Few Canadian policy issues are as polarizing as youth gender transition. Yet according to my analysis below, most Canadian media spent last month paying little to no attention to one of the most consequential reports on the topic.
The gender transition debate in Canada
In 2023, conservative governments in New Brunswick and Saskatchewan both introduced policies requiring parental consent for pronoun changes for school children, with the latter invoking the notwithstanding clause. More recently, Alberta announced it will bring in a host of policies related to youth transition, including restricting the use of hormone therapies, puberty blockers, and gender reassignment surgery. At the national level, Pierre Poilievre has publicly opposed puberty blockers for children.
Such restrictions have been rejected by major Canadian medical organizations, which remain committed to the “gender-affirming” model of care. Yet this medical consensus is being challenged at home and abroad.
Canadian investigative reports have raised questions about insufficient safeguards for hormone treatment and surgeries. Outside Canada, several European countries are actually moving away from the gender-affirming model. Then came the Cass Review.
On April 10, 2024, British pediatrician Dr. Hilary Cass released her long-awaited Independent Review of Gender Identity Services for Children and Young People. Commissioned by England’s National Health Service (NHS), the 387-page report was completed alongside independent reviews of the scientific evidence around youth gender medicine by a research team from the University of York, which were published as nine journal articles in the Archives of Disease in Childhood.
The Cass Review’s 32 recommendations call for an overhaul of how youth gender medicine is practiced in the United Kingdom. Cass found “a lack of high-quality evidence” for the gender-affirming model of care, particularly with respect to “the use of puberty blockers and masculinising/feminising hormones.”
The review recommended “extreme caution” for providing cross-sex hormones for children and raised concerns that puberty blockers “may change the trajectory of psychosexual and gender identity development.” Going forward, the review urged that youth gender services “must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.”
The Cass Review received significant media attention (positive and negative) in the U.S. and in Europe. It appears to have already had a serious impact in the U.K. and beyond. Both the Conservative Prime Minister Rishi Sunak and the Labour Party’s shadow health secretary praised the report, while Scotland’s NHS announced it would pause puberty blockers and cross-sex hormones for children (NHS England had already paused puberty blockers in March).
There are suggestions that Belgium and the Netherlands may soon follow suit. Alberta Premier Danielle Smith even cited the Cass Review as justification for her government’s proposed gender policies. Support for Cass was not merely confined to conservative sources, as the report was portrayed positively in the New York Times, The Atlantic, and The Guardian, as well as by the editor-in-chief of The British Medical Journal.
Canadian media coverage of the Cass Review
As a major medical report on an issue where there is considerable Canadian political debate, one would have expected the Cass Review to garner considerable Canadian media attention.
To determine how the issue was covered in Canada, I conducted a content analysis of online articles from five mainstream media outlets (The Globe and Mail, National Post, Toronto Star, CBC, and CTV) from the three-week period following the Cass Review’s publication (April 10 – April 30, 2024). These five outlets published a total of 15 stories that mentioned the Cass Review. Given that three stories (all from the National Post) only briefly mentioned it in passing, and one Associated Press story was published in two outlets, this meant a total of 11 unique stories in which the Cass Review featured prominently.
Coverage was dominated by the National Post, which featured seven articles on the Cass Review over an 11-day period between April 10 and April 20. By contrast, there were only two stories featuring the Cass Review in the Toronto Star, and only one each in CBC, CTV, and the Globe. Apart from the one AP story, every article applied the Cass Review to the Canadian context, with six mentioning Alberta’s proposed gender policies. The stories were split between hard news (six) and opinion pieces (five).
Given the National Post’s longstanding focus on youth gender transition, it is not surprising that it gave the Cass Review the most coverage. The other four outlets did not give it as much attention. The only hard news piece in the Toronto Star was a wire story written by the U.S.-based Associated Press. CTV’s one mention of Cass appeared in a piece about Alberta’s proposed gender policies and was only the result of Premier Smith raising it during an interview with the outlet. Meanwhile, the lone CBC article on the review was more of a condemnation than a news report (see below). The Globe and Mail did not feature Cass in a single hard news article, though the report was mentioned in an investigative opinion piece about gender transition in Canada written 16 days after the review was published. In total, only three of the six hard news pieces quoted from the Cass Review extensively, including two lengthy pieces from National Post reporter Sharon Kirkey and one Associated Press piece (published in both the Star and Post).
While there were only five opinion pieces published about the Cass Review, they shared several notable characteristics. All five opinion pieces—three from the National Post and one each in the Toronto Star and The Globe and Mail—portrayed the review positively, including descriptions such as “landmark” and “an exhaustive and rigorous report.” All five were broadly supportive of exercising greater caution around the use of puberty blockers and cross-sex hormones for youth. The Post’s Adam Zivo called such restrictions “a wise approach that Canada should follow,” while the Globe’s Robyn Urback cited multiple studies “exploring the potential long-term effects of puberty blockers and cross-sex hormones on bone density, fertility, sexual function, and cognitive development” (links in original). Moreover, the five opinion writers demonstrated considerable knowledge of the review itself, with Cass quoted or paraphrased a total of 16, 11, eight, four, and three times, respectively.