The medical establishment in Germany is calling on the government to replace its politically motivated approach to treating gender dysphoria with an evidence-based approach.

Medical transitioning may be “one of the greatest ethical scandals in the history of medicine.”

Report from French Senators
  1. ↩︎

“…there were no statistically significant changes reviewed in gender dysphoria or mental health outcome measures whilst on puberty blockers.” – Cass Report

These systematic reviews all reached the same conclusion: there is no high-quality evidence to support medical transitioning for minors. 

“…if no high quality evidence for medical transitioning is established in the coming years – that medical transitioning for minors is the great medical scandal of our time.” – Dr. J. Edward Les

Would you rather have a live son or a dead daughter? 

Medical and surgical transitioning won’t fix these problems. If anything, they are likely to make them worse in the long-term. 

The claim that medical transitioning is necessary to prevent suicide is not supported by high quality evidence.

  1. Greta R. Bauer et al., “Intervenable Factors Associated with Suicide Risk in Transgender Persons: A Respondent Driven Sampling Study in Ontario, Canada,” BMC Public Health 15, no. 1 (June 2, 2015): 525, ↩︎
  2. Cecilia Dhejne et al., “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLOS ONE 6, no. 2 (February 22, 2011): e16885, ↩︎
  3. Richard Bränström et al., “Transgender-Based Disparities in Suicidality: A Population-Based Study of Key Predictions from Four Theoretical Models,” Suicide and Life-Threatening Behavior 52, no. 3 (2022): 401–12, ↩︎
  4. Kai Dallas et al., “Mp04-20 Rates of Psychiatric Emergencies before and after Gender Affirming Surgery,” Journal of Urology 206, no. Supplement 3 (September 2021): e74–75,  ↩︎
  5. Inês Rafael Marques et al., “The Impact of Gender-Affirming Surgeries on Suicide-Related Outcomes: A Systematic Review,” Journal of Psychosexual Health 5, no. 3 (July 1, 2023): 134–44, ↩︎
  6. Sami-Matti Ruuska et al., “All-Cause and Suicide Mortalities among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study,” BMJ Ment Health 27, no. 1 (January 1, 2024), ↩︎

Time to turn public opinion into public action and public policy. 

In Finland, surgical treatments are not considered treatment methods for dysphoria in minors.

A growing refrain from these national reviews is that there is a lack of evidence to support these medical and surgical interventions, particularly in the long-term.

Fundamentally, biological sex cannot change but the self-perception of the psychological, social, and cultural aspects of being male and female can change.

  1. Society for Evidence Based Gender Medicine, “One Year Since Finland Broke with WPATH Standards of Care,” July 2, 2021,  ↩︎
  2. Society for Evidence Based Gender Medicine, “Sweden’s Karolinska Ends All Use of Puberty Blockers and Cross-Sex Hormones for Minors Outside of Clinical Studies,” May 5, 2021, ↩︎
  3. Society for Evidence Based Gender Medicine, “Summary of Key Recommendations from the Swedish National Board of Health and Welfare,” February 27, 2022, ↩︎
  4. Cass, “Interim Report – Cass Review.” ↩︎
  5. NHS England, “Interim Specialist Service for Children and Young People with Gender Incongruence,” June 9, 2023, ↩︎
  6. French National Academy of Medicine, “Medicine and Gender Transidentity in Children and Adolescents,” February 25, 2022, ↩︎
  7. National Commission of Inquiry for the Health and Care Service, “Patient Safety for Children and Young People with Gender Incongruence,” Ukom, March 9, 2023, ↩︎
  8. Although we profoundly disagree with their framing of this issue, the Human Rights Campaign has an informative map of which states have banned some form of gender-affirming care that is regularly updated:  ↩︎
  9. Section 320.101, Criminal Code of Canada. ↩︎
  10. Bailey and Blanchard, “Gender Dysphoria Is Not One Thing.” ↩︎

International Numbers

Canadian Numbers 

Age matters because informed consent matters.

There currently are no age restrictions for receiving puberty blockers, cross-sex hormones, or gender reassignment surgery.

It is impossible for minors to have the capacity to give informed consent to the irreversible effects of medical and surgical transitioning.

  1. Justice Education Society, “Youth Age-Based Legal Rights in BC,” accessed March 31, 2023, ↩︎
  2. Coleman et al., “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.” ↩︎
  3. For a full overview of Canada’s informed consent legislation see, Gerald B Robertson & Ellen I Picard, Legal Liability of Doctors and Hospitals in Canada, 5th ed (Toronto: Thomson Reuters Canada, 2017) at 100-109; 154-204 [Legal Liability of Doctors]. ↩︎
  4. See, Reibl v Hughes, [1980] 2 SCR 880, 114 DLR (3d) 1, aff’m in Ciarlariello v Schacter, [1993] 2 SCR 119, 100 DLR (4th) 609. ↩︎
  5. Sarah Birmingham, Christen Rachul & Timothy Caulfield, “Informed Consent and Patient Comprehension: The Law and Evidence” (2013) 7:1 McGill JL & Health 123 at para 5 [Informed Consent and Patient Comprehension]. ↩︎
  6. BM Stanley, DJ Walters & GJ Maddern, “Informed Consent: How Much is Enough?” (1998) 68 Australian & New Zealand Journal of Surgery 788; Jeff Whittle et al, “Understanding of the Benefits of Coronary Revascularization Procedures Among Patients Who are Offered Such Procedures” (2007) 154 American Heart Journal 662; Allison E Crepeau et al, “Prospective Evaluation of Patient Comprehension of Informed Consent” (2011) 93:19 Journal of Bone & Joint Surgery American Volume 114; Jü JW Wulsow, T Martin Feeley * Sean Tierney, “Beyond Consent: Improving Understanding in Surgical patients” (2012) 203:1 American Journal of Surgery 112; Sonu Pathak et al, “Consent for Gynaecological Procedure: What Do Women Understand and Remember?” (2013) 287 Archives of Gynecology & Obstetrics 59. ↩︎
  7. Informed Consent and Patient Comprehension, supra note 35 at para 8. ↩︎
  8. An elective procedure is one that is not medically necessary. See, Philion v Smith, [2008] OJ No 3412. Other examples of elective procedures include cosmetic surgery, sterilization, and even abortion. See Legal Liability of Doctors, supra note 33 at 180-81. ↩︎
  9. Kitchen v McMullen, 100 NBR (2d) 91, 62 DLR (4th) 481 (NBCA), leave to appeal to SCC refused [1990] 1 SCR viii. ↩︎
  10. Revell v Chow, 2010 ONCA 353 at para 43. ↩︎
  11. See, for example, BC Children’s Hospital Gender Clinic, “Information Sheet: Testosterone for Assigned Females with Gender Dysphoria,” December 5, 2022,; BC Children’s Hospital Gender Clinic, “Information Consent Form: Minor Youth Testosterone for Assigned Females with Gender Dysphoria,” December 14, 2020,; Sick Kids, “Information Form: Testosterone Therapy for Individuals with Gender Dysphoria Assigned Female at Birth,” 2023. ↩︎
  12. Bell v. Tavistock, [2020] EWHC 3274 ↩︎
  13. See, for example, the legal case of A.B. v. C.D. and E.F., 2020 BCCA 11 ↩︎
  14. National Post, “B.C. father arrested, held in jail for repeatedly violating court orders over child’s gender transition therapy,” March 17, 2021, ↩︎

There are no studies that compare the health outcomes of children and adolescents who receive gender-affirming care with those whose gender dysphoria resolved after puberty without medical or surgical intervention.

“We wouldn’t consider a drug that stunted your growth in height and weight to be a psychologically neutral intervention – because it isn’t…”

Abigail Shrier

“Gender-affirming care” is a misnomer.
It’s not caring at all.

  1. See Michelle A Cretella, “Gender Dysphoria in Children and Suppression of Debate” 21, no. 2 (2016). ↩︎
  2. See Society for Evidence-Based Gender Medicine, “International Perspectives on Evidence-Based Treatment for Gender-Dysphoric Youth Conference,” October 10-11, 2023, New York ↩︎
  3. See Yarhouse, Understanding Gender Dysphoria, 102–3. for a description of these approaches ↩︎
  4. Shrier, Irreversible Damage, 165. ↩︎
  5. Shrier, 164. ↩︎
  6. Lupron, (October 12, 2021), RxList, ↩︎
  7. Talal Alzahrani et al., “Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population,” Circulation: Cardiovascular Quality and Outcomes 12, no. 4 (April 2019): e005597,; Michael S. Irwig, “Cardiovascular Health in Transgender People,” Reviews in Endocrine and Metabolic Disorders 19, no. 3 (September 1, 2018): 243–51,; Stephen M. Rosenthal, “Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist’s View,” Nature Reviews Endocrinology 17, no. 10 (October 2021): 581–91,; Silvano Bertelloni et al., “Final Height, Gonadal Function and Bone Mineral Density of Adolescent Males with Central Precocious Puberty after Therapy with Gonadotropin-Releasing Hormone Analogues,” European Journal of Pediatrics 159, no. 5 (April 1, 2000): 369–74,; Ana Antun et al., “Longitudinal Changes in Hematologic Parameters Among Transgender People Receiving Hormone Therapy,” Journal of the Endocrine Society 4, no. 11 (November 1, 2020): bvaa119,; Hayley Braun et al., “Moderate-to-Severe Acne and Mental Health Symptoms in Transmasculine Persons Who Have Received Testosterone,” JAMA Dermatology 157, no. 3 (March 1, 2021): 344–46,; Mauro E. Kerckhof et al., “Prevalence of Sexual Dysfunctions in Transgender Persons: Results from the ENIGI Follow-Up Study,” The Journal of Sexual Medicine 16, no. 12 (December 1, 2019): 2018–29,; Spyridoula Maraka et al., “Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis,” The Journal of Clinical Endocrinology & Metabolism 102, no. 11 (November 1, 2017): 3914–23,; M. Kyinn et al., “Weight Gain and Obesity Rates in Transgender and Gender-Diverse Adults before and during Hormone Therapy,” International Journal of Obesity 45, no. 12 (December 2021): 2562–69,; Sebastian E E Schagen et al., “Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones,” The Journal of Clinical Endocrinology & Metabolism 105, no. 12 (December 1, 2020): e4252–63,; Daniel Klink et al., “Bone Mass in Young Adulthood Following Gonadotropin-Releasing Hormone Analog Treatment and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria,” The Journal of Clinical Endocrinology & Metabolism 100, no. 2 (February 1, 2015): E270–75,; Magdalena Dobrolińska et al., “Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment,” The Journal of Sexual Medicine 16, no. 9 (September 1, 2019): 1469–77,; Darios Getahun et al., “Cross-Sex Hormones and Acute Cardiovascular Events in Transgender Persons,” Annals of Internal Medicine 169, no. 4 (August 21, 2018): 205–13,; Mariska C. Vlot et al., “Effect of Pubertal Suppression and Cross-Sex Hormone Therapy on Bone Turnover Markers and Bone Mineral Apparent Density (BMAD) in Transgender Adolescents,” Bone 95 (February 1, 2017): 11–19,; Iris E. Stoffers, Martine C. de Vries, and Sabine E. Hannema, “Physical Changes, Laboratory Parameters, and Bone Mineral Density During Testosterone Treatment in Adolescents with Gender Dysphoria,” The Journal of Sexual Medicine 16, no. 9 (September 1, 2019): 1459–68,; Michael Biggs, “Revisiting the Effect of GnRH Analogue Treatment on Bone Mineral Density in Young Adolescents with Gender Dysphoria,” Journal of Pediatric Endocrinology and Metabolism 34, no. 7 (July 1, 2021): 937–39,; Rafael Delgado-Ruiz, Patricia Swanson, and Georgios Romanos, “Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy,” Journal of Clinical Medicine 8, no. 6 (June 2019): 784,; Tobin Joseph, Joanna Ting, and Gary Butler, “The Effect of GnRH Analogue Treatment on Bone Mineral Density in Young Adolescents with Gender Dysphoria: Findings from a Large National Cohort,” Journal of Pediatric Endocrinology and Metabolism 32, no. 10 (October 1, 2019): 1077–81,; Kyinn et al., “Weight Gain and Obesity Rates in Transgender and Gender-Diverse Adults before and during Hormone Therapy”; Noreen Islam et al., “Is There a Link Between Hormone Use and Diabetes Incidence in Transgender People? Data From the STRONG Cohort,” The Journal of Clinical Endocrinology & Metabolism 107, no. 4 (April 1, 2022): e1549–57, ↩︎
  8. See Coleman et al., “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.” for a sample of studies ↩︎
  9. Cecilia Dhejne et al., “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLOS ONE 6, no. 2 (February 22, 2011): e16885, ↩︎

Among children who exhibit gender dysphoria prior to puberty, approximately 80% will “desist” or out-grow this dysphoria by adulthood.

“The fundamental problem with gender-affirming care is that it misdiagnoses the problem.”

“The solution is not to radically reshape the body through drugs, hormones, and surgery. The solution is to help someone accept and love their natural body. ”

The message from the Alberta premier is clear: children do not have the capacity to make these profound decisions about their bodies.

These developments – particularly the age restrictions for medical transitioning – are enormous.