Four years in the making, the final “Independent Review of Gender Identity Services for Children and Young People,” written by esteemed pediatrician Hilary Cass, was released back in April. It was commissioned by NHS England in the United Kingdom, following well-publicized whistle-blowing over allegedly reckless medical experimentation on gender-confused children at the National Health Service’s prestigious Tavistock gender clinic (which was closed following the Cass Review’s inculpatory interim report in 2022).
The interim report alleged inadequate assessment, rushed medicalization, failures to safeguard children, indifference to the special vulnerability of autistic and same-sex attracted patients, substandard research, undue influence of political actors and intimidation of whistleblower staff.
Now, in the same plain language, the final report has brought the hammer down hard on the presumed gold standard of treatment for gender-confused children and teenagers: “gender affirmation.” In practice, gender affirmation translates into rapid access to puberty blockers, then to cross-sex hormones and surgeries, with little or no traditional therapeutic exploration of other mental-health issues.
Amongst the report’s key findings were: “poor quality” of studies adduced by ideologues to support the need for gender affirmation; “weak evidence” on the benefits of puberty blockers; and the inability to distinguish with certainty those whose gender dysphoria was permanent from those whose confusion would resolve after puberty without intervention (the vast majority, according to reputable data).
The most important conclusion was that, “For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress.” Even for those clearly eligible for a medical pathway, “it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.”
Taken together, these findings, along with the report’s recommendation that therapists should consider youngsters “holistically and not solely in terms of their gender-related distress,” should have sparked a crisis of conscience and an outburst of debate in Canada’s medical community.
Yet the theories and treatment that the Cass Review deplores continue to be considered best practices in Canada. Indeed, the Trudeau government favours the “gender affirmation” model so enthusiastically, it passed a “conversion therapy” law that potentially criminalizes the withholding of cross-sex drugs from, or offering holistic psychotherapy to, gender-confused children.
But no such debate in medical circles has occurred in Canada. According to Montreal endocrinologist Roy Eappen, Calgary pediatrician J. Edward Les and U.S. researcher Ian Kingsbury — authors of a comparative study recently published by the Aristotle Foundation for Public Policy (AFPP) in collaboration with Do No Harm, a medical policy non-profit — Canadian medical professionals remain “cowed” on the issue of pediatric gender medicine.
The AFPP report compares the gender transition policies for children and teenagers in the United States and Canada with those of northern and western Europe. The authors looked at metrics across many jurisdictions, including the minimum age for prescribing puberty blockers and cross-sex hormones, the minimum age for sex-reassignment surgery and the requirements for medical transitioning.
They found that, “Canada and the United States are the most permissive countries when it comes to the legal and medical gender transition of children.” For example, in Canada, outside of Alberta and Nova Scotia, there is no minimum age for puberty blockers, a policy mirrored only in France, Iceland and Ireland.
In the U.S., robust debate on the subject flourishes. U.S. whistleblowers in gender clinics, for example, are given platforms in the media. And some American detransitioners — who were once marginalized, shunned and browbeaten into silence by trans activists — are becoming a burgeoning, organized force, some of them assuming high public profiles as victims of rapid gender affirmation.
Chloe Cole, a 20-year-old from California, for example, thought she wanted to be a boy when she was 12 and was rapidly affirmed, with all the medical intervention implied. Now detransitioned, she has been described as “the face of a national movement.”
As evidence of the movement’s growing traction, in February, the New York Times published an in-depth, sympathetic feature article on detransitioners. Of the parents who told the Times they felt their kids were gay or suffered from other issues, “all said they felt compelled by gender clinicians, doctors, schools and social pressure to accede to their child’s declared gender identity even if they had serious doubts.”
Canadian Aaron Kimberly, 50, a transman who transitioned as an adult, was interviewed for the article. Kimberly left the British Columbia clinic where he dealt with the intake and assessment of gender-dysphoric youngsters when the gender-affirmation model was introduced.
Kimberly said he was reluctant to recommend hormone treatment for patients who he deemed “severely unwell,” and when he referred patients for further mental health care, he was accused of “gatekeeping.”
“I realized something had gone totally off the rails,” he said.
Kimberly subsequently founded the Gender Dysphoria Alliance and the L.G.B.T. Courage Coalition, a group of LGBTQ+ adults who reject gender affirmation as “not evidence-based.”
The AFPP report has recently been publicized by some high-profile people. Elon Musk tweeted a snappy graphic highlighting its findings, which has received nearly 30 million views since August 2. Likewise, Conservative Leader Pierre Poilievre tweeted a link to an op-ed published in these pages by the report’s authors.
If all this publicity doesn’t provoke self-interrogation amongst Canadian medical associations, gender clinics and rational liberals regarding the risks associated with the gender affirmation model, then what will? Discuss amongst yourselves.
National Post
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