This article originally appeared in the National Post.
By Mia Hughes, May 9, 2025
On May 1, the U.S. Department of Health and Human Services (HHS) released a bombshell 409-page report laying bare the troubling state of paediatric gender medicine. This moment presents yet another opportunity for Canada to reckon with a medical scandal that has long gone unaddressed.
The HHS report highlights the exceptionally weak evidence used to support puberty blockers, cross-sex hormones, and surgeries for youth who identify as transgender, exposing how ideology dominates over science in the field of gender medicine. Its conclusion is damning: the medical establishment has failed vulnerable young people.
The review was commissioned by an executive order from U.S. President Donald Trump, whose directive was laced with politically charged and inflammatory language. In sharp contrast, the report itself is measured and grounded in evidence. Its recommendations echo the cautious, evidence-based approach to youth gender care now taking hold across much of Europe, contradicting the ideological positions of all major medical associations in the U.S. and Canada.
Acknowledging the political controversy surrounding the issue, the as-yet anonymous authors move past slogans and ideology to deliver a methodical, yet scathing, assessment of the current state of paediatric gender medicine. At the heart of the report is an “umbrella review” that synthesizes all the existing systematic reviews for these interventions, including those conducted in Sweden, Finland, England, and Canada. Unsurprisingly, like every one of those prior systematic reviews, the HHS review concludes that the evidence is of “very low” quality.
That’s because the research in this field, particularly surrounding claims that hormonal and surgical interventions improve mental health or reduce suicidality, is methodologically weak, lacking control groups or long-term follow-up. Meanwhile, the known risks of such interventions — infertility, reduced bone density, disrupted psychosocial development, and impaired sexual function — are not theoretical. They are documented outcomes of these interventions.
Until now, the typical response to this lack of evidence has been to call for more research, but the HHS report makes clear that, given what we already know, further research cannot ethically be justified. It does so by invoking the Nuremberg Code — the bedrock of international research ethics — citing that the anticipated results justify the performance of the experiment — and the Belmont Report which report emphasizes that no trial should proceed unless the intervention has a “favourable risk/benefit profile.” In paediatric gender medicine, every systematic review to date has found that the risks outweigh any potential benefits, making further research unjustified.
One of the most important sections of the report centres on psychotherapy. In a cultural climate where talk therapy is often dismissed or derided as being equivalent to gay conversion therapy, the HHS report makes a strong case for this non-invasive approach to replace life-altering medical interventions.
Echoing the U.K.’s landmark Cass Report, the authors call for gender dysphoria to be “de-exceptionalized,” meaning therapists need to approach treating these young people in the same way they would any other distressed patient. Instead of viewing them as “transgender adolescents” in need of powerful hormones and drastic surgeries, the report suggests that therapists should help these young people “develop self-understanding, engage with emotional vulnerability, and build practical strategies for managing distress.”
This therapeutic approach mirrors what has been implemented by leading European health authorities. It reflects a growing awareness that gender dysphoria among adolescents, especially girls, is a complex symptom of deeper psychological distress. And yet, while these developments are reshaping care standards across Europe, Brazil, and now the United States, one country remains notably absent from this evolving consensus: Canada.
Despite mounting evidence that a major medical scandal is unfolding, Canada has yet to launch a review of the practices in its paediatric gender clinics. Canadian guidelines remain closely aligned with those of the World Professional Association for Transgender Health (WPATH), an organization that has been discredited for prioritizing ideological commitments over scientific rigor. To date, only Alberta has taken concrete steps to shield vulnerable young people from a medical establishment that has abandoned science and basic ethical principles. In December 2024, the Alberta government banned puberty blockers and cross-sex hormones for youth 16 and under and placed restrictions on access for those age 17 and 18.
Canadian activists may insist the science here is settled, but that claim is becoming increasingly untenable. Science does not respect national borders. Canada has witnessed the same dramatic surge in referrals, the same demographic shift from mostly young boys to predominantly adolescent girls, and our gender clinics were among the earliest and most enthusiastic in adopting these experimental medical interventions. If other countries lack solid evidence or ethical justification for this treatment, the same holds true for Canada.
And yet, calls for a Canadian Cass-style review have so far gone unheeded, and the political environment continues to render even cautious scepticism as taboo.
Canada’s inaction on this issue has already brought shame on the nation. There are two lawsuits underway, and there will undoubtedly be many more over the coming years as the number of detransitioners steadily rises. Our government should take the publication of the HHS’s sobering report as a cue. If the rest of the world, including our closest neighbour, can reassess the science and revise their standards accordingly, there is no excuse for Canada to remain on autopilot. In the face of mounting international consensus and rising domestic concern, doing nothing is its own action — one that puts ideology before evidence and vulnerable youth in harm’s way.
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” and a senior fellow at the Macdonald-Laurier Institute.
