The Debate over Gender-Affirming Care

 

(Note:  The following post is drawn from an academic article I wrote entitled "Trans and Women's Rights" that will be published in August 2026 in Human Rights Quarterly.  Please contact me if you would like my sources for any of the material below).

A huge controversy has erupted at McMaster University in Hamilton, Ontario over the effectiveness of gender-affirming care. According to an article in The Hamilton Spectator on September 6, 2025, Dr. Gordon Guyatt and his colleagues concluded that “good-quality evidence was lacking for mastectomy, hormone therapy, and puberty blockers [as treatments] for young people with gender dysphoria.” These conclusions have angered some trans activists.

Yet Dr. Guyatt’s results are not surprising. Several European studies came to the same conclusion.   

A Finnish study found that 75 per cent of adolescents who wanted sex-reassignment surgery had other psychiatric problems. Most were girls with no history of gender dysphoria: seventy-five per cent had histories of severe psychopathology. The Finnish Council of Choices in Healthcare concluded that medical transition for minors was “an experimental practice.”

Noting similar concerns, the Astrid Lindgren Children’s Hospital in Stockholm announced in April 2021 that aside from clinical trials, it would no longer prescribe cross-sex hormones and puberty blockers to children under 18.

In 2023, the Norwegian Healthcare Investigation Board concluded that there was “insufficient evidence for the use of puberty blockers and cross sex hormones in young people, especially for teenagers.” Therefore, such treatments should be considered “treatment under trial.”

In a 2024 summary report, the European Academy of Paediatrics [EAP] noted that “the severity of discomfort that GD [Gender Dysphoria] produces in prepubescent children varies and is often transient….[L]ong-term follow-up studies suggest that over 80% of boys referred …to GID [Gender Identity Development] services desisted from gender dysphoria in adulthood.” The EAP also argued  that  “the role of social media [in persuading children that they were trans]…is overdue serious academic exploration,” suggesting that social media may be convincing children that they should unnecessarily change sex.

Between 2009 and 2019, the number of boys treated at the United Kingdom’s Tavistock Gender Identity Development Service rose from 40 to 624, while the number of girls rose from 32 to 1,740.  “[S]ome whistle-blower clinicians [reported] that significant numbers of trans-identifying children and teens are same-sex attracted…[and] seem to be interpreting their own patterns of sexual attraction as a sign that they must have a mis-aligned gender identity.”

As a result of the controversy over its gender-reassignment practices, the British government appointed Dr. Hilary Cass to prepare a report on trans medical treatment. Her report noted broad agreement that the increased number of young people presenting trans identities was “a result of a complex interplay between biological, psychological and social factors.” It also stated that there was “no reliable evidence base upon which to make clinical decisions…The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health.” Moreover, “the use of masculinising/feminising hormones in those under age 18 also presents many unknowns.”

The Cass Report further found that “Not enough is known about the longer-term impacts of puberty blockers for children and young people with gender incongruence to know whether they are safe.” Thus, it argued, “For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress.”

Yet some activists have vilified Cass for claiming that the use of puberty blockers is as yet untested and may be dangerous. Cass was advised after issuing her final report that she should not take public transit, given the many threats of violence against her. 

This is the same kind of vilification that Dr. Guyatt, and his colleagues are now enduring. One suspects that if Dr. Guyatt’s research discovered strong evidence that gender-affirming care has positive results, activists would be cheering, not vilifying, him. 

 

Ordinary (Israeli) Men: Jewish Guards in a Gaza Prison 1991

 Ordinary (Israeli) Men: Jewish Guards in a Gaza Prison, 1991

Lately, (August 2025) I have been reading the Israeli journalist Ari Shavit’s 2013 book, My Promised Land: The Triumph and Tragedy of Israel (Spiegel and Grau). This is an episodic history of the establishment of the state of Israel, and how it affected the original Palestinian residents. The entire history is too complicated for me to summarize here: I just want to focus on one small part of it.

In 1991 Shavit was a member of the Israeli military reserve. During his compulsory one-month annual tour of duty, he was assigned to act for 12 days as a guard in a Gaza beach Detention Camp. This prison was built in response to the 1987 intifada, an uprising by Palestinians against Israel. At first, Shavit thought he should decline the posting and risk being jailed. Then he thought that since he was a journalist, it would be better to become a guard and write about what it was like. He did so, writing a 3000-word account that he published in 1991 and re-published in his later book (pp. 227-36).

The behavior of these Israeli guards resembles that of the men in Battalion 101, the subject of Christopher R. Browning’s book Ordinary Men: Reserve Police Battalion 101 and the Final Solution in Poland (1998), These were ordinary middle-aged German men, too old to be drafted into the army, who were conscripted to the killing fields of Eastern Europe instead. Browning recounts how easily these men adapted to their new jobs, especially to the group dynamic required for them to engage in mass killings and round-ups of Jews.

The Israeli guards in 1991 were not engaged in mass killings, of course. Rather, they guarded, interrogated, and humiliated their prisoners. For example, three or four times a day, the Palestinians had to scrub the Israeli guards’ toilets. Once a young prisoner was “broken” through interrogation and revealed names of his friends, Israeli soldiers fanned out to arrest the friends, often bringing them back already beaten to the camp. The camp doctor, as Shavit observed, was no Mengele, yet he screamed at a beaten 17-year-old prisoner in severe pain, “I wish you were dead.” (p. 231) Everywhere Shavit went, he heard the screams of men and boys being tortured. And he knew that these men and boys were not traitors, spies or terrorists.

Shavit’s account varies in one significant way from Ordinary Men. The Jewish guards were aware of what they were doing and discussed it. One guard, observing the teen-aged prisoners, said “How have we come to this? How have we come to chasing such kids?” (p. 231) Another guard commented sarcastically that he “ha[d] accumulated so many days of reserve duty during the intifada that they [would] soon promote him to a senior Gestapo official.” (p. 231) Another, observing a line of prisoners moving under guard, says “Look, the Aktion has begun.” (p. 230) (Aktion was the German term for round-ups of Jews). Others commented on the similarity of the Gaza prison watchtowers to the watchtowers in the concentration camps their parents or grandparents had survived.

Only one or two of sixty reserve guards recruited along with Shavit refused duty in the interrogation wing. The others adjusted. Just as Nazis adjusted to mass murder via its bureaucratic routinization, so the prison camp in Gaza ran smoothly through a division of labor.

Shavit was a guard back in 1991. Imagine how guards are behaving now. I have read horrific accounts of Israeli tortures of Palestinian prisoners over the last several years. Often these accounts are written by Jewish authors critical of Israeli policies. One article I recently read described how many recently-imprisoned Palestinians have had to have their hands amputated, because the handcuffs they were forced to wear for days at a time cut off all circulation to their hands. 

Presciently, by the way, Shavit wrote in 1991 that “One day, when Free Palestine is established, its government will surely lease this piece of land to some international entrepreneur who will build the Gaza Beach Club Med.” (p. 228) This is what international entrepreneur and corrupt President Donald Trump wants, though he intends to first expel all the Gazans who aren’t killed by Israeli forces, or die of starvation or disease.

Pre-War Malnutrition in Gaza and the West Bank

 

Pre-War Malnutrition in Gaza and the West Bank

In 2016 I published State Food Crimes (Cambridge University Press). This book analyses the causes of starvation and malnutrition in several historical cases and four contemporary cases, my research ending in 2015. In North Korea, starvation was already occurring. In Venezuela and Zimbabwe, state policies were causing severe malnutrition and the beginnings of starvation. In the Occupied Territories (OT), Gaza and the West Bank, rates of malnutrition were very high.

This blog is a short summary of my findings about the OT, in chapter 7 of my book, pp. 114-31. (I have published other blogs about the West Bank in the past: see “Water Rights of West Bank Palestinians (2013) https://rhodahassmann.blogspot.com/2013/08/water-rights-of-west-bank-palestinians.html, and Property Rights of West Bank Palestinians,” (2013) https://rhodahassmann.blogspot.com/2013/05/property-rights-of-west-bank.html/)

In 2012, the rate of malnutrition in the Arab world as a whole was about 10 per cent. Yet in the same year, 31 per cent of people in the OT were undernourished, while 42.2 per cent suffered from food inadequacy. By the 2010s, 80 per cent of Gazans relied on food aid.

 In the West Bank, Palestinians found it increasingly difficult to herd animals or cultivate crops while illegal Israeli settlers took over their land. The government also confiscated land for nature reserves, transportation corridors restricted to Israeli citizens, and military firing ranges. The illegal wall that Israel constructed on West Bank territory cut off some farmers from their land, which was on the other side of the wall from their dwellings.

West Bank Palestinians also suffered from lack of water, at the same time as Israeli settlers had swimming pools. Palestinians required permits to build new wells, which the Israeli government rarely granted. Then as now, some settlers deliberate uprooted Palestinians’ olive trees and polluted their wells.

After it withdrew its settlements in 2005, Israel blockaded access to Gaza by sea and air. It also declared about 29 per cent of Gaza along its eastern and northern border to be a “no-go” buffer zone closed to Gazan farmers and herders, yet almost a third of Gaza’s arable land lay in that zone. In 2009 Israel imposed a three nautical mile limit on Gazan fisheries, even though Gazan fishing waters were supposed to extend for twenty nautical miles. After the 2012 war, the limit was changed to just over 5 nautical miles.

In early 2009, only 20 per cent of Gaza’s water was drinkable, as a result of Israeli restrictions on fuel and chlorine needed for water treatment plants. By 2014 only one-tenth of Gaza’s water was fit for drinking. Many children suffered from diseased caused by polluted water, in part because Gaza lacked electricity to treat sewage plants. In 2015 Israel announced that it would double its supply of water to Gaza, but this was still far from enough.

Blockaded on all sides by Israel and Egypt, and with their own capacity to produce food severely restricted, Gazans needed to import about 400 truckloads of food a day from Israel to survive.  Yet the several wars between Israel and Gaza in the 2000s and 2010s resulted in severe reductions of the amount of food entering the territory. In 2008, Israel’s Ministry of Defense cynically calculated that the minimum number of truckloads per day needed was 106, including 77 truckloads of food and 29 of other humanitarian goods. This calculation did not take into consideration inequitable distribution of food within Gaza, or the despoiling of food as trucks waited to get through checkpoints into Gaza.

It is not surprising, then, that as a result of Israel’s actions during the terrible war since October 7, 2023, Gazans are now starving. This is “genocide by attrition,” a term coined by the late (Jewish) scholar Helen Fein, which she originally applied to countries like Cambodia under Pol Pot (1975-1979), as well as to the way that the Nazis murdered Jews and others in concentration camps by starvation, disease, and lack of clean water.

Hamas bears responsibility for starting this terrible war. It also bears responsibility for neglect of its own people and conducting warfare from civilian locations. Egypt also bears responsibility for its own blockade of Gaza.

But it is Israel’s decision not to permit the several hundred truckloads of food aid per day that Gazans need to enter the territory. It is also Israel’s decision not to permit reputable international agencies into Gaza to distribute what little food gets in, instead relying on paid mercenaries to guard supplies (by killing Gazans desperately seeking food) and distribute it in a random fashion. Foreign governments such as my own (Canadian) government have also bought food for Gaza and are prevented from sending it into the territory.

 

 

 

Letter to the US Ambassador

Here is a letter I am sending to the US Ambassador to Canada.  Venting my spleen, probably. This so-called Ambassador recently called Canadians "Nasty" (Trumps favourite word) because so many have decided not to travel to the US since Trump took power for the second time.  I truly believe that the US is now a fascist state.  Immigrants (especially Hispanics and Blacks) are the new Jews. 

Ambassador Pete Hoekstra,

Embassy of the United States to Canada,

PO Box 866, Station B,

Ottawa, Ontario K1P 5T1

 

July 29, 2025 

Mr. Hoekstra:

I am one of millions of Canadians who object to your depiction of us as “nasty” because we are boycotting travel to the US and US goods, as a reaction to bullying by your President.

You, sir, are a diplomat. Diplomats are supposed to use language that is courteous and tactful. Instead, your language is childish, churlish and crude.

Further, as you well know, the “nastiest” and most evil man in the Western world today is President Trump.  He—and you as his sycophant--is bullying the rest of the world about tariffs. He is causing immense suffering and pain within the US by his cuts to welfare programs and medical care. He is a fascist. He undermines the rule of law, undermines freedom of the press, and has declared entire classes of people persona non grata. When armed, masked men without any identification or accountability can arrest people without cause on the streets of American cities, we know we have already entered the fascist era.

Shame on you.

 

Letter to Israeli Ambassador opposing starvation in Gaza

 Here is the text of a letter I have just sent to the Israeli Ambassador to Canada (I am a Canadian).  I encourage anyone who feels as I do to write to the Israeli Ambassadors to their own countries.

Ambassador Iddo Moed'

Embassy of Israel,

50 O’Connor Street.

Ottawa, ON K1P 5E1

 

Your Excellency, 

I am writing to you in my dual capacity as a Jewish Canadian and a retired scholar of international human rights and comparative genocide studies. I wish to express my extreme concern about the ongoing war crimes, crimes against humanity, and possible genocide being committed by the state of Israel in Gaza. I am particularly concerned about the starvation that Israel’s continual blockade is causing.

Prime Minister Netanyahu has denied that there is starvation in Gaza. This is an outright lie. Israel is engaging in what the late (Jewish) scholar Helen Fein called genocide by attrition. An example of genocide by attrition is the Holocaust. Jews who were not outright murdered were starved to death, both in the camps and in the ghettoes.

Many pro-Israel organizations consider comparison of the current situation in Gaza to the Holocaust to be anti-Semitic. Sadly, however, this comparison is apt. I happened to be reading a book about the murders of Jews in Lithuania at the same time I was reading news stories about Gaza. In the concentration camps, Nazis fed Jews thin soup with potato peels. In Gaza, mothers are forced to feed their children thin soup with a few lentils.

Please stop this starvation at once.  Air drops are insufficient and dangerous.  The so-called Gaza Humanitarian Fund is a farce. Truckloads of food donated inter alia by the Canadian government and various well-established, efficient and knowledgeable non-government organizations are waiting at Gaza’s border. Let them in.