A recent decision by Justice Andrew Strum in the Family Court of Australia has cast a spotlight on the complex intersection of gender-affirming healthcare and family law, and it has indicated a change in the way that previous decisions of this nature have been decided by the Court, potentially opening the way for the matter to be appealed to the Full Court of the Family Court.
The decision handed down in April 2025 concerned “Devin”, a 12-year-old child whose mother sought to facilitate the use of puberty blockers to support Devin’s gender affirmation.
The Competing Positions
The case involved competing applications for sole parental responsibility from the child’s separated parents, and an order as to Devin’s ability to access “puberty blocking” medical treatment. The mother, supported by experts advocating for the gender-affirming approach, argued that Devin was experiencing gender dysphoria and should be supported in a medical transition, including the use of puberty blockers.
On the other hand, the father, backed by the Independent Children’s Lawyer (ICL), contended that Devin’s feelings were more exploratory and fluid, cautioning against medical intervention at this stage of development.
Medical Evidence and the Gender Clinic’s Role
Justice Strum criticised the gender clinic that was treating Devin for what he saw as an “ideological commitment to a gender-affirming model” strongly focused on only one way of helping children with gender questions and supporting them to transition. His Honour was concerned that the clinic didn’t seriously consider other possible approaches or give families real choices. Instead of exploring different options or waiting to see how Devin developed over time, the clinic seemed set on a path that led to medical treatment leaving little room for alternative treatment options.
In addition, His Honour found that there appeared to be a systematic approach to prescribing puberty blockers to every child referred to the clinic, without consideration of the potential long-term risks. His Honour rejected the notion that puberty blockers are entirely reversible and risk-free, highlighting concerns over the potential effects on fertility, sexual function, bone health, brain development, and other critical areas in a child’s development.
His Honour also took issue with an expert witness who dismissed the findings of the UK’s Cass Review, an independent inquiry led by paediatrician Dr. Hilary Cass, which had raised concerns about the quality of research supporting the widespread use of puberty blockers. Justice Strum found this dismissal to be misleading, noting that the expert’s response was inconsistent with their duty to the Court.
The Cass Review questioned the reliability of existing evidence on puberty blockers finding that, although there is considerable research in the field, much of it is of poor quality, making it difficult for families to make informed clinical decisions and well-grounded choices about treatment.
Justice Strum echoed the Cass Review’s call for a more cautious approach to gender-affirming care, particularly when it comes to minors. He criticised Australian health authorities for dismissing the review, emphasising the importance of taking a holistic and careful approach to the treatment of gender dysphoria in children and adolescents.
Drawing on the writings of physician and educator Maria Montessori, Justice Strum reinforced the idea that childhood is a period of development that should be respected and nurtured. He noted that children are developing both physically and psychologically, and decisions that have long-term consequences, especially medical ones, should not be rushed. His Honour argued that, at this stage in Devin’s life, all options should remain open, with no undue risk of harm.
His Honour’s comments aligned with established legal principles recognising that children lack full legal capacity and must be protected from decisions that could permanently affect their lives. In this case, Justice Strum highlighted the need for caution and for ensuring that medical interventions are not pursued prematurely.
Diverging Professional Opinions
Rather than the cautious stance taken by Justice Strum and the Cass Review, some professional organisations in Australia continue to endorse the use of puberty blockers in adolescents with gender dysphoria, maintaining that puberty blockers can provide a valuable tool for treating gender dysphoria, particularly by giving young people more time to explore their gender identity without experiencing irreversible physical changes.
Advocates for puberty blockers argue that the treatment helps prevent irreversible changes, such as the development of unwanted sex characteristics, and that the vast majority of adolescents who begin this kind of treatment continue to identify as transgender into adulthood. They also point out that calls for randomised controlled trials (RCTs) are somewhat misplaced, as RCTs are rare in paediatric medicine and absent for many established treatments, such as birth control and COVID-19 vaccines.
Justice Strum’s decision underscores the Court’s protective role over children, particularly when the medical treatments being considered could have unknown and/or irreversible consequences. Justice Strum’s judgment reinforces the importance of taking a cautious and evidence-based approach when it comes to gender-affirming care for minors.
As gender-related healthcare continues to evolve, this decision may prompt broader discussions and reviews of clinical practices, regulatory frameworks, and the way the legal system interacts with medical decision-making in family law cases.
This case highlights the need for more robust, objective, and reliable research to guide clinical practices and inform decisions about medical treatment for young people.
Although Justice Strum emphasised that the case was about the best interests of the child, rather than transgender rights, his ruling raises significant questions about the provision of gender-related healthcare to minors in Australia. It should be noted that there is an appeal that lies from his decision which may provide some clarity in a number of single-judge first instance decisions which signal a change of direction by the Court.
About the Author: Melanie Tonon is one of our Family Law lawyers. She holds a Law Degree from Curtin University and was admitted to the Supreme Court of Western Australia in 2019. Melanie also has a Bachelor of Commerce and a Graduate Certificate in Australian Law and Migration. With experience in various areas of law, she is committed to ongoing professional development and client care.
