PATHA puts a nail in its own coffin
In NZ, PATHA reveals itself to be a body modification activist group, not a professional healthcare organisation.
PATHA (Professional Association of Transgender Health Aotearoa) published its new “Guidelines for Gender Affirming Healthcare” on its website on Friday 28 November, nine days after the NZ government had announced a ban on new prescriptions for puberty blockers for the treatment of gender dysphoria.
PATHA had been contracted by the Ministry of Health in 2024 to write the Guidelines but they were not released when ready in March 2025 while the government was completing its review into the safety and efficacy of puberty blockers. The resultant Minister of Health’s announcement on 19 November that NZ would join the UK and most Nordic countries in restricting the use of these drugs for minors meant that the puberty blocker section of the Guidelines became obsolete.
Although Te Whatu Ora (Health NZ) invited PATHA to change the Guidelines to align them with the new regulations, PATHA declined the offer and instead published them independently, complete with the Te Whatu Ora logo still on the cover page. This use of the logo is improper because it implies Ministry support for the Guidelines while simultaneously directly contradicting government policy.
Contemptible content
Calling the Guidelines “contemptible” is not an exaggeration. Here are some of the most outrageous statements in the nearly 200 page Guidelines:
There is a consistent and growing evidence base from observational studies around the world showing the benefits to psychological wellbeing of puberty suppression and gender affirming hormone therapy (GAHT) when used in line with current clinical practice and guidelines. (p61) Not true. See Cass and the recent Health and Human Services report from the US.
The UK [Cass] review has been critiqued in depth internationally regarding a number of matters, including (but not limited to) for how it describes evidence quality, for disregarding the values and preferences of patients, and for the reasoning and justifications it uses to come to its recommendations. (p61) Not true. Both major UK political parties and the NHS have accepted Dr Cass’ recommendations and her conclusions have been replicated in four other systematic reviews.
In healthcare in general, it is not uncommon to provide treatments that lack high quality evidence of effectiveness. Practising medicine, and paediatric medicine in general (not just within gender affirming healthcare), often necessitates providing care without a high quality evidence base. (p61)
In other branches of paediatric medicine, providing care without high quality evidence would only be undertaken when there is significant risk to the child’s life - not simply because a child has negative feelings.
Puberty blockers are considered to be largely reversible and have the benefit of allowing the young person time before making any decisions regarding starting on gender affirming hormone therapy (GAHT).134 There is no good evidence to suggest that blockers impact negatively on cognitive and emotional development. (p67) Not true. There are no long term studies on the effects of blockers on cognition and multiple reports have found that most children (92-98%) who start puberty blockers progress to cross-sex hormones with indisputably irreversible effects.
Sperm for fertility preservation can be found from Tanner stage 3 (testicular volume ≥10 ml)144 and occasionally young people can get to this stage without much in the way of unwanted physical changes, but for others this will not be possible. (p68) True, so why does PATHA even contemplate halting puberty before Tanner Stage 3 thus making fertility preservation impossible?
Puberty blockers are likely to affect final height if they are started prior to growth plate closure and this may influence the timing of starting GAHT. (p70) True. PATHA uses this as a justification for starting on cross-sex hormones even earlier - before the age of 18.
Cross sex hormones for children
As if the above isn’t bad enough, the Guidelines contain eight pages (73-81) of information on how to administer cross-sex hormones to children, from as young as Tanner Stage 2.
Tanner Stage 2 is the first stage of puberty, when girls (typically aged 8-13) start developing breast buds and boys (typically aged 9-14) begin experiencing growth in their genitals and height.
PATHA thinks it is acceptable to give ten year olds drugs that they know cause irreversible changes, including sterility.
It is important to take time for this supported decision making, due to the irreversible effects which come with taking GAHT*. (p73)
*GAHT is a euphemism standing for “Gender Affirming Hormone Therapy”, otherwise known as dosing girls with testosterone and boys with oestrogen.
PATHA says “Capacity, maturity in decision making and whānau (or other adult) support should all be taken into consideration” but does not explain how a ten year old can possibly answer suggested questions like:
Are your expectations for the effects of hormones and the time frame for changes realistic? What do you understand about the changes that will happen and what will not change? (p73)
These eight pages alone should be enough to prompt the Ministry of Health to officially cut all ties with PATHA and its Guidelines.
The credibility coffin
PATHA, like its parent organisation, WPATH, is a self-selected group of activists who support the belief that extreme body modification to ‘pass’ as the opposite sex is a human right, even for very young children.
Anyone with an interest in ‘transgender healthcare’ can join the organisation. PATHA’s website says membership “includes people who provide direct or indirect care to transgender people, people in paid or unpaid roles, and transgender and cisgender people… Our members are not restricted to people with health qualifications” and “There is no difference in functionality or membership rights between the membership options.”
PATHA has promoted itself as a professional organisation with special expertise but releasing these Guidelines has exposed that PATHA is no more than an activist group pushing its own barrow.
The Guidelines contradict government policy that is based on international peer-reviewed evidence contained in five systematic reviews so far - Finland, Sweden, Norway, Cass/UK, and the HHS report just released in the US. All have reached the same conclusion:
The harms from sex-rejecting procedures — including puberty blockers, cross-sex hormones, and surgical operations — are significant, long term, and too often ignored or inadequately tracked. (HHS report)
The release of such flawed “Gender Affirming Guidelines” should be the impetus for PATHA to lose all future government support. It has shown itself to be an activist group, not a credible medical organisation seeking best practice, nor a team player.
As an activist group, it is entitled to advocate for its position but by implying it retains Ministry of Health support for its Guidelines, PATHA has broken trust with the government and with the public.
We hope this presumptuous action by PATHA will be a nail in its credibility coffin.
Who is in charge of our children’s healthcare? Is it the Ministry of Health or an evidence-denying lobby group?
Thank you for pointing out that PATHA, like its parent organization WPATH, is about as far from a "professional" group as one can get. Can anyone who pays a membership fee join a doctor's, nurse's, lawyer's or engineer's group just because they want to? Um, that would be a nope.
To start a boy on puberty blockers at Tanner Stage 3 would be considered a late start by WPATH and even then, it is doubtful that any viable sperm could be preserved. I wrote here about the effects of puberty blockers on future fertility: https://lucyleader.substack.com/p/removing-the-possibility-of-normal
We don't need to do any further research around the loss of fertility that puberty blockers initiate because the study of pediatric cancer treatment on fertility is very clear about what happens to reproductive capacity in children when their lives are disrupted by giving them certain drugs that affect their future parental possibilities. The difference is that children with cancer will die without treatment, while children who are unhappy with their sexed bodies will mostly be fine if supported through this normal stage of human development.
It is impossible to obtain informed consent from prepubescent children to start them on the path to becoming lifetime medical patients, which is what puberty blockers do. The reason every country on the planet has legislation that creates age-related restrictions around activities that adults engage in is because it is well understood that immature brains lack the capacity to make sound decisions that take into consideration everything that may affect the outcome of those decisions.
The concept of "time to think" is totally ridiculous when you realize that puberty is the last step on ending up with a mature adult brain, which is a time sensitive period in our development. To not experience puberty is to miss out on an important stage in becoming an adult. https://lucyleader.substack.com/p/time-critical-brain-development
Brazen and arrogant mask-drop move by PATHA. Lets see it receive the reciprocal contempt it has now publicly solicited.
Thanks for the factcheck RGE, timely!