On May 12, I published a Quillette essay criticizing the Canadian Paediatric Society’s ongoing advocacy of “gender-affirming care” for transgender-identified minors.

The practice of gender-affirming care, sometimes referred to as GAC, is based on the principle that health professionals should uncritically accept the claimed gender identity of dysphoric patients; and, where possible, facilitate their access to puberty blockers, “gender-affirming hormone therapy,” and “gender-affirming surgeries.”

Those latter euphemisms—which helpfully serve to obscure the risks of stunted development, painful physical disfigurement, sterility, and sexual dysfunction—entered common usage in the 2010s, a period during which transgender identification became an object of fascination in popular culture.

The number of minors seeking referrals to gender clinics exploded in western nations.

By far, the largest demographic consisted of adolescent females—many of them suffering from autism, trauma, psychiatric comorbidities, and internalised homophobia—who’d become convinced their anxiety and pain were caused by being trapped (as the expression goes) “in the wrong body.”

The idea that doctors should uncritically heed a patient’s self-diagnosis was an unsettling innovation, and one that is generally alien to other branches of health care.

To this day, the Canadian Paediatric Society proselytises the idea of gender identity as a soul-like ether that most children can categorise reliably when they are just three years old.

In many cases, old-fashioned conservative stereotypes about what boys and girls are supposed to wear, what colours they should prefer, and what toys they should play with have been transformed into purportedly meaningful indicators that could eventually serve to propel a child down a life path that includes amputated body parts and a lifelong drug regime.

Possible evidence of gender identity, the CPS indicates to parents who consult its “Caring for Kids” resources, for instance, includes the fact that she refuses to put on a dress, “even on special occasions.”

By the early 2020s, the mania for “affirmation” properly became an object of concern among medical experts, who noted that the underlying theory was based more on slogans than science; and that the studies purporting to support GAC’s efficacy typically were marked by small samples, biased design, and circular reporting.

A vocal detransitioner community emerged, with harrowing tales of gender-clinic doctors eagerly expressing their “allyship” with a hastily produced set of drug prescriptions.

All of this has been pointed out to the CPS leadership in peer-reviewed form.

But the organisation still stands by its original 2023 Position Statement on the subject of GAC—a document that exhorts Canadian doctors to adopt an “affirming approach to routine health care provision for all youth,” and enshrine gender-affirming care as the unquestioned “standard of care for transgender or gender-diverse youth.”

The timing of the CPS Position Statement was unfortunate, as it came less than a year before Dr Hilary Cass, a former president of Britain’s Royal College of Paediatrics and Child Health, released a blockbuster Report that exhaustively analysed the international evidence for and against gender-affirming care.

Critics had been picking GAC apart for years by this point.

But what Dr Cass achieved was on another level: The Cass Review, as it has come to be called, was the most authoritative analysis of the available literature regarding the treatment of gender dysphoric minors that had ever been published.

It still is.

Dr Cass concluded that the “potential risks to neurocognitive development, psychosexual development, and longer-term bone health” associated with the use of puberty blockers to treat trans-identified children are substantial.”

Her analysis also showed that the widespread claim that “hormone treatment reduces the elevated risk of death by suicide” among trans-identified youth isn’t supported by the available evidence.

This latter conclusion was especially important, because the morbid claim that trans-identified children are at imminent risk of suicide without rapid and enthusiastic “affirmation” from all quarters had always been deployed as a propaganda weapon of last (and sometimes first) resort by activists and “gender-affirming” medical personnel.

Indeed, many whistleblowing parents who’d expressed scepticism of the GAC provided to their children have reported hearing some version of this ghoulish theme from zealous therapists and doctors.

Moreover, the idea that gender affirmation was a form of suicide prevention turned what had once been a medical debate into a contest of moral virtue, as it allowed GAC proponents to present their movement in heroic life-or-death terms—an epic human-rights struggle against heartless (and presumably transphobic) naysayers who were prepared to condemn transgender children to the grave.

To this day, in fact, this self-valorizing nature of the GAC movement seems to be one of the main attractions for social-justice minded medical-school graduates.

Critics initially tried to dismiss Dr Cass as a stooge of right-wing Bible-thumpers, and confidently predicted that her analysis would collapse under scrutiny.

But that didn’t happen.

Just the opposite, in fact: The British Medical Union (BMU), the trade union for British doctors, spent two years trying to debunk the Cass Review at the behest of the union’s pro-GAC activist constituency.

Yet once this singularly thorough investigation of Dr Cass’s work wrapped up in early 2026, the BMU wound up conceding that Dr Cass’s “robust” analysis had been vindicated.

Dr Cass’s report effectively sounded the death knell for the “affirmation” model in the UK, and did much to accelerate the rollback of GAC policies internationally—and not just in conservative jurisdictions such as Republican-controlled U.S. states.

Socially progressive nations that have rolled back GAC-style policies in recent years include not only the UK, but also Denmark, Finland, the Netherlands, Sweden, Norway, New Zealand, and Italy.

Since the Cass Review was published, more primary research has emerged in support of Dr Cass’s conclusions.

This includes newly released Finnish data, covering every under-23-year-old individual who’d been referred for gender treatment in Finland between 1996 and 2019—a cohort containing almost 2,100 people.

Following gender-clinic referrals, the study found, clinically trans-affirmed patients exhibited greater psychiatric morbidity than members of a control group.

While all of this has no doubt comprised a bitter pill to swallow for doctors and therapists who’ve devoted their careers to the precepts of GAC, these professionals have a responsibility to align their clinical practice with the best available research, no less in Canada than anywhere else.

And on this basis, I (somewhat earnestly) concluded my May 12 article with a prediction that the CPS would surely (if belatedly) catch up with its international counterparts.

“Doctors don’t live in a bubble,” I wrote.

“And it is only a matter of time before new leadership drags such organisations [as the CPS] into the post-Cass era.”

Just eleven days after my column appeared, the CPS made nonsense of my words with the choice of its new President: an unusually zealous gender-affirmation advocate named Natasha Johnson.

Dr Johnson, a Paediatrics professor at McMaster University in Hamilton, Ontario, not only champions the right of dysphoric minors to access gender-affirming care: She’s devoted much of her professional life to personally stewarding them on their “gender journeys,” having founded McMaster’s youth GAC program in 2016.

It may not rank as the worst prediction I’ve made during my journalistic career.

But I’m fairly certain it was the most rapidly falsified.

Dr Johnson studied medicine at McGill University in Montreal, where she also conducted her paediatrics residency after graduating in 1997.

In 2003, she completed a second residency at the University of Toronto, this one in the field of adolescent care.

For the last two decades, she’s served as an Associate Professor of Paediatrics at McMaster.

All three of these institutions rank prominently among Canada’s top research universities.

Putting ideology to one side, it would be difficult to argue that Dr Johnson lacks the academic credentials required to lead a prominent medical organisation.

While Dr Johnson was already in her 40s when the social-justice movement began sweeping Canadian campuses, she proved a quick study.

Of the five areas of expertise listed by McMaster on Dr Johnson’s university web page, only one is directly related to what most of us would recognise as the health sciences.

(This would be “nutritional physiology,” as her publication record demonstrates a longstanding focus on adolescent eating disorders.)

The other four are “social change,” “social oppression and marginalisation,” “race,” and “race and ethnicity.”

Dr Johnson has served as the Associate Chair, Equity, Diversity, and Inclusion for McMaster’s Paediatrics department since 2021.

She is a strong advocate for race-based affirmative action in medical education.

By her own description, the line separating her social-justice activism from her medical practice is blurry.

On social media, Johnson, who is black, self-identifies as “a straight cisgender [i.e. not transgender] racialised woman” who is “privileged to be a guest on Indigenous lands.”

She often shares consciousness-raising slogans about the value of pronoun pins and the need to fight racism and “misogynoir.”

She argues that Canada is full of “racist systems,” and reports that she sometimes arrives at her workplace “traumatised” by news that a Black person was gunned down “for the ‘crime’ of simply existing.”

Dr Johnson became a nationally prominent voice within the pro-GAC movement in 2021, when she was featured in a Canadian television documentary about youth gender transition.

In that CTV News W5 interview, she appeared to downplay concerns about transition regret and medical risks.

Instead, she focused on a more upbeat message: Patients should be informed of the “thousands” of youth who were not only happy to have transitioned, but believed that it had saved their lives.

A year later, Dr Johnson delivered a presentation to the World Professional Association for Transgender Health (more on that organisation below), in which she expressed concern that “the perspectives and worries of parents” were being prioritised “over the lived experiences of youth.”

Dealing with parents in this context, she warned her audience, “introduces additional barriers to accessing gender-affirming care.”

Dr Johnson also appeared to challenge the idea that psychosocial assessments of trans-presenting youth must be conducted by specialists, and suggested that minors should be able to obtain approval for transition therapies on the initiative of “a variety of health care professionals.”

This is consistent with the CPS position that rank-and-file “health care providers”—a broad category that generally is taken to include not only nurses but even social workers—may “develop the knowledge and skills required to initiate adolescents on hormone-blocking agents and gender-affirming hormones.”

While researching this article, I spoke with two detransitioned women who’d received care from Dr Johnson in their mid-teens—including one named Faith Groleau, who’s already gone public with her complaints.

They both describe appearing at Dr Johnson’s clinic as teenagers, while suffering from a variety of acutely debilitating psychiatric problems.

(As has been well-documented, such comorbidities are common among gender-distressed youth.)

They both alleged that Dr Johnson and her colleagues were overly hasty in “affirming” their trans identities.

Both of these young women had back stories that included trauma and suicidal ideation.

Like legions of other depressed girls who self-diagnosed their dysphoria on the internet, they came to believe they were animated by male gender spirits.

(In Ms Groleau’s case, she reports that she also took inspiration—if that is the right word—from the TLC reality television series I Am Jazz.)

Dr Johnson didn’t respond to Quillette’s request for comment, which included a list of specific questions relating to the facts reported in this article.

But her side of Ms Groleau’s story is already a matter of public record, to such extent that it was summarised in a 2024 decision rendered by the Ontario College of Physicians and Surgeons (CPSO) following an investigation into Ms Groleau’s complaints about her treatment.

Dr Johnson denied the claims made against her.

And the CPSO’s Inquiries, Complaints, and Reports Committee found no documented evidence that Dr Johnson had acted improperly.

(The full text of the Committee’s decision can be found on Benjamin Ryan’s Substack.)

No disciplinary action was taken against Dr Johnson in this case; nor, to my knowledge, in any other case.

And she continues to be held in high regard at McMaster University.

No doubt, some of my gender-critical readers may be harbouring suspicions that the CPSO had gone to bat for Dr Johnson based on ideological considerations, and that the fix was in against Ms Groleau from the time she filed her complaint.

But I saw no evidence of that.

Moreover, it’s important to remember that Ms Groleau appeared at Dr Johnson’s clinic a decade ago, in 2016—which is to say, at a time when “affirmation” was first being widely heralded by the North American medical establishment as a panacea for gender-distressed children, and had not yet attracted systematic scrutiny from the likes of Dr Hilary Cass.

The most canonical formulation of GAC precepts can be found in the Standards of Care promulgated by the above-referenced World Professional Association for Transgender Health (WPATH), an Illinois-based organisation whose self-described mission is to “develop evidence-based medicine and strive to promote a high quality of care for transsexual, transgender, and gender-nonconforming individuals internationally.”

Dr Johnson indicated to CPSO investigators that she’d “closely” followed WPATH guidelines in treating Ms Groleau, an approach that, at the time of treatment, would hardly have been regarded as controversial.

But in recent years, WPATH’s reputation has been diminished by a series of scandals.

Leaked emails, for instance, appear to indicate that WPATH had tried to suppress publication of commissioned studies seen as unfavourable to the interests of the surgeons, endocrinologists, and “affirming” therapists who comprise the bulk of WPATH’s membership.

At around the same time, the Cass Review demonstrated that the principles encoded in WPATH’s Standards of Care were scientifically dubious.

The CPS itself cited WPATH’s Standards of Care at several points in its 2023 Position Statement.

And as recently as November 2025—a year and a half after the Cass Review was published—the CPS doubled down on the same document in a follow-up letter published in the Archives of Sexual Behavior.

In that letter, a set of five CPS-affiliated authors claimed, in somewhat lawyerly fashion, that “based on our review of the literature since publication, no new primary evidence has emerged that refutes the information presented in the position statement” (my emphasis).

The authors also added that the Position Statement “is scheduled for routine review and update to incorporate emerging evidence.”

But it isn’t clear when or if that will happen.

Last week, I emailed Megan Harrison, Chair of the CPS Adolescent Health Committee (and a co-author of the above-referenced 2025 letter) about the status of any pending updates.

Like everyone else at the CPS whom I contacted, she never responded.

On conservative news sites, the appointment of Natasha Johnson to the top position at the Canadian Paediatric Society is being treated as something of a scandal.

But the paediatricians I interviewed for this article—including several who were already known to me as critics of the CPS (and of “gender-affirming” dogma more generally)—didn’t seem particularly surprised by her appointment.

While Dr Johnson might be unusually tireless in her public endorsements of GAC, by the lights of Canadian medical orthodoxy, there is nothing scandalous about the substance of her views.

Where my interviews took a more interesting turn is when we began talking about the special features of the Canadian intellectual climate that have allowed the views promoted by the CPS to remain enshrined as the baseline of acceptable clinical practice.

To some extent, it became apparent, the roots of the phenomenon extend beyond the medical sphere, and relate to Canada’s political and legal systems, which lack some of the checks and balances that exist south of the border.

It was largely thanks to American court cases such as United States v.

Skrmetti that the public learned how far WPATH had deviated from scientific neutrality in its pro-transition advocacy.

(Some intra-WPATH emails that have been leaked, for instance, feature doctors boasting about having approved transition surgeries on minors who were obviously suffering from significant mental illness.)

Earlier this year, a jury in New York State awarded US$2-million to a detransitioned woman who’d been fast-tracked into a mastectomy by a psychologist and plastic surgeon when she was 16.

Many U.S. hospitals have stopped performing sex-change operations on minors altogether, out of fear of losing certification for the federal government’s Medicare and Medicaid programs.

And in recent weeks, the Cleveland Clinic entered a settlement with the U.S.

Department of Justice, pledging not to perform sex-change operations on minors for the next two decades, and assigning US$2-million to care for recovering detransitioners who’d been medically altered as children.

In Canada, by contrast, where the rules governing tort law are restrictive, and politicians are more reluctant to weigh in publicly on the nuts and bolts of health policy (with some obvious exceptions, such as the public-health response to the COVID-19 pandemic), it is much easier for highly motivated professional cliques to co-opt medical subcultures.

The only Canadian province that has banned sex-change therapies for minors is Alberta, and even there, the provincial government felt compelled to invoke a rarely used constitutional loophole to prevent litigants from getting the move struck down as an infringement of the Canadian Charter of Rights and Freedoms.

(Following the usual pattern when such laws are passed, Alberta’s move proved popular with ordinary Canadians, but was widely denounced by an alphabet soup of activist groups, labour unions, and media outlets.

I need scarcely add that the CPS raised its voice in strenuous objection.)

At Canadian gender clinics that are affiliated with academic programs—as with Dr Johnson’s facility—the problem of ideological capture can become especially acute: McMaster is typical of Canadian universities in that it has explicitly hardwired the sanctity of “gender-affirming care” into not just its educational curriculum, but even its administrative mission.

The McMaster Student Wellness Centre, for instance, pledges its “commit[ment] to providing gender-affirming care and resources to support you at every step of your journey—whether you’re exploring, questioning, or transitioning.”

Universities have learned that GAC can even attract money from corporate donors seeking to boost their social-justice bona fides.

In 2022, TD, one of Canada’s “Big Six banks,” donated C$500,000 to Dr Johnson’s clinic, as a means to promote “medical and mental health services to trans and gender diverse youth.”

(Dr Johnson personally Tweeted her appreciation for the contribution, though the linked TD press release appears to have been deleted from the bank’s web site.)

One health-sciences academic at McMaster told me that “trying to debate any of these issues at the university has become impossible.”

At one point, she was even thrown off a department-wide Zoom call featuring a talk by a prominent expert on gender affirmation.

And this was done before the seminar had even started.

Her presence on the call, an organiser fretted, would make people feel unsafe.

“I saw the whole idea of medicine at McMaster become identity-centered instead of knowledge-centered [in the 2010s],” she explained.

“So you’d have people emphasise ‘competencies’ in, say, poverty, homelessness, colonialism, and racism.”

While an understanding of culture and wider societal problems has always informed the medical school curriculum to some extent, an identifiable shift took place in the mid-2010s that, by her observation, caused these topics to become increasingly prominent.

With her double-barrelled focus on the “lived experience” of both black and transgender-identified Canadians, and her announced expertise in all manner of “anti-oppressive” doctrines, few Canadian scholars were in a better position than Natasha Johnson to combine activism, scholarship, and clinical practice into a single professional brand.

The future CPS president had very much found her moment.

Another phenomenon at play is the general spirit of parochialism that often infects all manner of Canadian policy discussions.

Historically, this tendency is rooted in anti-Americanism, and the associated presumption that our postures on social and bioethical issues must present an enlightened counterpoint to those advocated by (what are presumed to be) ignorant American reactionaries.

It’s an insular reflex that, as in this case, sometimes gets extrapolated to the international sphere more generally

When the Cass Review came out, it was treated as an important news story around the world.

In Canada, by contrast, many news outlets did their best to ignore it.

It took the CBC five days to even acknowledge the report’s existence, for instance—and even then, the article that CBC News produced consisted largely of quotes from Canadian doctors explaining why they would carry on as if Dr Cass’s research had never been published.

“Though the review’s findings are being used to restrict access to puberty blockers in the U.K., no Canadian medical organisation that responded to CBC News said it would change advice here,” the CBC reported.

The same parochial attitude was channelled in a 15 October 2025 webinar delivered by one of GAC’s most respected Canadian luminaries, BC Children’s Hospital paediatric endocrinologist Daniel Metzger, who’s been treating transgender-identified patients since 1998.

In 2023, when the CPS released its Position Statement on gender-affirming care, it was Dr Metzger’s name that sat at the top of it, alongside that of co-author Ashley Vandermorris, a Staff Paediatrician in the Division of Adolescent Medicine at SickKids Hospital in Toronto.

Dr Metzger’s hour-long presentation, delivered under the auspices of the Children’s Healthcare Canada network, was entitled, Gender-Affirming Care for Youth: Essential Knowledge for Healthcare Providers.

As with many events of this type, it wasn’t clear whether the main purpose was education or political advocacy, as the associated promotional materials were circulated with the hashtag #WeAreAllies, and Dr Metzger freely mixed detailed medical information with barbed remarks about jurisdictions he regarded as hostile to gender-affirming precepts.

In many medical fields, this sort of explicit political bias would be seen as unprofessional.

In this one, it is part of the expected boilerplate.

Dr Metzger’s presentation was oriented toward health-care professionals who regularly treat child patients, but who are not specialists in GAC.

His goal, he said, was to “demonstrate for you the foundations of gender affirming care for trans and gender diverse youth,” and to disabuse audience members of “disinformation” concerning gender-affirming care’s “impact on the mental and physical safety of our trans kids.”

The term “disinformation” appeared repeatedly in the speech.

So did the word “suicide” and its variants, which Dr Metzger used 11 times.

“Once kids get into a medical facility that is affirming,” Dr Metzger told his audience, “the incidence of suicide [and] suicidal ideation goes way down.”

As noted earlier, Dr Cass had quite a lot to say about the claimed effects of GAC on youth suicide.

But Dr Metzger mentioned the Cass Review only once—and even then, only so he could inform his audience that it was “a pile of garbage” that had been concocted by trans-ignorant researchers (who, he speculated, had probably come to their task with “a particular mindset”).

By way of evidence to impugn Dr Cass’s analysis, Dr Metzger directed audience members to a notoriously shoddy anti-Cass critique co-authored by an American paediatrician named Meredithe McNamara—a non-peer-reviewed document that had been summarily exposed by British Medical Journal authors as a cynical effort to protect the legal and financial interests of doctors who provide transition services to minors.

Dr Metzger said that trans-presenting children can be eligible for puberty blockers as early as age nine.

“There are some side effects,” he acknowledged, but then added, “I don’t have a lot of time to talk about them.”

However, he did find time to note “concerns about whether or not [puberty blockers are] having an effect on brain and cognition.”

This topic apparently did not require much elaboration, however, because, as Dr Metzger put it, “gender dysphoria [itself is] also not good for your brain.

And so I think even if we do find that there’s something going on there with cognition and the blockers, I think we have to also balance [that against] what would happen to the kids’ brains if they continue to suffer.”

To be fair to Dr Metzger, he did actively discourage the practice of rushing any child into transition therapies as soon as they claimed to be transgender:

All children [should] undergo a comprehensive bio-psychosocial assessment, [even if that] sounds a little bit like gatekeeping or hoop-jumping.

But it is really important that someone has sat down with the kids and their family and their support group to really, like, help the kids work out where their gender journey is taking them and whether or not, initially, like social transition and then, medical transition is the right step for these children.

More worryingly, however, Dr Metzger doesn’t seem to believe that such “assessments” need be performed by psychiatrists or psychologists: In a recently published co-authored paper, he approvingly described them being performed by a set of “transcompetent” health workers whose ranks included adolescent medicine specialists and social workers.

Toward the end of his presentation, Dr Metzger increasingly segued into political advocacy.

He ominously declared that “gender affirming care is under siege,” and put up a world map, colour-coded to indicate who was enlightened (blue) and who was “naughty” (red).

“We’re in the blue, which is nice,” he explained.

But in the same breath, he cautioned that even some Canadian politicians may be “backpedaling” by allowing more decision-making rights for parents; and that the health community was now facing unwanted “scrutiny from the haters that are out there.”

In some ways, Kwame McKenzie was ahead of his time as well.

His attacks on Zucker were launched in the early period of what came to be called North America’s great awokening.

At a time before the term “cancel culture” had even been coined, McKenzie showed how turning on a colleague could be a winning career play if you expressed the attack in the idiom of social justice and got the media onside.

Natasha Johnson, who was just about to start her own gender clinic, seems to have been paying attention.

In 2025, as documented at Quillette, a group of McMaster researchers—led by Gordon Guyatt, an internationally renowned expert in the field known as evidence-based medicine—began publishing results from systemic reviews they’d conducted on the question of whether various “gender-affirming” interventions actually deliver psychological, psychiatric, or physical benefits to gender-distressed children and youth; and whether such benefits outweigh the attendant risks.

An uproar ensued—not because anything they’d published was scientifically invalid—but because the facts were inconvenient to pro-affirmation orthodoxy, and because Prof Guyatt’s team had received funding from the Society for Evidence-Based Gender Medicine (SEGM), a U.S.-based 501(c)(3) nonprofit organisation widely (and speciously) reviled by transgender activists as a supposed “hate group.”

Guyatt’s team had managed to publish three papers based on its systemic reviews of gender therapies—all containing results broadly in line with the Cass Review (which is to say, factually reliable but ideologically heretical).

But they were overtaken by an in-house activist mobbing before they could publish two others, and various team members were even pressured into penning a mortifying confession to the effect that they’d highlighted facts that had the “potential” to be “misused to harm trans youth and to deny gender-affirming care.”

An op-ed published in a local newspaper, co-authored by a McMaster scholar, argued that unless all of Guyatt’s research in this area were “retracted,” it would be akin to the university endorsing—and I am not making this up—the “extermination” of transgender people.

Dr Johnson’s name does not appear as a co-author of that op-ed.

But in a long and detailed Instagram post responding to its publication, she applauded the attack on her McMaster colleagues.

“I totally agree with [the] opinions of the authors that the articles written by ‘McMaster researchers’ is causing real harm to the trans community and needs to be addressed,” she wrote.

In fact, she was upset that the authors hadn’t heaped more specific abuse on Prof Guyatt—or, as she refers to him, “the very powerful white male researcher.”

Johnson also complained, at considerable length, that the op-ed authors had criticised her friend, Sarro Sharda, McMaster’s DEI boss in the Health Sciences department, for not going after Prof Guyatt sooner.

Prof Sharda, Johnson argued, actually deserved praise, because she’d (apparently) been working behind the scenes as one of the McMaster officials who successfully agitated to get Prof Guyatt’s SEGM funding shut down.

All of which goes to prove just how misguided I was with my prediction that internal pressure within the CPS would push it toward a path of reform.

With the ascension of Natasha Johnson to its presidency, the CPS now has a president who doesn’t just support GAC.

She also supports the campaign to vilify and defund its critics.

As the old expression goes, “things are never so bad they can’t be made worse.”

How Canada Jumped the Rails on ’Gender-Affirming Care’: A Quillette Investigation ^⁠88%

Speakers

Faith Groleau

Analysis

Biases

Fallacies

Manipulations

How Canada Jumped the Rails on ’Gender-Affirming Care’: A Quillette Investigation ⁠88%