The Vine Review
- parents-of-trans-kids
- Feb 23
- 6 min read
In short
The Vine Review has not given us anything new. It is clunky, lacks clarity, and at times contradicts itself. This is not surprising, as it was rushed by the LNP government and apparently created to legitimise the government’s ban on gender-affirming medical treatment for young people in the public system, a decision that went against the majority of professional medical organisations in Australia and throughout the western world.
In addition, the LNP has spent time and money on a review whose advice they haven’t followed.
Options explained
The Vine Review advised the government on three options it could follow regarding GAMT for young people:
Option 1: As per the current ban; no treatment through the public system for minors. GAMT would only be available through private or primary care or interstate services.
Option 2: Affirming care as it existed prior to the start of the ban in January 2025.
Option 3: Affirming care as it existed with additional measures for compliance-based oversight and monitoring of use and in collaboration with commonwealth-funded health services.
Each option was further expanded upon with identified risks and/or benefits. While the Review clearly favours Options 2 or 3, the government followed Option 1. This option has the most risks attached to it and the least benefits for trans young people. What this option does have is an alignment with the government’s ideology.
The government tied its decision to the outcome of the ethically unsound NHS PATHWAYS trial in the UK, which is due to be finished in 2031. The continuation of the ban until the outcome of this trial is further proof of the government’s insistence on moving its goalposts. Not only is the LNP playing political football with our kids, but they are also cheating while doing it.
Evidence and research
The Vine Review refers to “low quality evidence” in relation to GAMT, a term that is easily misunderstood, invoking a negative emotional connotation that is often exploited in anti-trans rhetoric.
In fact, only one in ten medical treatments are supported by “high-quality evidence”. In addition, it is randomised controlled trials (RCTs) that provide most of this kind of evidence. However, it is widely accepted that RCTs are unethical when they involve young people.
Though there is plenty of strong evidence for gender affirming care, it is observational in nature – and for good reason! Conducting RCTs for gender-affirming care is highly unethical and impossible. The physical effects of hormones are extremely evident, making blinding for such trials unfeasible. Furthermore, it would be unethical to pretend to treat a transgender person with hormones while withholding them – no such study would ever get approved given the massive weight of evidence in favor of gender affirming care.
What we need is to increase funding for longitudinal studies and listen to the evidence we already have, which, as the Vine review points out, is mostly positive. Yet funding allocated to gender services for young people and research was pulled by the LNP government in early 2025, contrary to the recommendations of the Queensland Children’s Gender Service (QCGS) External Clinical Services Evaluation. As a consequence, furthering this area of research became much more difficult.
But what we really need to do is just listen to trans people, most of all young trans people: “We don’t need even more evidence, we just need to be believed.”
Consultation
Many of our families responded to the public call for written consultation. These submissions were combined with the Review’s targeted interviews and written consultations. The information collected was presented in the Review labelled “The Panel heard in consultation…”
However, as no context was provided, there is no clear way to interpret this information. For example, negative statements may have come from experienced physicians working in the field, or – far more likely – from anti-trans physician-campaigners with no relevant experience at all. The Review gives us no clues.
In short, the Review has given us a chaotic melange of opinions by anyone who would like to have a finger in the pie.
GAMT and funding
When the Review draws its own conclusions, they are often on the side of the banned treatments.
In summary, it appears from the available research that the effects of PB [puberty blockers] are reversible. They are best started early in puberty and for a limited time. Unwanted side effects are rare, provided there is regular monitoring of relevant hormone levels.
And:
Overall, the evidence suggests that the treatments induce the desired physical changes and that there is increasing evidence suggesting positive psychosocial outcomes. The evidence also suggests that, in healthy people, apart from the impact on fertility, the risks to bone health and of cancer and cardiovascular events are low and comparable to those in cisgender counterparts.
The Review advises on additional measures of oversight and makes recommendations on how care should be provided. Many of these recommendations were already implemented by the QCGS prior to the ban. Though we would love to see more data collection and research, and are not against improved systems of oversight and monitoring and quality assurance, as the Review advises, all of this might already be happening if the service was properly funded and staffed. Furthermore, this area of medical care is already scrutinised more than most other areas of healthcare.
In addition, the wait lists are already over a year, and without proper funding would blow out even further at a time when young people need to see medical professionals without delay as the physical development of their bodies won’t wait.
Mental Health
We were encouraged to read that “being transgender or gender diverse in itself is not a mental health condition”.
Sadly though, our young people often do have an increased need for mental health services, especially when they are denied the medical care they need. But also because their existence is stigmatised, questioned, or straight-out denied. They deal with bullying and abuse just for being who they are. The government’s ban has exacerbated the harm to our young people and with it the need for mental health services.
The reality is that public services such as Child and Youth Mental Health Services (CYMHS) also have long waiting lists and are under-funded.
Justification
The countries upheld as examples by the government to justify their health directives have all seen a shift towards right-wing ideology.
Maybe the most worrying aspect of the Vine Review is its frequent praise of Finland’s youth gender services. The Review goes so far as to refer to Finland’s approach as “neutral”. However, the physician responsible for rewriting the Finnish treatment guidelines, Riittakerttu Kaltiala, is a key figurehead for the anti-trans movement, and reports have emerged from Finnish young people of abuses by mental health staff untrained in treating trans patients. In addition, Finland’s non-affirming approach denies that Finnish young people are the ones who know themselves best and is absolutely the worst way to build a strong therapeutic alliance.
Gender-Affirming Hormone Treatment
The review points out that puberty blockers alone do not reduce gender dysphoria.
It is not expected that suppression alone will reduce distress related to gender dysphoria, since it arrests sexual maturation, but does not cause any development of physical characteristics in the direction of the person's gender identity.
This is why some of our young people ask for Gender Affirming Hormone Treatment (GAHT), because dysphoria can only be alleviated when their bodies align with their gender identities. Puberty blockers inoculate against the increased distress that may arise when a young person sees their body develop in opposition to their gender. But only GAHT will help their body align with their gender.
Fertility
It was heartening to read that even though some trans adults consulted by the panel had changed their minds regarding fertility since they were adolescents, they “would not retrospectively change their decisions to commence hormones due to the beneficial outcomes they experienced”.
When it comes to GAHT, decisions around fertility are tough for the young person and their family. No child in the public system is given GAHT without many educational sessions, assessments and various family and team meetings. In addition, the Review failed to acknowledge that family is created in many ways, not just the heteronormative way.
While most parents would like to preserve their children’s options to have biological children, the fertility preservation process is extremely distressing and costly, as this care is not available in the public system.
Loving our children
Being a parent of a transgender young person comes with a huge learning curve for most families. But ultimately, it is no different to parenting any other young person. Wanting health care for our children while affirming their gender, chosen names and pronouns, is not extreme, is not ideology, but it is in fact sound parenting.
This overreach by the LNP government is the start of the politicisation of health care, and creates a precedent for further meddling in other people’s care, not just the care of trans young people. If this doesn’t affect you or your family now, it may very well do so in the future.
