Yvonne van Dongen
Veteran NZ journo incredulous gender ideology escaped the lab. Won’t rest until reality makes a comeback.
Below are the questions I put to Dr Claire Achmad on 17 June. The replies arrived on 29 June.
Do children have a right to be protected from medical experimentation? If yes, can you provide evidence that shows giving puberty blockers to gender distressed young people is beneficial?
Children have a range of rights, including the right to be protected from harm, the right to life, survival and development, and the right to access the highest attainable standard of health. Puberty blockers provided through holistic structured clinical pathways with counselling and ongoing informed consent should not be characterised as medical experimentation.
While evidence continues to develop, clinical practice and lived experience indicate that puberty blocker medications can benefit young people’s mental health, including reducing anxiety, when used as part of a clinical approach. The focus should be on strengthening safeguards and access to effective clinical care rather than restricting care for children and young people who may need to access it.
One of your recommendations is to consult mokopuna with lived experience and involve their families: will that include the detransitioners and their families?
When children and young people are asked about their experiences, then we get better decisions and better outcomes – and all children have a right to participate in decisions affecting them – this is protected by Article 12 of the UN Convention on the Rights of the Child, to which New Zealand is a State Party. Children and young people hold wisdom about their own lives and experiences, and it is their right to share their perspectives and views and to be listened to and understood on the matters that are important to them in their lives.
Does a child have the right to go through their natural puberty?
Children have a right to the highest attainable standard of health, which includes both protection from harm and access to appropriate healthcare for them to meet their needs.
Children and their whānau, just like the rest of us, also have the right to privacy in making personal health and wellbeing decisions – because they are about their own personal health. In doing so, they must be free from the impacts of public scrutiny and opinion from those without relevant clinical expertise or lived experience.
Where clinically indicated, and with informed consent through a robust multidisciplinary process including counselling, accessing puberty blockers can be a legitimate way to support a young person’s rights to health, wellbeing, identity, and development.
Children and young people have the right to make informed decisions about their own bodies and health, with the support of their families and medical professionals
What is your view of the Cass Review, which found that the evidence base for using puberty blockers (GnRH analogues) in gender dysphoria to be remarkably weak overall, with major gaps in high-quality studies, long-term follow-up, and demonstrated benefits?
I acknowledge that the evidence base on puberty blockers is still developing, with important gaps and uncertainties, and the evidence in the round should be used to inform clinical decision-making.
However, inconclusive evidence does not justify restricting access; rather, it reinforces the need for things such as robust clinical pathways and ongoing informed consent processes, just as would be the case with any other medicine and clinical matters where some people experience clear wellbeing benefits from those clinical pathways.
As outlined in my advice to the Ministry of Health, young people seeking gender-affirming care should have access to all available health care and treatment options, including counselling, mental health therapies and puberty blockers when there is an indication of need and this is supported by clinical expertise and decision-making with the young person.
Is the practice of gender affirming care a departure from investigative or questioning treatment more commonly practiced by medical and other professions?
Gender‑affirming care is not a departure from investigative or questioning practice. The current approach in New Zealand already involves careful, multidisciplinary assessment, including mental health evaluation, exploration of a young person’s needs and circumstances, and ongoing clinical judgement and the application of health professional expertise before any treatment is provided.
Holistic gender-affirming care, as described in our advice to Ministry of Health, relies on a thorough and evidence‑informed process. It supports ongoing informed consent and considers each young person’s circumstances, and a careful and thorough balancing of potential risks and benefits, and their rights to health and wellbeing.
What, if anything, would prompt you to alter your view that gender affirming care is safe for young people?
My position is that gender affirming healthcare can be a clinically appropriate and beneficial option for some young people when delivered through a robust, multidisciplinary process with counselling and ongoing informed consent, where young people are advised throughout by clinical health experts. I’ve acknowledged the evidence base is still developing, and that uncertainty reinforces the need for strong safeguards, careful assessment, and ongoing monitoring.
Any high‑quality, credible evidence showing significant harm, lack of benefit, or systemic failure of current clinical pathways would need to be taken seriously and could prompt a reassessment.
However, in the absence of that, and given reported wellbeing benefits and the rights of young people to access a full range of healthcare to uphold their right to the highest attainable standard of health, the priority should remain strengthening clinical practice and continuing to be informed by the developing evidence rather than restricting access.
My Response to the Children’s Commissioner
First reaction? She’s dodging and weaving, clutching the puberty blocker ball all the way to the finish line. Hers is an evasive, rights-framed selective response. It downplays the weak evidence base and prioritises access over caution.
Achmad’s response overlooks the fact that puberty blockers (GnRH analogues) were originally used for precocious puberty and prostate cancer; their use for gender dysphoria is off-label and exploratory in many jurisdictions. Very few (if any) countries have formal regulatory approval for the use of puberty blockers specifically for gender dysphoria in minors.
Experimental or low-evidence interventions on minors require exceptional justification, strong safeguards, and high-quality evidence of net benefit – especially irreversible or sterilising ones.
The commissioner’s claim that “holistic structured clinical pathways... should not be characterised as medical experimentation” dodges the core issue. When evidence is weak, it is closer to experimentation on a vulnerable population.
The Cass Report was not the only critical review of these drugs. There have been multiple systemic reviews demonstrating that the evidence is remarkably weak, with no reliable demonstration of clear, sustained benefits outweighing harms.
Achmad knows full well that under the UN Convention on the Rights of the Child (which NZ has ratified), children have rights to protection from harm (Article 19), the highest attainable standard of health (Article 24), and life/survival/development.
There are physical risks associated with taking these drugs. Reduced bone density, impacts on height, potential effects on brain development and unknown fertility and sexual function impacts. The majority of young people on these drugs proceed to cross-sex hormones. It has never been an option that gave children time to think. Most found themselves on an irreversible pathway to further medication and often surgery.
As for mental health – sure, there have been mixed short-term reports of reduced distress in some. But no high-quality randomised control trials show puberty blockers improve long-term mental health, reduce suicide, or resolve gender dysphoria better than watchful waiting/exploratory therapy. Post-puberty ‘rapid onset’ cases show high comorbidity (autism, trauma, mental health).
International shifts: England, Sweden, Finland, Norway, and parts of Australia have restricted or banned routine use outside research/trials due to Cass-style findings. New Zealand has moved toward caution (e.g., restrictions on new prescriptions pending evidence).
About time. Our approach has lagged behind evidence; continuing ‘affirmation’ pathways risks more harmed youth.
As for ‘lived experience’, that’s a purely anecdotal approach to a serious medical issue. Medicine requires controlled evidence. Many medical interventions with ‘lived experience’ support (e.g., historical lobotomies, certain hormone therapies) were later abandoned.
Achmad continues to advocate for ‘gender affirming care’. Gender-affirming care is a contradiction in terms. It starts with the affirmation of a child’s confusion (‘your identity is valid’), not a full differential diagnosis of co-morbidities (autism ~20–30 per cent, trauma, same-sex attraction, social contagion via peers/social media). This differs from standard paediatric psychiatry. This is not care.
The fact that the Children’s Commissioner argues that accessing puberty blockers “can be a legitimate way to support a young person’s rights to health, wellbeing, identity, and development” is concerning. She ignores the fact that puberty is a normal developmental process with multiple benefits (bone health, fertility, brain maturation) that cannot be replicated later. Blocking puberty is not neutral.
A truly child-rights-focused commissioner would emphasise:
- exploratory care
- desistance support
- caution given desistance data, co-morbidities, and European reversals.
Her response prioritises ideological access. She should be prioritising precaution demanded by weak evidence and serious risks. Instead she argues for ‘strengthening safeguards’ while opposing restrictions.
Evidence should drive policy, not rights rhetoric shielding low-quality practice.
This article was originally published on the author’s Substack.
