Two new Canadian reviews have found there is inconclusive medical evidence to support minors receiving medical treatment to change their gender.
The two research reviews are the first in Canada to assess medication for gender-affirming care.
The reviews, which were both published in January, follow a string of similar European reviews. These reviews also concluded there was insufficient evidence to support the gender-affirming care model, which treats gender dysphoria with medication and surgery.
“The recommendations following any rigorous systematic review, [which] all basically say the same thing, [is that] we need to exercise caution,” said Chan Kulatunga-Moruzi, co-author of the review and an independent scholar.
The reviews were supervised by Dr. Gordon Guyatt, a health sciences professor at McMaster University. Guyatt is an inductee into the Canadian Medical Hall of Fame and the 2024 recipient of the prestigious Henry G. Friesen International Prize in Health Research for his leadership in evidence-based health research.
Both reviews were funded by the Society for Evidence-Based Gender Medicine, an advocacy group critical of gender-affirming care for transgender youth. The society commissioned the studies from McMaster University and did not manage the study.
Unlikely to spur change
Many European countries — including the U.K., Sweden and Finland — have recently imposed restrictions on gender-affirming care. These restrictions followed the publication of national reviews discouraging medical and surgical intervention for gender transition in minors.
But Canada’s reviews seem unlikely to spur change among Canadian medical practitioners, sources say.
Most of Canada’s medical associations and provincial health authorities have not updated their practice guidelines in response to the reviews conducted by other countries.
In response to a request for comments, the Canadian Medical Association, a national association for physicians, sent Canadian Affairs a February 2024 press release stating the organization “strongly opposes government efforts to restrict access to care.”
That press release was originally published in response to Alberta’s stated plan to introduce legislation restricting medical treatment for transgender minors. In December 2024, Alberta enacted restrictions on gender-affirming care for youth, becoming the first province to do so.
Under Alberta’s law, youth under 16 cannot be prescribed medication for gender transition, subject to limited exceptions. The law also prohibits physicians from performing gender reassignment surgery on youth under 18.
“Ensuring children have universal access to a full range of medical care is essential for their well-being,” the Canadian Medical Association’s press release says.
“By providing comprehensive health care options, we affirm the dignity and humanity of transgender individuals, reinforcing the notion that everyone deserves access to the medical support necessary for authentic self-expression,” it says.
‘Want to take a chance?’
One of the new Canadian reviews evaluated 10 peer-reviewed research studies on the “evidence regarding the effects of puberty blockers in youths with gender dysphoria.”
The review found that “there remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing [gender dysphoria].” Gender dysphoria is the psychological distress felt when one’s sex does not match their gender identity.
The second Canadian review evaluated 24 peer-reviewed medical studies that examined the effects of gender-affirming hormone therapy in individuals with gender dysphoria. Gender-affirming hormone therapy refers to the use of cross-sex hormones to promote the development of sex characteristics of the opposite sex in patients.
Both systematic reviews concluded that they “cannot exclude the possibility of benefit or harm” of the respective medication studied in the review.
Both reviews recommended further study on the effects of puberty blockers and hormone therapy to “produce higher certainty evidence” for medical intervention to treat gender dysphoria.
Guyatt, who supervised the reviews, says they should spur clinical practitioners to acknowledge the potential risks of using medical treatments for gender transition.
“[The clinician should say to patients,] ‘So here’s the situation. Maybe [the medical treatment] helps, but we have no idea. Probably has some harms associated with it, but the magnitude we have little idea. So, you want to take a chance?’,” he said.
Kulatunga-Moruzi, one of the study’s co-author, says it is up to medical institutions to change their medical practices based on these reviews.
“It is my hope that once the reviews are known, that medical organizations … will use them to develop evidence-based guidelines,” she said in an email statement.
The Canadian Pediatric Society, the national association of pediatricians, recommends on their website that “Gender-affirming care must be upheld as [the] standard of care for [transgender or gender-diverse] youth.”
The society did not respond to multiple requests for comment on the recent Canadian reviews.
The B.C. Ministry of Health said in an emailed statement that they “remain committed to providing British Columbians with comprehensive and compassionate gender-affirming care based on available research and evidence, which is routinely reviewed and validated by prescribing clinicians operating under Health Canada guidelines.”
Medical associations in Ontario and Alberta and Ontario’s health ministry did not respond to requests for comment about the reviews.
Politicized issue
The topic of gender-affirming care for minors has become politicized, says Kulatunga-Moruzi. Liberals largely support the gender-affirming care model, while conservatives criticize it, polls show.
But Kulatunga-Moruzi, a self-described liberal, says she evaluates the issue through an evidence-based lens.
The topic has become a growing concern for people across the political spectrum, says Dr. Joanne Sinai, a registered psychiatrist in B.C. In the hospital, she has seen the rise of gender-diverse youth seeking mental health services since the early 2010s.
Sinai, who also describes herself as a liberal, says many medical practitioners have come to have concerns regarding the gender-affirming treatment model. But many critics of the model are often afraid to speak out for fear of being labelled right-wing and transphobic, she says.
“I think this topic should really cross over any political boundaries, because everyone wants to protect vulnerable children,” said Sinai, who is associated with the Society for Evidence-Based Gender Medicine.
Kulatunga-Moruzi says there needs to be more open communication between researchers, medical practitioners and gender-diverse patients and consideration of the evidence of gender-affirming care in order to seek the most effective interventions for gender-diverse minors.
“[H]opefully with better dialogue with clinicians, with patients, with detransitioners, with families, we could come to a more informed approach,” says Kulatunga-Moruzi. “I think right now, there’s been little dialogue, and I don’t think that that’s helpful.”
FINALLY!
The trans activist Community does not care about kids, or science, nor does that community acknowledge, let alone hear the thousands of desister and detransitioner voices screaming for recognition.
Whoever made up the expression “gender-affirming care” should be put in jail for making the process of castrating children sound like something gentle and even desirable instead of the mutilation that it is
👏👏👏
Historically, and in all cultures there has always been a small minority of people with transexual identities, either because of hermaphroditism or out of choice. Unfortunately these people have often been shunned and reviled. And recently they have become the focus of right wing fear mongering. It would be good if we could tone down the fear and rhetoric on all sides of this issue. In my opinion the internet and the increase in smartphone use among teens and pre-teens has led to a rise in transitioning and non-binary gender identities in young people. In other words, it has become a fad. For this reason I think the medical profession should be a lot more cautious than they have been in facilitating sex changes in minors, so I agree with Alberta’s decision to restrict hormone therapy and surgical interventions in those under eighteen. I think there is a lot of over-reaction going around, from young people convinced that they’re in the wrong body, to right-wing political operatives manufacturing fear, to medical professionals getting overly defensive about questionable decisions.
Follow the money. Surgeons & pharma make $1,500,000 per trans patient. $200,000 to $300,000 for surgery, and $1,200,000 for the dangerous, non-FDA approved drugs they must take for the rest of their lives. They are maiming our children to make billions and they belong in jail.