How Canada Jumped the Rails on ’Gender-Affirming Care’: A Quillette Investigation
On May 12, I published a Quillette essay criticizing the Canadian Paediatric Society’s ongoing advocacy of “gender-affirming care” for transgender-identified minors. The practice of gender-affirming care, sometimes referred to as GAC, is based on the principle that health professionals should uncritically accept the claimed gender identity of dysphoric patients; and, where possible, facilitate their access to puberty blockers, “gender-affirming hormone therapy,” and “gender-affirming surgeries.”Those latter euphemisms—which helpfully serve to obscure the risks of stunted development, painful physical disfigurement, sterility, and sexual dysfunction—entered common usage in the 2010s, a period during which transgender identification became an object of fascination in popular culture. The number of minors seeking referrals to gender clinics exploded in western nations. By far, the largest demographic consisted of adolescent females—many of them suffering from autism, trauma, psychiatric comorbidities, and internalised homophobia—who’d become convinced their anxiety and pain were caused by being trapped (as the expression goes) “in the wrong body.” The idea that doctors should uncritically heed a patient’s self-diagnosis was an unsettling innovation, and one that is generally alien to other branches of health care. To this day, the Canadian Paediatric Society proselytises the idea of gender identity as a soul-like ether that most children can categorise reliably when they are just three years old. In many cases, old-fashioned conservative stereotypes about what boys and girls are supposed to wear, what colours they should prefer, and what toys they should play with have been transformed into purportedly meaningful indicators that could eventually serve to propel a child down a life path that includes amputated body parts and a lifelong drug regime. Possible evidence of gender identity, the CPS indicates to parents who consult its “Caring for Kids” resources, for instance, includes the fact that she refuses to put on a dress, “even on special occasions.” Detail from a public-service document published on the Canadian Paediatric Society web site.By the early 2020s, the mania for “affirmation” properly became an object of concern among medical experts, who noted that the underlying theory was based more on slogans than science; and that the studies purporting to support GAC’s efficacy typically were marked by small samples, biased design, and circular reporting. A vocal detransitioner community emerged, with harrowing tales of gender-clinic doctors eagerly expressing their “allyship” with a hastily produced set of drug prescriptions.Canada’s Paediatric Gender Medicine Must Follow EvidenceWhile other jurisdictions adopt balanced, evidence-based protocols for treating gender dysphoria, the CPS has doubled down on an obsolete policy instructing doctors to reflexively ‘affirm’ trans-identified youth.All of this has been pointed out to the CPS leadership in peer-reviewed form. But the organisation still stands by its original 2023 Position Statement on the subject of GAC—a document that exhorts Canadian doctors to adopt an “affirming approach to routine health care provision for all youth,” and enshrine gender-affirming care as the unquestioned “standard of care for transgender or gender-diverse youth.” The timing of the CPS Position Statement was unfortunate, as it came less than a year before Dr Hilary Cass, a former president of Britain’s Royal College of Paediatrics and Child Health, released a blockbuster Report that exhaustively analysed the international evidence for and against gender-affirming care. Critics had been picking GAC apart for years by this point. But what Dr Cass achieved was on another level: The Cass Review, as it has come to be called, was the most authoritative analysis of the available literature regarding the treatment of gender dysphoric minors that had ever been published. It still is. Dr Cass concluded that the “potential risks to neurocognitive development, psychosexual development, and longer-term bone health” associated with the use of puberty blockers to treat trans-identified children are substantial.” The Cass EffectA landmark report properly emphasises the application of science, not slogans, in establishing treatment protocols for trans-identified children.Her analysis also showed that the widespread claim that “hormone treatment reduces the elevated risk of death by suicide” among trans-identified youth isn’t supported by the available evidence. This latter conclusion was especially important, because the morbid claim that trans-identified children are at imminent risk of suicide without rapid and enthusiastic “affirmation” from all quarters had always been deployed as a propaganda weapon of last (and sometimes first) resort by activists and “gender-affirming” medical personnel. Indeed, many whistleblowing parents who’d expressed scepticism of the GAC provided to their children have reported hearing some version of this ghoulish theme from zealous therapists and doctors. Moreover, the idea that gender affirmation was a form of suicide prevention turned what had once been a medical debate into a contest of moral virtue, as it allowed GAC proponents to present their movement in heroic life-or-death terms—an epic human-rights struggle against heartless (and presumably transphobic) naysayers who were prepared to condemn transgender children to the grave. To this day, in fact, this self-valorizing nature of the GAC movement seems to be one of the main attractions for social-justice minded medical-school graduates. Critics initially tried to dismiss Dr Cass as a stooge of right-wing Bible-thumpers, and confidently predicted that her analysis would collapse under scrutiny. But that didn’t happen. Just the opposite, in fact: The British Medical Union (BMU), the trade union for British doctors, spent two years trying to debunk the Cass Review at the behest of the union’s pro-GAC activist constituency. Yet once this singularly thorough investigation of Dr Cass’s work wrapped up in early 2026, the BMU wound up conceding that Dr Cass’s “robust” analysis had been vindicated. Dr Cass’s report effectively sounded the death knell for the “affirmation” model in the UK, and did much to accelerate the rollback of GAC policies internationally—and not just in conservative jurisdictions such as Republican-controlled U.S. states. Socially progressive nations that have rolled back GAC-style policies in recent years include not only the UK, but also Denmark, Finland, the Netherlands, Sweden, Norway, New Zealand, and Italy. Many on the left have attacked the Cass Review that raised serious concerns over gender identity treatments for children. They often cite opposition of the British Medical Association. Yesterday, the BMA dropped its opposition after reviewing the study... https://t.co/8UNAzOKf6p— Jonathan Turley (@JonathanTurley) May 7, 2026
Since the Cass Review was published, more primary research has emerged in support of Dr Cass’s conclusions. This includes newly released Finnish data, covering every under-23-year-old individual who’d been referred for gender treatment in Finland between 1996 and 2019—a cohort containing almost 2,100 people. Following gender-clinic referrals, the study found, clinically trans-affirmed patients exhibited greater psychiatric morbidity than members of a control group. While all of this has no doubt comprised a bitter pill to swallow for doctors and therapists who’ve devoted their careers to the precepts of GAC, these professionals have a responsibility to align their clinical practice with the best available research, no less in Canada than anywhere else. And on this basis, I (somewhat earnestly) concluded my May 12 article with a prediction that the CPS would surely (if belatedly) catch up with its international counterparts. “Doctors don’t live in a bubble,” I wrote. “And it is only a matter of time before new leadership drags such organisations [as the CPS] into the post-Cass era.”Recommendations from a 20 June 2023 Position Statement published by the Canadian Paediatric Society, titled, An affirming approach to caring for transgender and gender-diverse youth.Just eleven days after my column appeared, the CPS made nonsense of my words with the choice of its new President: an unusually zealous gender-affirmation advocate named Natasha Johnson. Dr Johnson, a Paediatrics professor at McMaster University in Hamilton, Ontario, not only champions the right of dysphoric minors to access gender-affirming care: She’s devoted much of her professional life to personally stewarding them on their “gender journeys,” having founded McMaster’s youth GAC program in 2016. It may not rank as the worst prediction I’ve made during my journalistic career. But I’m fairly certain it was the most rapidly falsified.
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