Reflections on the investigation are written by PVGenspect360, who is a Canadian Genspect parent.
On October 24, 2021, CTV’s W5 aired an investigation into the exponential increase in gender-questioning youth seeking treatment and whether there are enough safeguards in place for those wishing to transition.
I commend CTV, W5, and their team in producing and opening up the conversation in Canada with their report on young people and gender medicine. It was balanced and respectful and covered as many angles as possible in a limited time frame.
However, did CTV answer their own question of whether there was enough safeguarding in place for gender-questioning young people? Did the W5 producers come up against any resistance that influenced their reporting? Is that why they simply tried to bring Canadians up to speed on various viewpoints rather than exploring the underlying drivers of this rapidly evolving standard of healthcare for young people? Unfortunately, I would say they did not answer their question and and hope there will be subsequent investigations to follow-up and explore more in-depth these exceedingly complex issues.
The episode did convey well and with dignity the experiences of two young people who experienced gender healthcare in very different contexts. Kian is a young Canadian adult who suffered gender dysphoria since early childhood and transitioned as an adolescent, while Sinead is a young Scottish detransitioner whose gender dysphoria began in her teens and was amplified by unwanted male attention. It also told the story of the UK’s Keira Bell and her court case as well as interviewed medical experts in two countries and family members. I want to thank Sinead and her family and Kian and his family for telling their respective sides of the transition experience; their stories were raw, detailed, and valiant. I also sincerely appreciate everyone’s participation and W5’s reporting on the topic.
However, the show unfortunately failed to address or distinguish between childhood-onset (Kian’s experience) and adolescent-onset (Sinead and Keira’s experiences). In attempting to cover a large body of clinical information and conflicting scientific evidence, the show confused diagnostic criteria from the DSM-4 and -5, which refer to the “Dutch Protocol” (a study of just 55 children with child-onset gender dysphoria), while failing to address the current, rapidly expanded cohort of adolescent-onset young people, primarily females. This new, unstudied adolescent cohort does not meet the same diagnostic criteria seen in the younger group .
While the W5 investigation showed a balanced perspective, it barely scratched the surface of rapidly shifting clinical approaches and changing policies around the world, only quickly mentioning the sea changes in Sweden, Finland, and the UK when it comes to their gender-dsyphoric youth. The interview with Dr. Natasha Johnson, founder of the gender clinic at McMaster Children’s Hospital, conveyed a false sense that Canada is in control of the current medical approach – it is not. It was also concerning to hear the doctor’s confidence to what is being offered, considering that there has not been one clinical trial performed with children, or any age for that matter, anywhere in the world. Such systematic reviews are crucial for evidence-based medicine. Indeed, when it comes to life-altering clinical decisions, such reviews should be essential in informing institutional treatment policies. Clinicians who do not seem familiar with the most recent study findings and who seem to quote numbers only seen on social media do not instill confidence in those of us watching the evolution of this field. What we did learn from the investigation is that there are Canadian clinicians who are concerned but afraid to speak out (although she seems to dismiss this concern). Canadian viewers thus may conclude that because a Canadian pediatrician asserted that this is “the” current approach, perhaps she is the only one who “has it right.”
Moreover, Dr. Johnson quoted some staggeringly positive results of transitioning children, which are unfamiliar to any of us who keep up with the scientific literature. Accordingly, I have reached out to Dr. Johnson and W5 for clarification (and am still awaiting replies). I would like to see the citations from which Johnson quoted those numbers. For now, her claims seemed outrageous to those of us in Canada familiar with the recent literature and changes in international health policy. Her reporting of “500 children,” “96% satisfied with the transition,” and “60% of untreated transgender youth are suicidal” implies to the unaware that medical transition is “lifesaving treatment” when in fact those numbers are not produced in peer-reviewed studies anywhere to my knowledge. Unless there is a compelling study out there that most of my colleagues have not seen, the “60%” quote is meaningless. Furthermore, “96% satisfaction” alludes to what may be short-term satisfaction rather than long-term outcomes in children who have not yet matured enough to fully appreciate all the consequences of their childhood or adolescent decisions.
Even if the numbers Dr. Johnson quotes reflect a true population, there is cause for concern. If we apply the “60%” suicidality number to the 500 quoted in the study, we get 200 young patients who were not suicidal. We then have to assume they were fully assessed and found to have no comorbidities to treat. Two hundred nonconforming healthy children with the perception of themselves as in the wrong body have then been placed on a medicalized treatment pathway. What were the assessments for those children that would warrant such a pathway? Were they assessed at all? Furthermore, how is the off-label use of powerful hormone blocking and stimulating agents, on such a grand and growing scale, being ignored by Health Canada? These medical and surgical treatments lead to irreversible changes to the secondary sex characteristics as well as permanent sterility, damage to their sexual lives, and physical disfigurement. No other mental health issue is treated with surgery – none. With an extremely fine line diagnosis of body dysmorphia versus gender dysphoria, why aren’t surgeons amputating body parts of those suffering body dysmorphia or telling anorexics to keep starving themselves because they “believe” they cannot continue with their distress?
Given the information provided by Dr. Johnson, we can estimate that roughly 20 transitioners were not satisfied. What services will be available to those 20 children when they require intensive medical and mental health treatments as they carry that medical burden through their lives? Children and adults who medically transition will re-enter – or remain – in the healthcare system with shortened lifespans and bone health issues, at the very least. The medicalization of gender dysphoria in children and youth means lifelong medical needs. All transgender patients will require intensive medical or at a minimum mental health treatments as they carry that medical or non medical transition throughout their lives. Currently, those who are dissatisfied with transition are left with no recourse and limited medical care, abandoned “collateral damage” in the world’s greatest medical experiment.
As well, we have to consider the impact on families. As Sinead’s mother pointed out, the immense impact of such a decision hits the immediate family and beyond. Additionally, parents will experience disruption in their parenting dynamics and home stability as a result of secretive affirming approaches in schools. This is an area I hope W5 will explore: the catastrophic impact on families from a mental, social, and economic perspective.
Here are more ideas on how W5 can continue to delve deeper. What are the drivers of so many young people wishing to transition? What is the right amount of safeguarding? Is there a social element, at least for some? How can we distinguish between those who will benefit from medical transition like Kian, and those who won’t, like Sinead? Is it just about an underrecognized and undertreated health condition that is now more societally accepted? Or is this a marketing niche where the drivers of the medical and surgical interventions are powerful business machines with promising futures? I look forward to future such investigations.