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National Post

Mia Hughes: Canada must launch review of paediatric gender clinic practices

Article content On May 1, the U.S. Department of Health and Human Services (HHS) released a bombshell 409-page report laying bare the troubling state of paediatric gender medicine. This moment presents yet another opportunity for Canada to reckon with a medical scandal that has long gone unaddressed. Article content Article content The HHS report highlights the exceptionally weak evidence used to support puberty blockers, cross-sex hormones, and surgeries for youth who identify as transgender, exposing how ideology dominates over science in the field of gender medicine. Its conclusion is damning: the medical establishment has failed vulnerable young people. Article content Article content The review was commissioned by an executive order from U.S. President Donald Trump, whose directive was laced with politically charged and inflammatory language. In sharp contrast, the report itself is measured and grounded in evidence. Its recommendations echo the cautious, evidence-based approach to gender-affirming care now taking hold across much of Europe, contradicting the ideological positions of all major medical associations in the U.S. and Canada. Article content Article content Acknowledging the political controversy surrounding the issue, the as-yet anonymous authors move past slogans and ideology to deliver a methodical, yet scathing, assessment of the current state of paediatric gender medicine. At the heart of the report is an 'umbrella review' that synthesizes all the existing systematic reviews for these interventions, including those conducted in Sweden, Finland, England, and Canada. Unsurprisingly, like every one of those prior systematic reviews, the HHS review concludes that the evidence is of 'very low' quality. That's because the research in this field, particularly surrounding claims that hormonal and surgical interventions improve mental health or reduce suicidality, is methodologically weak, lacking control groups or long-term follow-up. Meanwhile, the known risks of such interventions — infertility, reduced bone density, disrupted psychosocial development, and impaired sexual function — are not theoretical. They are documented outcomes of these interventions. Article content Article content Until now, the typical response to this lack of evidence has been to call for more research, but the HHS report makes clear that, given what we already know, further research cannot ethically be justified. It does so by invoking the Nuremberg Code — the bedrock of international research ethics — citing that the anticipated results justify the performance of the experiment — and the Belmont Report which report emphasizes that no trial should proceed unless the intervention has a 'favourable risk/benefit profile.' In paediatric gender medicine, every systematic review to date has found that the risks outweigh any potential benefits, making further research unjustified. Article content Article content Echoing the U.K.'s landmark Cass Report, the authors call for gender dysphoria to be 'de-exceptionalized,' meaning therapists need to approach treating these young people in the same way they would any other distressed patient. Instead of viewing them as 'transgender adolescents' in need of powerful hormones and drastic surgeries, the report suggests that therapists should help these young people 'develop self-understanding, engage with emotional vulnerability, and build practical strategies for managing distress.'