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.