New Zealand’s High Court has struck down Government regulations banning new puberty blocker prescriptions for young people with gender dysphoria or gender incongruence, finding the restrictions unlawfully discriminated against gender-diverse young people and were introduced following inadequate consultation.
Aotearoa’s controversial restrictions on puberty blockers for transgender and gender-diverse young people have been overturned by the High Court.
In a decision released on 21 October, Justice Cooke ruled that regulations preventing new patients from being prescribed puberty blockers for gender dysphoria or gender incongruence were unlawful and invalid.
The Court ordered that the regulations be set aside.
The judgment follows a challenge brought by the Professional Association for Transgender Health Aotearoa (PATHA), which argued that decisions about this healthcare should remain between patients, their whānau and their clinicians.
What did the High Court find?
The Court identified two major problems with the Government’s approach.
First, it found the consultation process was inadequate.
Although the Ministry of Health had previously consulted the public about whether additional safeguards should apply to puberty blockers, the Court found people had not been adequately consulted on the substance of the eventual regulations.
It also found the Government had failed to consult directly with gender-diverse young people who would be affected by the restrictions.
Second, the Court found the regulations breached the New Zealand Bill of Rights Act’s protection against discrimination.
The rules prohibited new puberty-blocker prescriptions where the treatment was for gender dysphoria or gender incongruence, while the same medicines remained available for other conditions, including precocious puberty.
The Court found this created materially different treatment for young people seeking gender-related healthcare.
Complete prohibition was disproportionate, Court finds
The High Court did not find that the Government was prohibited from introducing safeguards around puberty-blocker prescribing.
Instead, it concluded that the particular measure chosen — an indefinite ban on new prescriptions for gender-related care — went too far.
The Court accepted there was a rational basis for considering additional restrictions because of uncertainty in the available medical evidence.
However, it found a complete prohibition for new patients was a disproportionate response.
Earlier court material also recorded that the Ministry of Health had presented ministers with several policy options and advised that preserving clinician discretion best met the policy objectives.
Its analysis warned that banning new prescriptions carried a high risk of adverse health outcomes, including possible negative impacts on young people’s mental health.
What happened to the ban before this ruling?
The Government announced the restrictions in November 2025.
Under the regulations, people already receiving puberty blockers for gender dysphoria or gender incongruence could continue treatment, while new patients would generally be unable to start.
The medicines remained available for other medical purposes.
PATHA launched judicial-review proceedings the following month.
Before the regulations could effectively be enforced, the High Court granted interim relief directing the Crown not to enforce them while the legal challenge was resolved.
The Court of Appeal later clarified that doctors could continue prescribing under the pre-regulation position while the judicial review was underway.
That means the regulations technically took effect in December 2025, but enforcement had already been blocked by the courts.
The latest judgment goes significantly further: the regulations themselves have now been declared unlawful and set aside.
PATHA welcomes ruling
PATHA has welcomed the decision.
President Jennifer Shields said the organisation was relieved by the outcome and argued that restrictions on transgender healthcare had caused significant concern for young people and their families.
PATHA has consistently maintained that decisions about puberty blockers should be made through individualised clinical assessment rather than a blanket political restriction.
Vice-president and GP Dr Elizabeth McElrea has similarly argued that treatment decisions belong in the consultation room between clinicians and patients.
PATHA had previously pointed to the Ministry of Health’s own regulatory analysis, which did not recommend an outright ban and warned of potential adverse consequences from restricting access.
What does the evidence say about puberty blockers?
The evidence surrounding puberty blockers for adolescents with gender dysphoria remains contested and incomplete.
New Zealand’s Ministry of Health concluded in its evidence review that there was a lack of high-quality evidence establishing either the longer-term benefits or risks of puberty blockers when used for gender dysphoria or gender incongruence.
That uncertainty was central to the Government’s argument for a precautionary approach.
But uncertainty does not automatically determine what policy should follow from it.
The Ministry’s own policy work recognised risks on both sides: potential unknowns associated with treatment, but also the risk of adverse outcomes if young people who might benefit from treatment were denied access entirely.
The High Court’s ruling therefore does not amount to a judicial finding that puberty blockers are risk-free or that every young person seeking them should receive them.
It addresses whether the Government’s blanket restriction was lawfully made and proportionate.
The Court concluded it was not.
Family First condemns decision
Conservative advocacy organisation Family First NZ reacted strongly against the judgment.
Chief executive Bob McCoskrie said the organisation was “shocked” and argued the Court had given insufficient weight to uncertainty in the scientific evidence.
Family First supports restrictions on puberty blockers for transgender young people and has argued that a precautionary policy is justified while evidence remains contested.
Its response also criticised the Court’s discrimination finding.
The High Court’s judgment, however, was not a determination of which side of the medical debate was correct.
It was a legal assessment of the Government’s decision-making process, the differential treatment created by the regulations and whether the resulting limitation on rights could be justified.
Court rejects claims of an improper political purpose
PATHA did not succeed on every part of its challenge.
The Court rejected its argument that the Health Minister had effectively surrendered his decision-making authority to Cabinet.
It also did not accept the allegation that the Minister had exercised his powers for the improper purpose of advancing New Zealand First’s political opposition to what the party has described as “woke” policy.
Justice Cooke found the evidence showed the Minister had made the relevant decision himself after consultation with Cabinet.
That distinction is important: the regulations were overturned because of failures including consultation and unjustified discrimination, not because the Court found the Minister had acted in bad faith.
Government considering next steps
The Government has maintained that stronger safeguards are needed while uncertainty around the evidence remains.
Health Minister Simeon Brown said when announcing the policy in 2025 that the Government was taking a precautionary approach because of the lack of high-quality evidence around longer-term outcomes.
Following the High Court judgment, the Government said it remained committed to safeguards around prescribing and was seeking advice on its next steps.
New Zealand First has called for the decision to be appealed.
An appeal would not itself reverse the High Court’s judgment unless a higher court subsequently overturned or altered the decision.
What happens for trans young people now?
The immediate legal effect is straightforward: the regulations imposing the blanket restriction have been set aside.
Clinicians are therefore no longer constrained by those regulations when considering new puberty-blocker prescriptions for gender dysphoria or gender incongruence.
That does not mean treatment becomes automatic.
Doctors still have professional obligations around assessment, informed consent, clinical appropriateness and the available evidence.
What changes is who gets to make that assessment.
Rather than the Government imposing an across-the-board prohibition, individual cases can again be considered clinically.
For PATHA and many transgender advocates, that distinction has been at the centre of the case from the beginning.
For the Government, the question now is whether to appeal or devise a different system of safeguards that can survive legal scrutiny.
Either way, one of the most consequential legal battles over transgender healthcare in Aotearoa has produced a clear result:
The Government’s blanket ban on new prescriptions was unlawful.
