Ani O’Brien
Like good faith disagreements and principled people. Dislike disingenuousness and Foucault. Care especially about women’s rights, justice, and democracy.
I have taken several deep breaths before bashing this response out, but do excuse me if my incredulity and rage is particularly evident. You can read the initial piece I wrote about the puberty blocker ban here. This piece was written in a rush so apologies for errors.
The New Zealand High Court has just handed down a judgment that effectively says because puberty blockers are being prescribed, they must therefore be safe. Pretty circular logic there, champ. Basically the reasoning is that because doctors are using them, they must be okay and the state should not interfere. And because harm has not yet been universally acknowledged by the medical establishment, the law should treat that harm as unproven, marginal, or speculative. Sounds a bit back-to-front.
That is the practical effect of 2025-NZHC-4045, delivered by Justice Wilkinson-Smith.
Thank goodness Justice Wilkinson-Smith wasn’t in charge of banning lobotomies. Many of us would likely be vegetables now if that was the case.
The judgment halts the ban on puberty blockers announced by the government, and intended to go into force in two days, until a judicial review can be held. The way the judgement is written lays a clear the path for the judiciary to ensure continued use of these drugs by rejecting the idea that they warrant prohibition or serious restriction. It accepts that they remain part of ordinary medical practice and treats that fact as decisive. Never mind that the judgment is riddled with false and out-of-date activist propagated talking points laundered as facts. The message from our judiciary, at least for now, is if doctors are still prescribing them, the courts will not stand in the way because… doctors are still prescribing them.
It is an astonishingly lazy piece of reasoning. And it is years behind the evidence.
The frustration here is not that the court reached a controversial conclusion. It is that it did so by leaning on weak and disproven assumptions that have been exploding in real time across the world. The judgment ignores emerging medical evidence and actively refuses to grapple with the fact that the medical consensus it defers to is already in retreat.
The judgment rests on the belief that medicine self-corrects neatly and promptly, and that harm would already be obvious and universally acknowledged if it were real. Medicine does not work like that. It never has. And every major medical scandal of the last century follows the same pattern now being repeated: widespread use, professional reassurance, early warnings dismissed, and eventual reckoning, always late, always after damage has already been done. Justice Wilkinson-Smith may as well have shot the canary in the coal mine because it was a nuisance.
If current medical use were proof of safety, thalidomide would never have been prescribed to pregnant women. Surgical mesh wouldn’t have caused catastrophic harm in women’s bodies. Lobotomies would never have been performed tens of thousands of times under the enthusiastic endorsement of experts, institutions, and regulators. At every stage, doctors prescribed these treatments, courts deferred, and the victims were told the system knew best.
The High Court has just repeated that mistake, almost verbatim.
What makes this judgment particularly indefensible is its refusal to seriously engage with the Cass Review in the United Kingdom, not as a political intervention, but as the most comprehensive, sober, and damning review of the evidence conducted. Commissioned by NHS England and led by Dr Hilary Cass, this was not an activist exercise, it was a forensic audit of the science. And what it found saw the Tavistock Clinic shut in disgrace and other jurisdictions move to ban puberty blockers.
The Cass Review concluded that the evidence base underpinning these drugs was weak, fragmented, and frequently overstated. Long-term outcomes were largely unknown and claimed benefits were not supported by high-quality data. Risks, including impacts on bone density, sexual development, neurodevelopment, and mental health, were insufficiently studied and poorly communicated. The review’s most devastating finding was that these drugs had been embedded into clinical practice before the evidence justified anything like that confidence.
That is a global scandal. It is a systemic failure of systems across the planet. And it has been enabled by painfully ‘right-on’ members of the establishment including politicians, NGOs, media, academics, and, of course, the judiciary. They have allowed deranged activists, like those involved with PATHA who took this case to the courts, to drive policy and law when they are frankly not capable of regulating their own emotions.
The degree of institutional capture in New Zealand is evident in the judgement and mirrors the disastrous erosion of credibility in medical institutions overseas as well. A witness referred to as Dr A pointed to statements from the following professional health organisations: (a) The Royal Australasian College of Physicians. (b) Te Kāhui Korowai Rangatahi|Youth Health Aotearoa. (c) The Royal Australian and New Zealand College of Psychiatrists. (d) The New Zealand Nurses Organisation|Tо̄pūtanga Tapuhi Kaitiaki o Aotearoa. (e) The New Zealand Society of Endocrinology. (f) The Association of Salaried Medical Specialists|Toi Mata Hauora. (g) Te ORA Māori Medical Practitioners. (h) Sexual Wellbeing Aotearoa.
It is terrible that we cannot trust any of them to be apolitical. They are totally captured by an activist class that has convinced them to ignore evidence and sacrifice the health of young people in order to satisfy an ideological agenda that is driven for the most part by adult males who wish to be seen as women.
Dr A demonstrates behaviour that is typical of aggressive activists who have been content to use the most despicable tactics to bully decision-makers into making poor decisions. In this judgement, we see the worst example of these:
[81] Dr A anticipates an increase in distress, anxiety and depression in relation to pubertal changes in young people with gender incongruence, including self-harm, as a result of the regulations.
Threatening suicide, despite the fact that the “statistics” they point to being thoroughly debunked, is manipulative and frankly evil. No one wants to see young people self harming or taking their own lives and scaremongering about it effectively terrifies parents, doctors, and decision-makers into complying with activist demands.
This doctor, whose qualifications are not apparent as their details are suppressed, also indulges in a often repeated, but repeatedly disproven, lie:
[84] Dr A says that whilst puberty blockers simply put a pause on puberty and are reversible, gender-affirming hormone therapy results in irreversible physical effects.
As Helen Joyce says: “Both social transition and puberty blockers are presented to parents as easily reversible. But in reality, they are the early stages of what physicians call a ‘cascade of intervention’.”
And health secretary for the current Labour Government in the UK, Wes Streeting, agrees:
The Cass Review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are safe or beneficial.
That evidence should have been established before they were ever prescribed for that purpose. It is a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.
Following the Cass Review, the NHS ceased the routine use of puberty blockers to treat gender incongruence in children. In May, the previous government issued an emergency order to extend these restrictions to the private sector.
And as I have said ad nauseam: PUBERTY BLOCKERS ARE NOT REVERSIBLE.
It is sickening that Dr A goes even further to say that:
…there is no evidence of clinically significant harm from pubertal suppression to support recommending a ban of this medication; however, the risk of harm from denial of care is immediate, significant and profound.
This is not medical reasoning. It is opinion and it is unfounded.
The Cass Review explicitly found that the evidence base is too weak to draw conclusions about long-term safety and identified bone health compromise during treatment. Sweden and Finland restricted use precisely because the risks were not hypothetical. To describe that landscape as “no evidence of clinically significant harm” is reckless and deliberate blindness.
But the real tell is the second half of the sentence, where uncertainty about medical harm is contrasted with complete certainty about the “immediate, significant and profound” harm of denial of care. This is a rhetorical move designed to short-circuit scrutiny. The alleged harms of withholding medication are treated as axiomatic and urgent, while the harms of administering it are treated as speculative and distant despite the fact that one involves introducing powerful endocrine interventions into developing bodies and the other involves not doing so.
What is being presented as a sober risk assessment is, in reality, a value judgment: that medicalisation is preferable to uncertainty, that intervention is morally safer than waiting, and that psychological distress justifies irreversible biological risk. Those are not settled medical facts. They are contested claims: ones that multiple countries, after reviewing the evidence, have explicitly rejected.
To elevate this framing into judicial reasoning is not deference to expertise. It is surrender to narrative.
Yet the New Zealand High Court, has opted to swallow this activist rubbish whole and ignored the seismic developments around the world that have seen organisations like WPATH (the world version of PATHA) seriously discredited. Justice Wilkinson-Smith seems unconcerned by the many countries who have moved to ban the puberty blockers. As if the collapse of medical confidence in our closest comparator jurisdictions is merely a difference of opinion, rather than a red flag the size of a container ship.
Sweden, once an early adopter, conducted its own evidence review and concluded that the risks outweigh the uncertain benefits. These drugs are no longer offered as first-line treatment and are restricted to exceptional cases. Finland reached the same conclusion, explicitly prioritising psychotherapy and psychological care instead, citing concern about long-term harm and lack of robust evidence.
These are not reactionary states! They are cautious, technocratic, evidence-driven health systems. Ones that we are usually happy to try emulate. When they independently arrive at the same conclusion, pretending this is all just academic debate is wilful blindness. And pretending this is political is immoral and devious.
Across Europe more broadly, the direction of travel is unmistakable. Medical associations are issuing warnings, treatment protocols are being rewritten, prescribing thresholds are being raised, and long-term outcome data is being demanded, not assumed. France, Germany, and others are stepping back from medicalisation and urging caution. It. isn’t. moral. panic. It is medicine doing what it is supposed to do when the evidence shows the narrative is bonkers.
This High Court judgment is out of step with this reality. It appears not to understand it at all. This part of Justice Wilkinson-Smith’s judgment just about made my head explode:
[179] There is also no evidence of a particular need to act urgently to prevent new prescriptions because of some immediate risk to physical health if young people commence treatment. Puberty blockers are reversible. There is no evidence that they affect fertility. If they did, they would hardly be prescribed for children with precocious puberty and they have been prescribed for that purpose for decades. They may alleviate distress for a child who is simply not ready to cope with puberty either because they are too young or because their mental health is such that a delay is recommended. The only evidence-based impact on physical health is on bone density and that impact results from long-term use. A period of months until the judicial review can be heard is not said to create any issues with bone density. The evidence relating to mental health outcomes suggests negative outcomes from a ban are a far more immediate concern.
The harms are documented! Peer-reviewed studies raise serious concerns about bone density loss during adolescence, impaired sexual development and fertility, unknown effects on brain maturation, and deteriorating mental health outcomes for some patients.
But the court apparently prefers to listen to PATHA, which is led by a trans-identifying male with no clinical qualifications despite his role. It is alarming that the court, in this case, has demonstrated itself to be either so captured by activism or so incompetent that they did not encounter the plethora of available evidence that would have disproven many of the erroneous claims it made.
Perhaps one of the most obscene consequence of this logic is what it does to detransitioners; the young people who trusted the system and paid the price. Many describe being rushed onto medication, having complex mental health issues ignored, being told the interventions were reversible, safe, and well-established. They now live with permanent physical changes they were never warned about. Their existence alone demolishes the idea that current use is harmless. Yet the judgment tells them that their suffering is of no matter.
Dr A claims that “puberty blockers simply put a pause on puberty and are reversible” while there are young people walking around with osteoporosis, zero sexual function, infertility, potential brain development issues, and significant mental health distress because adults who should know better put them on drugs that are for prostate cancer!
This is a moral failure of our dogmatic systems and the weak people who are content to see young people’s bodies and futures destroyed by this utter nonsense. Courts are not supposed to fossilise error: they are supposed to interrogate power, including medical power, especially when the evidence is shifting under its feet.
Funnily enough, our courts seem eager, thrilled even, to challenge our government. They will take any chance to slap a minister down or discredit a statutory process. But ask them to stop doctors prescribing harmful off-label drugs and they suddenly respect jurisdiction. I smell a rat.
The idea that ‘doctors wouldn’t prescribe harmful drugs’ is one of the most dangerous myths in modern medicine. Doctors are not evil, but they are human. They operate within cultures, incentives, and ideological climates. Medical consensus has been wrong before. Spectacularly wrong. And it has always insisted on its own benevolence right up until the moment it collapses.
What makes this judgment so infuriating is that it repeats the debunked and the bullshit. I may be sceptical of the ability of our judiciary to set aside their elitist social politics, but I did not think they were so useless as to resort to arguments that were being used more than five years ago and are completely dead in other parts of the world. Do your bloody homework! There is not a lack of information, there is a lack of will to engage with it because it undermines the house of cards this revoltingly abusive system is built on.
But perhaps it is unsurprising that Justice Wilkinson-Smith has a different appetite for risk when it comes to the welfare of children. As the NZ Herald reports:
She was involved in a number of high-profile cases, including defending Chris Kahui, who was acquitted of murder following a High Court trial over the deaths in June 2006 of his three-month-old twin sons, Chris and Cru.
The court’s interim order says that the puberty blockers ban cannot be put in place until after a full judicial review. Please let me know if you are a medical professional or any other kind of expert who could assist in intervening in this judicial review. PATHA are going to put up cranks as witnesses and we must have credible, sane alternatives.
This article was originally published by Thought Crimes.
