Amid the flurry of executive orders signed by Donald Trump on his first day back in office was one taking direct aim at the gender ideology that has held sway over mainstream medical institutions and political policymaking for the past decade or so: he declared that his administration was restoring “biological truth to the federal government” and would “only recognize two sexes, male and female.”
Here at home, Pierre Poilievre, being asked his thoughts on this order, declined to condemn it, stating that he was “only aware of two genders,” and that his preference is for a government that leaves people alone to make their own decisions. Meanwhile, two new reviews by Canadian researchers on puberty blockers and cross-sex hormones for young people concluded there was such low certainty about the drugs that it’s nearly impossible to determine if they help or harm. Harm could include irreversible risks to fertility or brain development.
This apparent shift away from progressive orthodoxy on the topic follows on recent developments in Britain, where the government has announced an indefinite ban on puberty blockers for under-18s who identify as transgender, outside of clinical trials. Health Secretary Wes Streeting stated that the decision follows expert advice that deemed the drugs “an unacceptable safety risk” for young people.
The announcement makes permanent the temporary ban enacted in that country earlier this year after the final report of the landmark Cass Review was published, revealing “remarkably weak” evidence supporting the use of puberty blockers and cross-sex hormones to treat young people who identify as transgender. Streeting described the way these drugs have been used thus far as “a scandal.”
Released in April, the Cass Report marked a pivotal moment in the debate over pediatric gender medicine. It was the result of a four-year investigation By Dr. Hilary Cass into England’s youth gender service that stands not only as the most comprehensive review of the contentious field of gender medicine ever undertaken but also as one of the most thorough examinations of any medical treatment ever conducted.
In its wake, Scotland joined England in halting the use of puberty blockers in gender clinics. Doctors in Belgium and the Netherlands called for similar guardrails to be put in place. These nations now join Finland, Sweden, Norway, France, and Italy in restricting or calling for restrictions on these experimental medical interventions for adolescents.
This raises a pressing question: will Canada finally recognize the shifting landscape and take action to protect vulnerable Canadian youth from the same unacceptable risk?
With the notable exception of Alberta, Canada continues to ignore the findings of the Cass Report, preferring instead to pretend that the science is settled and that puberty blockers are a safe and evidence-based treatment for gender-confused youth. The Canadian Pediatric Society even went so far as to attempt to discredit the Cass Review, calling it the work of a “single author” and implying that it has little relevance to Canada. This was coupled by critical coverage from the CBC.
Similarly, the Canadian Medical Association criticized Premier Danielle Smith’s proposed legislation, describing puberty blockers and cross-sex hormones for adolescents as “evidence-based.” This is, quite simply, misinformation. When every systematic review of youth gender medicine to date has found the evidence to be exceptionally weak, these treatments are anything but evidence-based.
If pediatric gender medicine were based on evidence, the puberty suppression experiment would have been halted from its inception. Puberty blockers were promoted as a reversible way of giving children identifying as trans additional time to decide if they wanted to transition. The gender-affirming hormones were promoted as a way to then induce their desired bodily features.
But foundational Dutch studies upon which the entire practice is built reported a fatality rate of nearly 2 percent and were riddled with methodological flaws so severe that no credible researcher would take them seriously. What’s more, the drastic, irreversible treatment protocol that has the potential to leave adolescents sterile contradicts everything known about child and adolescent development.
It is unfathomable that such an approach entered mainstream medical practice.
Yet it did. Because gender medicine is driven by ideology rather than evidence. The puberty suppression experiment aligned seamlessly with modern trans activism, which insists on affirming transgender identities and falsely equates ethical psychotherapy aimed at reconciling body and mind with conversion therapy.
Cass underscored this ideological influence in her report, describing the affirmative model of care, which has been widely adopted by Canadian gender clinics and applied by some “progressive” family physicians as being “based on a social justice model.”
A frequent complaint from those who oppose bans on these controversial interventions is that governments have no business meddling in the doctor-patient relationship. Under normal circumstances, this would be a fair criticism. However, these are not normal circumstances. When it comes to gender medicine, medical regulators and professional associations have shown themselves to be untrustworthy, leaving responsible governments little choice but to intervene on behalf of vulnerable young people to restore patient safety.
In truth, science does not respect national borders. The systematic reviews conducted in England, Sweden, and Finland all show that the evidence for puberty suppression is exceptionally weak.
The same holds true in Canada, presenting an urgent public health crisis that demands immediate action at both the federal and provincial levels.
At the federal level, Health Canada can act now to impose restrictions on these unproven drugs, if and until clinical trials prove otherwise. Typically, Health Canada would conduct its own review of the safety and efficacy of puberty blockers. In this case, it could do so swiftly, using the extensive evidence from around the world that has formed the basis of decisions in other countries.
Puberty blockers are but one part of the ideologically infected field of gender medicine. To ensure evidence takes the place of activism, the federal government should work closely with the Canadian Medical Association and the Canadian Pediatric Society to insist that they abandon their ideological stance, recognize the findings of the Cass Report, and establish national guidelines restricting the use of puberty blockers in gender clinics. While not under the direct authority of the federal government, these entities are closely connected to it, and like their provincial counterparts, are intertwined with the provincial professional medical colleges.
In the face of potential politicization from the provinces, the federal government could signal its seriousness by indicating a willingness to tie health transfers to meaningful action to not just ban puberty blockers but take action to rid gender medicine of unhealthy activism. In response to intransigence from health associations, the federal and provincial governments could exert indirect pressure through their arms-length influence over the Royal College of Physicians and Surgeons of Canada (RCPSC), through policy changes to health-care regulation, funding, licensing, and education priorities.
It is a scandal that so many young people have been subjected to irreversible medical treatments without evidence of their safety or effectiveness and without any long-term data demonstrating positive outcomes. Equally shameful is the failure of Canadian politicians to protect these youth from unproven and harmful interventions. Canadian leaders must act to ensure the safety and well-being of the nation’s most vulnerable.
