initiation of puberty blockers and cross-sex hormones for minors, pending further evidence review and government consideration.
- Publish interim clinical guidance reminding practitioners of their professional and legal obligations to obtain fully informed consent, including clear, age-appropriate disclosure of known risks, uncertainties, and potential long-term or irreversible consequences of medical interventions.
- Strengthen clinical safeguarding oversight within mental health services by reinforcing standards consistent with the National Principles for Child Safe Organisations, including expectations around transparency, parental involvement, documentation, and multidisciplinary review where children and adolescents are concerned.
We would welcome the opportunity to meet and discuss these matters further, and to support efforts to strengthen safeguarding and evidence-based psychiatric care in Tasmania.
Yours sincerely,
Dr. Elizabeth Caballero
Retired General Practitioner
Director, Women Speak Tasmania
Reply from Dr Arya on the 23.12.25
