Harm is a strong word but it appropriately describes the consequences of the pharmacological and surgical procedures being used by Canadian pediatric hospitals to change the genders of children who have what is called gender dysphoria. These children are incurring medical problems from these procedures that will affect them for the rest of their lives.
Puberty is a normal part of human development. Postponing or changing puberty, as current protocols at Canadian pediatric hospitals do, will almost certainly negatively affect all the normal features of puberty, including brain maturation, bone growth, the emergence of fertility and sexual capacity of the children going through the gender dysphoria protocols.
Children cannot, as the UK High Court of Justice noted, give informed consent to these procedures.
How can a ten-year-old assess procedures which in many cases make sexual satisfaction impossible? How can a minor adequately assess the impact of a double mastectomy on her life?
Children are also being harmed by propaganda and pressure that encourages gender transition. In fact, social media and pressure from schools are the likely explanations for the exponential growth in medical procedures to change the genders of children that has taken place over the past twenty years. There is no biological reason for this.
With the protocols in place, clinicians are expected to act quickly if a patient describes himself or herself as transgender. This means that other causes such as sexual orientation, mental health and social circumstances are often not considered sufficiently or at all.
This is a serious problem for some gay children. It is very easy to confuse the normal qualities of gay children with those of gender dysphoria. Consequently, these children are sometimes treated, with devastating consequences, for a problem they don’t have.
Children may also be harmed by phantasmagoric discussions and debate about gender issues generally. The cultural wars on this subject are raging.
Expecting children and their parents to make good decisions about gender transition may be unrealistic. It would be better for many children if they did not face this choice at all because there is no evidence available to them that truly supports the decision to transition.
Two major factors cause all this harm.
The first is that Canadian pediatric hospitals are ignoring the global scientific consensus that the evidence supporting current procedures to change the genders of minors is astonishingly weak or non-existent.
Over the past three or four years, there has been a cascade of authoritative studies in jurisdictions that range across the political spectrum that demonstrate the strength of this scientific consensus.
Finland, the United Kingdom, Sweden, France and a number of US states have limited or prohibited medical procedures to change the gender of minors.
Nevertheless, Canadian pediatric hospitals are ignoring the legal and financial risks they and the governments that fund them are running by performing procedures that are not supported by the scientific consensus. More than 100 people have joined a class action lawsuit relating to this matter in the United Kingdom and the first case involving an individual has been initiated in Ontario.
The second major contributor to the harms noted above is the sometimes perverse nature of medical regulation in Canada. The bodies responsible for the central elements of medical regulation in this country are provincial Colleges of Physicians and Surgeons. These determine matters related to registration, discipline and conformity to general practice patterns.
The difficulty relates to regulating more to general practice standards than hard clinical standards. The general procedures and protocols developed by physicians become standards if they are practiced often enough.
In correspondence, the Ontario College of Physicians and Surgeons has stated that “the CPSO reflects and relies on the standards and practices as developed by the profession”.
The problem is that the medical profession sometimes gets it wrong.
People were bled for a thousand years without the slightest evidence that it worked.
Prescriptions for thalidomide were given to large numbers of pregnant women in Canada and Europe. This resulted in thousands of children being born with severe deformities because evidence relating to the consequences of these prescriptions was lacking.
There are many other problems of this type including, in the present case, the use of drugs to prevent puberty which were never approved by regulators for this purpose.
The scale and nature of these problems are obvious at Toronto’s Hospital for Sick Children, a leading pediatric hospital. Sick Kids does not seem to be concerned about their gender-changing protocols.
Unfortunately, this hospital has been captured by the ideology surrounding gender transition procedures and protocols and not by the scientific research.
The practices at Sick Kids are clearly described in the website of its foundation. The website indicates:
“For some, puberty blocking is a first step…. for those who make the decision to move forward with gender transition, the next step is usually hormones that start a second puberty…. many of the youth we see eventually progress to wanting surgeries. We don’t do surgeries here but provide links to further information about this process and we help them complete the application forms”.
It would be easy to assemble a dozen authoritative studies, from sources such as the UK High Court of Justice to the leading hospital in Sweden to the British Medical Journal that describe the lack of evidence associated with this kind of treatment.
The most recent of these is a detailed briefing on gender affirming care by The Economist magazine which incorporates the observation that “it is impossible to justify the current recommendations about gender affirming care on the existing data”.
In another recent study, the Norwegian Healthcare Investigation Board noted that “the knowledge base, especially research based knowledge for gender affirming treatment (hormonal and surgical) is deficient and the long term effects are little known….this is particularly true for the teenage population where the stability of their gender incongruence is not known”.
Canadians need to find a path that avoids the problems identified here. That path starts with a significant modernization of medical regulation so that it focuses on clinical evidence and not so much on prevailing practice. The second step should be steps by political leaders to respond to events relating to gender transition in the rest of the world.
Above all, clinical leaders need to recognize that while medicine is both art and science, there can be no artistry without the science. Listening to the global scientific consensus on the issue should be a priority for everyone in leadership positions in healthcare.
David MacKinnon is a Senior Fellow at the Frontier Centre for Public Policy. He has served as Chair at two Ontario hospital boards and is a Past President of the Ontario Hospital Association.