Resource ● Last updated 15 May 2026 ● 10 min read
Frequently asked questions about stage 1 and 2 treatment
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This page provides information for:
children and parents
Who have questions about stage 1 and 2 hormone treatment
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Why would a child need access to stage 2 treatment?
A child is anyone who does not yet have legal adulthood. In relation to consent to medical treatment, this is everyone under the age of 16 in South Australia, and everyone under the age of 18 in all other Australian states and territories. This includes most adolescents and teenagers. A child may need access to stage 1 or 2 hormone treatment if their biological sex does not align with their gender identity. In other words, the sex they are assigned at birth is different from the gender with which they identify.
How can medical intervention help individuals align with their gender identity?
Trans and/or gender diverse children can receive stage 1 and stage 2 treatment to help them align their gender:
Stage 1 consists of the administration of puberty suppressant hormones, “puberty blockers”. This treatment suppresses the onset of puberty and physical characteristics which may be incompatible with their gender identity. Stage 1 allows children to explore their gender identity before beginning Stage 2. Stage 1 is reversible.
Stage 2 involves the administration of either estrogen or testosterone. Stage 2 results in the development of physical characteristics which are compatible with the child’s gender identity (such as facial hair and muscle growth for those taking testosterone and breast development and reduced visibility of body hair for those taking estrogen). Certain effects of stage 2 are irreversible without surgical intervention.
In addition to stage 1 and stage 2 hormone treatment, sex affirmation surgery is also available (usually once the child reaches 18 years of age) (Stage 3).
What does “affirming your gender identity” mean?
Irrespective of whether a trans and/or gender diverse person receives hormone treatment, they may at some point begin to affirm their gender publicly. This may be known as “social transitioning”. “Affirming one’s gender identity” usually involves using a preferred pronoun and a new name that aligns with the individual’s gender identity. It may also include wearing clothes, hairstyles and accessories that are consistent with their gender identity.
Why is it important for a young person to get access to stage 2 treatment quickly?
According to the Royal Children’s Hospital, “The health risks associated with inadequate care and support of transgender adolescents are well known”. The Trans Pathways survey found that 42% of trans children in Australia had reached out to a service provider who did not understand or respect their gender identity, and 60% felt isolated from medical and mental health services. The Health and Well-Being of Transgender Australians survey found that better training in trans health issues for doctors was the community’s top priority for government funding. The current lack of appropriate health care for trans children is a significant contributor to the extreme prevalence of mental health issues in the trans community. Further information on the mental health of trans children in Australia can be found in both these surveys.
If medical professionals have determined that a child needs access to stage 1 or 2 treatment, it is important that they receive it in a timely fashion. Without treatment, a child may begin to develop physical characteristics of the gender they do not align with. For example, if a child is assigned male sex at birth, but their gender identity is female, there is a risk their voice may break before they receive treatment. This may cause them extreme distress.
When does the Court have to authorise stage 1, 2 and treatments?
There are some conflicting approaches in decisions of the Court regarding when Court approval is required.
Given the conflicting approaches, it is prudent to proceed on the basis that all three stages of treatment for gender dysphoria in children and adolescents require consent from all parties who have parental responsibility over the child or adolescent.
A medical practitioner should not initiate any stage of treatment without first determining whether those with parental responsibility or the legal guardians consent to the proposed treatment. This is the case even when the child is assessed by the medical practitioner as being “Gillick” competent – that is, they have sufficient understanding and intelligence to enable them to understand fully what is proposed.
Currently, a child will need to seek a court order to gain access to stage 1, 2 or 3 treatment in the following circumstances:
- where there is a genuine dispute between parents, or people who have parental responsibility for a child, as to whether treatment should proceed;
- where there is a dispute between the child and / or their parents and medical staff as to whether treatment should proceed;
- where there is a genuine dispute between the child and their parents as to whether treatment should proceed (if the child is not competent); or
- where a child is under the protection of a state welfare authority.
How long can the process of going to court take?
Including the time it takes to obtain medical reports and affidavit evidence from parties, it will take several months before the matter is finalised. It may take longer if one party actively opposes the treatment proceeding. An application will not go straight to a substantive hearing. There will usually be several “procedural” hearings early in the matter to set up the timetable for the matter and deal with any preliminary issues.
What is the process of applying to the Federal Circuit and Family Court for stage 2 treatment?
If an application is required, an application to the Court can be made by:
- a parent of the child;
- a person who has a parenting order in relation to the child;
- the child themselves;
- the independent children’s lawyer;
- any other person concerned with the care, welfare and development of the child.
An application must be served on the “prescribed child welfare authority”, which is currently the Department of Families, Fairness and Housing.
To make the application, affidavit evidence must be collected from medical and psychiatric experts, parents, guardians, and other individuals involved in the child’s upbringing. The matter will then be listed for hearing.
Who has to attend the hearing?
If the application is being made by a parent then they will usually have to attend Court for the hearing. The lawyers and barristers will be talking directly to the Judge and answering their questions. If a parent/guardian has filed an affidavit in the application, they may be cross examined when the hearing progresses.
It is not possible for the child to enter into a Court session without permission from the Judge. The child can provide evidence in the form of an affidavit, if they have made the application, or if the Court gives them permission. What will the Court decide during the hearing?
What the Court needs to decide will depend on the facts before it. The Court may only need to declare that the child is Gillick competent. Or the Court may consider it is necessary to look at the medical evidence and authorise the treatment.
Privacy
Lawyers are required by law to protect client privacy and confidentiality throughout the entire process leading up to, including, and after the Court hearing.
During the Court hearing, the names of all participants (including the child, their family members, and lawyers) will be suppressed by an order of the Court. This means that no-one will be able to access any information that could identify any of the individuals involved in the case, nor will they be able to access the Court’s records.
A party can request that the hearing be “closed”, meaning that no one other than the parents or guardians of the child and their lawyers can enter the Courtroom and listen to the proceedings. It is also common practice for the Court to “anonymise” the case, meaning the child and parties will be given a pseudonym so they cannot be identified.
In which identity documents can I change my gender?
Passport
The Australian Passport Office can issue a passport to sex and gender diverse applicants, identifying them as male, female or X (non-binary/indeterminate/intersex/unspecified/other). Surgery is not a prerequisite for a passport to be issued in your preferred gender.
To apply for a passport in your preferred gender, you would need to provide one of the following documents:
- a gender recognition certificate, revised birth certificate or recognised details certificate issued by an Australian Registry of Births, Deaths and Marriages (RBDM); or
- a declaration from a registered medical practitioner or psychologist confirming your gender.
For more information, please refer to the Australian Passport Office’s website.
Services Australia
Centrelink will allow a record of gender as male, female or non-binary. Most people can update their gender details for Centrelink through their online account or by phoning. The parent who provides the highest percentage of care for the child can also update the child’s gender details on their behalf. Most people will not need to provide any supporting documentation. For more information, please refer to the Services Australia website.
Medicare and Child Support Records
To update your Medicare or Child Support personal record, you will need to provide supporting documents, which may include a declaration from a registered medical professional, an updated form of identification (such as a passport or a birth certificate), or a gender recognition or recognised details certificate issued by an RBDM. For more information, please refer to the Services Australia website.
Birth Certificates
The Victorian Registry of Births, Deaths and Marriages can issue a birth certificate to sex and gender diverse applicants, and will allow most sex descriptors, as long as they are not offensive or impractical. There is no longer a requirement to have sex affirmation surgery in order to apply to have a change of sex recognised on a birth certificate. An application can be made irrespective of any treatment that has or has not occurred. However, a child will need both parents named on their birth certificate to consent to the application, or, a court order approving the application. For more information please refer to the Births Deaths and Marriages Victoria website.
When you register a change of sex or gender to the Births, Deaths and Marriages office, a new birth certificate will be issued showing this but without referencing that a change has occurred unless requested.
Parents or legal guardians can apply for a change of sex or gender for children if the child was born in the Northern Territory (NT) and is under 18 years old. The change must be in the child’s best interests, and the child must be intersex or have received appropriate clinical treatment related to their sex or gender identity. The child must consent to the change if they understand its implications – typically assumed for children aged 14 or older.
The registration options for sex or gender include male, female, non-binary, or unspecified. Both parents must apply if named on the birth certificate, but one parent or legal guardians can apply under certain circumstances.
To apply, submit the completed application, evidence documents, proof of identification, the child’s existing birth certificate, and payment to the Births, Deaths and Marriages office. Evidence can include a statement from a registered medical practitioner or psychologist, a recognition certificate, and the child’s consent if they are 14 years or older.
For more information please refer to the Births Deaths and Marriages Northern Territory website.
People can apply to register their gender in Tasmania if their birth is registered in Tasmania. Parents or guardians can apply to register the gender of a child under 16 years old, but one parent or legal guardian can apply under certain conditions. A person can apply to register their own gender if they are over 16 years old. Applicants can choose whether to include gender and gender history on the birth certificate. Gender can only be registered once every 12 months.
The application process involves three steps:
- if the person is under 16 years: fill out and sign the Gender registration for under 16 years application form including confirmation that the registration aligns with the child’s will and preference. The Registrar may request evidence of counselling about whether to lodge an application and the implications of registering the chosen gender.
if the person is over 16 years old, the person registering their gender should fill out and sign the Gender registration for 16 years and over application form.
- attach evidence of identity documents.
- pay the fee.
Registration options for gender include male, female, non-binary or other (to be specified in the application). If the original birth certificate is sent with the application, an updated copy will be provided.
For more information please refer to the Births Deaths and Marriages Tasmania website.
Applicants who have their birth registered in WA can apply to record a change of sex or gender in their birth certificate. The new sex or gender will be recorded in the birth certificate, but not the previous sex or gender history unless the applicant requests a birth certificate with this information.
The registration options for proposed sex or gender include male, female or non-binary.
For children aged 12 to 17 years, parents or legal guardians can apply to the Registry of Births, Deaths and Marriages in WA to register a change of sex or gender if the child:
- was born in WA or their birth was registered in WA;
- has a statement from a doctor or psychologist certifying appropriate clinical treatment and understanding of the application;
- has not had a registered change of sex or gender anywhere in Australia in the previous 12 months; and
- if the child is a Restricted Person (prisoner, offender, etc.), approval from the child’s Supervisory Authority is required.
If consent from the other parent named in the child’s birth registration is not obtainable, an order from the Family Court is necessary. Evidence of a deceased parent must be provided, if applicable. The application form to use is BDM503. The application requires three forms of identification.
For children under 12 years, all applications must be submitted with an order from the Family Court. The application form to use is BDM505. The application requires three forms of identification.
For more information please refer to the Births Deaths and Marriages WA website.
Applicants who have their birth registered in WA can apply to record a change of sex or gender in their birth certificate. The new Applicants who have their birth registered in NSW can apply to record a change of sex or gender in their birth certificate. The new sex or gender will be recorded in the birth certificate, but it will not disclose that a change of sex or gender has taken place. If you have changed your name since your birth was first registered, an endorsement will appear on the new certificate stating your birth was ‘Previously registered in another name’.
The registration options for proposed sex or gender include female, male, non-binary, non-specified or any other descriptor prescribed the regulations.
If the person is under 18 years: parents or guardians may apply to the Registrar if they are all the parents or guardians of the child (including being the sole parent or guardian) or, alternatively, if an order of the court authorises the applicant to register a change of sex for the child.
An application must include:
- Either:
- If the child is able to make a statutory declaration, a declaration made by the child that they identify as the sex specified and lives, or seeks to live, as a person of that sex; or
- If the child is not able to make a statutory declaration but can express their view, a declaration from each applicant stating they believe on reasonable grounds that the alternation of the record of the child’s sex is in the child’s best interest.
- A statement from a qualified counsellor who has provided counselling to the child confirming that the child has received counselling regarding whether the application should be made and the implications of altering the record of the child’s sex.
- A statement from the same qualified counsellor that the counsellor supports the application.
- At least 3 forms of identification.
- Other documents or information the Registrar reasonably requires.
- Nomination of a sex descriptor.
From 1 July 2025 undergoing a sex affirmation procedure is no longer be a requirement.
If consent from the other parent named in the child’s birth registration is not obtainable, a parent or guardian may apply to the District Court to alter the child’s record. The District Court must be satisfied that the alteration is in the child’s best interest.
For more information please refer to the Births Deaths and Marriages NSW website.
Applicants who have their birth registered in ACT can apply to record a change of sex or gender on the birth register and receive a new birth certificate. You can choose whether your birth certificate shows your sex before the change, both before and after the change, your sex after the change only, or no sex identifier.
You can select your own sex descriptor, however, descriptors that are obscene or offensive, too long or contain symbols are prohibited.
If you are applying for your child: a parent, guardian or person with parental responsibility for a child can apply to change the sex of their child on their birth certificate, if:
- The child’s birth is registered in the ACT.
- You believe on reasonable grounds the change is in your child’s best interests.
To apply:
- The parent/guardian/s must fill out this application,
- Provide at least three forms of proof of identity for both parents, and
- If only one parent is making the application, they must provide an explanation for why it is not practicable or reasonable for the second parent to join the application.
For children aged 14 to 17 years: a child can apply on their own if they’re aged 14 to 17, if:
- Their birth is registered in the ACT.
- They haven’t changed their name within the last 12 months.
To apply:
- They must fill out this application, and
- Provide at least two forms of identification.
For children aged 12 or 13 years: a child can apply if:
- They have:
- The consent of both parents,
- The consent of one parent if it is not possible or reasonable to get consent from the other (e.g. the other parent has passed away), or
- permission from the ACT Civil & Administrative Tribunal (see here), where one or more parent does not support the application.
- Their birth is registered in the ACT.
- They haven’t changed their name within the last 12 months.
To apply:
- They must fill out this application, and
- Provide at least two forms of identification.
For more information please refer to the ACT Government Access Canberra website.
Applicants who have their birth registered in SA can apply to record a change of sex or gender in their birth certificate. The new sex or gender will be recorded in the birth certificate and the new birth certificate will not be marked in any way to suggest the sex or gender identity has been changed.
The registration options for proposed sex or gender include male, female, non-binary and indeterminate/intersex/unspecified.
For children under 18, the child or their parents or legal guardians can apply to the Births, Deaths and Marriages Consumer and Business Services if:
- The child’s birth is registered in SA.
- The child or their parent or legal guardian fill out this application.
- The child or their parent or guardian provides a statement by a medical practitioner or psychologist certifying that the child has undertaken a sufficient amount of appropriate clinical treatment in relation to the person’s sex or gender identity.
- The South Australian Civil & Administrative Tribunal (SACAT) approves the making of the application.
- They provide the child’s original birth certificate.
- At least 3 forms of identification for either the child or their parent or legal guardian, depending upon who is making the application.
You will require the approval of the SACAT. The requirements to apply to SACAT are detailed on their website. In order to apply, you must make an online application and submit:
- A statement by a medical practitioner or psychologist certifying that the child has undertaken a sufficient amount of appropriate clinical treatment, and
- a copy of the application form submitted to Consumer and Business Services above.
The SACAT will have regard to whether the child:
- Understands the means and implications of the application, and
- Has the capacity to the consent to the application.
Approval may be granted if the SACAT is satisfied that it would be in the best interests of the child.
For more information please refer to the Births Deaths and Marriages SA website.
Applicants who have their birth registered in QLD can apply to record a change of sex or gender in their birth certificate. Applicants will need to separately pay for a new birth certificate and may elect for;
- A ‘linking birth certificate’ showing their new sex and name on the front and previous details on the reverse (used to update their ID),
- A ‘birth certificate (with sex)’ showing their new sex and name and no previous details (used after ID is updated), and/or
- A ‘birth certificate (without sex)’ showing new first name and no previous details (cannot be used to prove sex).
The new birth certificates will show that their birth was re-registered but keeps details of the changes private.
The registration options for proposed sex or gender include male, female, or a self-nominated term including agender, genderqueer, and non-binary.
Children over 16 years can independently apply to the Registry of Births, Deaths and Marriages in QLD to register a change of sex or gender if;
- Their birth was registered in QLD.
- They provide at least three form of identification.
- They have part of their form completed by an adult confirming they believe the child is making the application honestly and in good faith and support the child’s application.
- They provide evidence showing why their current sex is different to what is shown on their birth certificate such as a change of record of sex document.
- They have not changed their sex within the last 12 months.
For children under 16 years, their parents or legally appointed parents or guardians can apply to change the gender or sex of their child on their birth certificate, if;
- Their child’s birth was registered in QLD.
- They provide an assessment from an authorised specialist that is a developmentally informed practitioner.
- They provide evidence explaining the reason their child’s current sex is different to the details on their birth certificate such as a change of sex document.
- They have not changed their child’s record of sex within the last 12 months.
- They provide at least three form of identification for both parents.
- They provide evidence of parental consent by;
- providing consent from both parents or other persons with parental responsibility,
- demonstrating they are the sole parent on the birth certificate, one parent is deceased by providing a death certificate, or that they are the sole legal guardian, or
- if both parents do not consent, submitting a court order allowing the child’s sex to be changed acquired by application by the child or a sole consenting parent to the Children’s Court.
- They have their child consent (including by signature if the child is aged 12 to 15).
For more information please refer to the Births Deaths and Marriages QLD website.
More services and support for trans children
Justice Connect can help you in finding legal assistance.
There are also many other support services available for trans and/or gender diverse individuals and their partners, families, and friends, including:
- Minus18: Australia’s largest youth led organization for LGBTQIA+ young people
- Transcend Australia: Peer led support network and information hub for trans and gender diverse children and their families
- Transgender Victoria: Transgender Victoria strives to achieve justice, equity and quality health outcomes and community service provision for trans and gender diverse people and their partners, families and friends
- Zoe Belle Gender Collective: An online not-for-profit seeking to provide support, training & resources for the Victorian trans and gender diverse community
- Parents of Gender Diverse Children: Provides peer support to parents and those parenting trans and gender diverse children
This resource was last updated on 15 May 2026. This is legal information only and does not constitute legal advice. You should always contact a lawyer for advice specific to your situation. Please view our disclaimer for more information.
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