This article originally appeared in the Hub.
By Dave Snow, May 28, 2024
The gender transition debate in Canada
In 2023, conservative governments in New Brunswick and Saskatchewan both introduced policies requiring parental consent for pronoun changes for school children, with the latter invoking the notwithstanding clause. More recently, Alberta announced it will bring in a host of policies related to youth transition, including restricting the use of hormone therapies, puberty blockers, and gender reassignment surgery. At the national level, Pierre Poilievre has publicly opposed puberty blockers for children.
Such restrictions have been rejected by major Canadian medical organizations, which remain committed to the “gender-affirming” model of care. Yet this medical consensus is being challenged at home and abroad.
Canadian investigative reports have raised questions about insufficient safeguards for hormone treatment and surgeries. Outside Canada, several European countries are actually moving away from the gender-affirming model. Then came the Cass Review.
On April 10, 2024, British pediatrician Dr. Hilary Cass released her long-awaited Independent Review of Gender Identity Services for Children and Young People. Commissioned by England’s National Health Service (NHS), the 387-page report was completed alongside independent reviews of the scientific evidence around youth gender medicine by a research team from the University of York, which were published as nine journal articles in the Archives of Disease in Childhood.
The Cass Review’s 32 recommendations call for an overhaul of how youth gender medicine is practiced in the United Kingdom. Cass found “a lack of high-quality evidence” for the gender-affirming model of care, particularly with respect to “the use of puberty blockers and masculinising/feminising hormones.”
The review recommended “extreme caution” for providing cross-sex hormones for children and raised concerns that puberty blockers “may change the trajectory of psychosexual and gender identity development.” Going forward, the review urged that youth gender services “must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.”
The Cass Review received significant media attention (positive and negative) in the U.S. and in Europe. It appears to have already had a serious impact in the U.K. and beyond. Both the Conservative Prime Minister Rishi Sunak and the Labour Party’s shadow health secretary praised the report, while Scotland’s NHS announced it would pause puberty blockers and cross-sex hormones for children (NHS England had already paused puberty blockers in March).
There are suggestions that Belgium and the Netherlands may soon follow suit. Alberta Premier Danielle Smith even cited the Cass Review as justification for her government’s proposed gender policies. Support for Cass was not merely confined to conservative sources, as the report was portrayed positively in the New York Times, The Atlantic, and The Guardian, as well as by the editor-in-chief of The British Medical Journal.
Canadian media coverage of the Cass Review
As a major medical report on an issue where there is considerable Canadian political debate, one would have expected the Cass Review to garner considerable Canadian media attention.
To determine how the issue was covered in Canada, I conducted a content analysis of online articles from five mainstream media outlets (The Globe and Mail, National Post, Toronto Star, CBC, and CTV) from the three-week period following the Cass Review’s publication (April 10 – April 30, 2024). These five outlets published a total of 15 stories that mentioned the Cass Review. Given that three stories (all from the National Post) only briefly mentioned it in passing, and one Associated Press story was published in two outlets, this meant a total of 11 unique stories in which the Cass Review featured prominently.
Coverage was dominated by the National Post, which featured seven articles on the Cass Review over an 11-day period between April 10 and April 20. By contrast, there were only two stories featuring the Cass Review in the Toronto Star, and only one each in CBC, CTV, and the Globe. Apart from the one AP story, every article applied the Cass Review to the Canadian context, with six mentioning Alberta’s proposed gender policies. The stories were split between hard news (six) and opinion pieces (five).
Given the National Post’s longstanding focus on youth gender transition, it is not surprising that it gave the Cass Review the most coverage. The other four outlets did not give it as much attention. The only hard news piece in the Toronto Star was a wire story written by the U.S.-based Associated Press. CTV’s one mention of Cass appeared in a piece about Alberta’s proposed gender policies and was only the result of Premier Smith raising it during an interview with the outlet. Meanwhile, the lone CBC article on the review was more of a condemnation than a news report (see below). The Globe and Mail did not feature Cass in a single hard news article, though the report was mentioned in an investigative opinion piece about gender transition in Canada written 16 days after the review was published. In total, only three of the six hard news pieces quoted from the Cass Review extensively, including two lengthy pieces from National Post reporter Sharon Kirkey and one Associated Press piece (published in both the Star and Post).
While there were only five opinion pieces published about the Cass Review, they shared several notable characteristics. All five opinion pieces—three from the National Post and one each in the Toronto Star and The Globe and Mail—portrayed the review positively, including descriptions such as “landmark” and “an exhaustive and rigorous report.” All five were broadly supportive of exercising greater caution around the use of puberty blockers and cross-sex hormones for youth. The Post’s Adam Zivo called such restrictions “a wise approach that Canada should follow,” while the Globe’s Robyn Urback cited multiple studies “exploring the potential long-term effects of puberty blockers and cross-sex hormones on bone density, fertility, sexual function, and cognitive development” (links in original). Moreover, the five opinion writers demonstrated considerable knowledge of the review itself, with Cass quoted or paraphrased a total of 16, 11, eight, four, and three times, respectively.
By contrast, the CBC’s one news story, published five days after the Cass Review, only quoted it twice. The 1,750-word article, “What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth,” spent more time criticizing the report than describing it. The story did not quote any proponents of the Cass Review, but it did contain over a dozen quotes from three organizations and three Canadian doctors who were supportive of the gender-affirming model. Two of those doctors criticized the Cass Review directly: one wondered if it was “coming from a place of bias” and “trying to create fear around gender-affirming care,” while another called it “politically motivated.”
One sentence in particular, written by the journalist, is indicative of the CBC’s framing: “The Cass Review, while aiming to be an independent assessment, has been criticized as flawed and anti-trans by trans activists in the U.K., and was described as a product of the U.K.’s hostile environment for trans people in the International Journal of Transgender Health” (links in original). The CBC journalist did not specify the difference between an “independent assessment” and “aiming” to be independent.
However, the International Journal of Transgender Health piece cited by the CBC journalist refers to the Cass Review as an example of “Cis-supremacy in the UK’s approach to healthcare for trans children.” It was written by a researcher who specializes in “trans inclusion and Applied Trans Studies” and currently holds a grant for “Building Lived Experience Accountability into Culturally Competent Health and Well-being Assessment for Trans Youth Social Justice.” The CBC did not address whether that piece, which was published nearly a month before the Cass Review’s final report came out, was similarly “aiming” to be independent in its assessment of Cass.
This CBC article has garnered considerable attention. It was criticized by American journalist Jesse Singal as “critically dangerous science miscommunication,” while Hub contributor Peter Menzies described it as “so bereft of balance that one could only conclude it [CBC] had abandoned any pretence of principled journalism in favour of playing the role of ally.” But, to regular observers of the CBC, this story was entirely in keeping with its ongoing approach to covering youth gender transition.
Canadian coverage of other LGBTQ topics
Given that major Canadian outlets paid limited attention to the Cass Review, apart from the National Post, observers may wonder if this simply reflected a media tendency to ignore LGBTQ issues.
To test for this, I also conducted a search of stories containing terms like “LGBTQ,” “transgender,” and “gender identity” at each of the five outlets during the same period (April 10-30). I then analyzed stories in which LGBTQ issues were the main topic.
Between April 10-30, in addition to the 11 stories about Cass described above, there were 25 stories on the topic of Canadian LGBTQ issues: 14 at the CBC, six at CTV, three at the Globe and Mail, and one each at the Toronto Star and National Post (this includes one identical Canadian Press wire story published by the Globe, Star, and CTV).
However, not one of these additional Canadian stories mentioned the Cass Review. Some of this was understandable, as most CBC and CTV articles, for example, were local stories covering topics such as a proposed LGBTQ community centre in Montreal, legal battles over New Brunswick’s pronoun policy, and a summer camp for LGBTQ children in Newfoundland and Labrador.
However, in addition to these 25 Canadian-focused LGBTQ stories, the five outlets also published 66 internationally-focused LGBTQ stories. None of these mentioned the Cass Review. All were written by foreign wire services.
Thirty stories were published by the National Post, 27 by the Toronto Star, five by CTV, four by he Globe and Mail, and none by the CBC. Nearly 80 percent (52/66) were focused on American politics, but the 14 other stories covered topics such as Swedish and German laws making changing your gender easier, the passage of an anti-LGBTQ law in Iraq, and a Hong Kong trans activist getting a male ID card.
Canadian news outlets’ lack of attention to the Cass Review cannot be explained by a lack of interest in international news on LGBTQ issues. The Toronto Star published 28 hard news stories about international LGBTQ issues during this period, but only one mentioned the Cass review. Likewise, the Globe and Mail and CTV published four and five international news stories on LGBTQ issues respectively, none of which mentioned the Cass Review.
Consequences for Canada
Three broad conclusions can be drawn from the Canadian media’s coverage of the Cass Review. First, apart from the National Post, hard news coverage of the groundbreaking report was limited. Moreover, this minimal coverage cannot be explained by a lack of interest in LGBTQ issues, as these outlets published many Canadian and international LGBTQ-focused stories about topics far less prominent. Perhaps it is unsurprising that a conservative outlet was more likely to report on a major study that appeared to vindicate arguments associated with conservative political positions. Yet the lack of reporting by other news outlets brings to mind a quote from American journalist Nellie Bowles about the 2020 riots around policing and African Americans in Kenosha, Wisconsin: “How the mainstream media controlled the narrative was by not covering it.”
Second, despite this minimal reporting in Canada, the Cass Review seems to have shifted the parameters of the debate over youth gender transition. The way that it has been covered in international media suggests it will now be far more difficult to paint those who favour a more cautious approach to social transition, puberty blockers, and cross-sex hormones as “transphobic.” Although Canadian hard news coverage of Cass was limited, Canadian opinion pieces demonstrate a similar shift. All five opinion pieces (including one from the Toronto Star) covered the Cass Review favourably. All raised criticisms about the prevalence of the gender-affirming model across Canada. In the recent past, the Globe and Star have not been shy about publishing opinion pieces lauding the gender-affirming model. But no such opinion pieces were published in response to the Cass Review.
Finally, as the debate around youth gender medicine shifts, the CBC appears to have dug in its heels in support of the gender-affirming model. In previous research for The Hub, I documented how the national public broadcaster chose allyship over objectivity in its coverage of youth gender transition. That trend has clearly continued. The CBC has often been criticized in general for progressive bias, but it is difficult to recall another policy issue for which the CBC’s lack of balance has been so strident and so sustained. As scientific and policy debates around youth gender transition evolve, this issue will provide a litmus test for whether CBC can provide objective coverage on contentious social and medical topics. For now, the public broadcaster is failing that test.
Dave Snow is an Associate Professor in Political Science at the University of Guelph and a Senior Fellow with the Macdonald-Laurier Institute.
