This article originally appeared in the National Post.
By Mia Hughes, December 18, 2025
Earlier this year, in response to Alberta restricting access to puberty blockers and cross-sex hormones for trans-identified adolescents, “2SLGBTQI” charity Egale Canada said that “all reputable medical associations” agree that gender-affirming care is “medically necessary and often lifesaving.” But recent developments have dealt a severe blow to this claim.
On Dec. 9, Florida announced a lawsuit against the three core groups responsible for promoting youth gender medicine — the World Professional Association for Transgender Health (WPATH), the American Academy of Pediatrics (AAP) and the Endocrine Society — alleging they misled families about the risks and benefits of these experimental interventions and engaged in “racketeering” and fraud.
Built on internal leaks, discovery documents from a separate legal case and rigorous evidence reviews, Florida’s legal complaint tells the story of a medical scandal so astonishing it almost defies belief.
The complaint, filed in court last week, alleges that the groups promoting youth gender medicine engaged in a “coordinated campaign” to develop clinical guidelines pushing a treatment protocol that “irreversibly alters children’s bodies” without credible evidence of safety or benefit. This allegation rests on the findings of a 2024 systematic review of gender medicine guidelines conducted by the University of York as part of the United Kingdom’s Cass Review, which examined the evidence for child transition. The York team’s analysis showed how WPATH and the Endocrine Society manufactured a consensus around the medical treatment of gender-distressed youth, despite the complete absence of reliable science.
Florida’s court filing states that the dubious endeavour started with WPATH’s poorly supported 2001 guidelines, which abandoned its previous age limit on cross-sex hormone use and suggested that gender dysphoric teens could attend school wearing the clothes and using a name from the opposite sex. The next link in the chain came in 2009, when WPATH co-sponsored the Endocrine Society’s guideline, which simply replicated WPATH’s flimsy recommendations. WPATH then closed the loop in 2012 with yet another set of guidelines that relied on the Endocrine Society’s 2009 document — which was based on WPATH’s shoddy 2001 version.
Yet, what happened next is even more remarkable. These guidelines — described in Florida’s complaint as “methodologically bankrupt” — were copied by medical associations around the world, triggering a cascade of policy statements and guidelines endorsing this unproven treatment protocol for healthy youth. The repetition created the illusion of scientific consensus. As Dr. Hilary Cass concluded in her review of the science for the U.K. government, this circularity explains how such aggressive treatments for children came to be seen as “standard of care” despite a striking lack of credible data.
The lawsuit filing claims that the American Academy of Pediatrics was a latecomer to this enterprise but played a decisive role in creating the “façade of legitimacy.” Its 2018 policy statement endorsed puberty blockers and cross-sex hormones, adopting the recommendations of WPATH and the Endocrine Society, and even went further by suggesting surgeries to remove internal organs from minors. In a 2019 fact check of the AAP policy, the University of Toronto’s Dr. James Cantor demonstrated that the AAP’s own citations in no way supported the claims it made. Florida’s lawyers have argued that the AAP’s official endorsement “shifted the medical profession’s Overton window,” noting the rate of these interventions for youth “exploded from 2019 to 2021.”
Thus, when Egale and other activists claim that “all reputable medical associations” support pediatric gender medicine, they are referring to this citation cartel.
In a video announcing the lawsuit, Florida Attorney General James Uthmeier said that “children were irrevocably harmed because truth was replaced with political activism” — a statement with strong supporting evidence. Internal WPATH emails from a legal case in Alabama released last year clearly demonstrate the group’s Standards of Care 8 (SOC8), published in 2022, were shaped by politics and not science.
Those Alabama court documents form a major pillar of Florida’s case. The emails show WPATH based some recommendations on low-quality evidence; stripped nearly all lower age limits from the adolescent chapter of SOC8 at the request of then-Admiral Rachel Levine, former president Joe Biden’s assistant secretary for Health and Human Services, who feared firm thresholds would undermine Democratic legislative battles; and liberally inserted the phrase “medically necessary” not because research supported it, but to secure insurance coverage and aid ongoing legal cases.
These revelations make clear that those accusing Alberta Premier Danielle Smith of politicizing this medical treatment have it exactly backwards. The field of “gender-affirming care” is guided by politics, and it was trans activism that framed access to puberty blockers and cross-sex hormones as an essential human right. As a consequence, any challenge to the evidence or ethics of this experimental treatment became synonymous with challenging the human rights of trans-identified people.
Yet no medical treatment should ever be above scrutiny. It should never be forbidden to demand high-quality evidence for invasive drugs and surgeries that will have a dramatic impact on a young person’s entire life. Arguably, to forbid scientific inquiry on this medical treatment violates a trans-identified person’s right to the safe, evidence-based healthcare provided in all other areas of medicine.
The success of Florida’s lawsuit is far from guaranteed, as the state must prove the defendants knowingly engaged in the alleged actions for financial gain. But whether the state wins or loses, the damning facts described in the complaint remain true, making pediatric gender medicine a scandal unrivalled in history. While Egale Canada may still insist that these medical institutions are reputable, the evidence tells a starkly different story — meaning Canada must now urgently reckon with how profoundly it has misplaced its trust.
Mia Hughes specializes in researching pediatric gender medicine, psychiatric epidemics, social contagion and the intersection of trans rights and women’s rights. She is the author of “The WPATH Files,” a senior fellow at the Macdonald-Laurier Institute, and director of Genspect Canada.
