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The shaky foundation of childhood gender transition | Commentary

By Dr. J. Edward Les 

The debate around childhood “gender transition” has become so toxic as to render calm and rational discussion nearly impossible. Each side is quick to smear their opponents as malevolent or ignorant—or both.

It’s easy to lose sight of the fact that most of us simply want what’s best for our kids. It’s high time we reverted to that principle as our guiding star, particularly in the immediate aftermath of the explosive “WPATH Files.“ These leaked files shine a bright light on the troubling quality of the “Standards of Care” issued by the World Professional Association for Transgender Health (WPATH) and the questionable—and often outright lack of—science underpinning those “standards.”

Reading through a report by Environmental Progress on the files, an Ernest Hemingway quote comes to mind: “All things truly wicked start from innocence.”

The report references an excellent 2023 review by Abbruzzese et al. (“The Myth of Reliable Research in Pediatric Gender Medicine”) describing Dutch researchers in the late 1980s and early 1990s as among the first to champion the “innovative practice” of pediatric sex-trait modification. They weren’t motivated by malevolence but were genuinely looking to improve the lot of transgendered adults suffering from the disconnect between their physical bodies and their gender identity. (Historically, gender identity disorder is a real, but rare, affliction.)

Their motivations were innocent enough—laudable, even. But their analysis was shot through with methodological errors and has since been thoroughly discredited.

Yet as Abbruzzese et al. detail in their paper, the Dutch experiment “escaped the lab”; the small, flawed study diffused rapidly through the international medical community as justification for puberty suppression of gender-confused children as a prelude to cross-sex hormones and surgical modification. And despite the lack of proper evidence, those practices were adopted by WPATH as the “standard of care.”

That, coupled with the social-media-enabled explosion in adolescents identifying as transgender in the mid-2010s, led directly to where we are today: science replaced by full-blown ideology.

Jurisdictions like the UK, Norway, Sweden, Finland, and France have belatedly realized the harm caused by these experimental practices and have begun severely curtailing their use. Britain just announced a ban on puberty blockers for minors under 18, outside of regulated clinical trials. Yet Canada and the United States remain laggards.

The release of the WPATH Files—a collection of messages from an internal WPATH chat system, along with a video of an internal panel discussion—should change that. It’s clear, as whistleblower Jamie Reed put it recently, that transgender clinicians have been “building the plane while flying it.”

In the files, Dr. Daniel Metzger, a pediatric endocrinologist in B.C. and a co-author of the Canadian Paediatric Society’s position statement on gender-affirming care for youth in Canada, openly admits that gender clinicians are “often explaining these sorts of things to people who haven’t even had biology in high school yet,” and “most of the kids are nowhere in any kind of a brain space to really, really, really talk about it in a serious way.”

Fellow WPATH member and child psychologist Dr. Dianne Berg, co-author of the child chapter of WPATH’s “Standards of Care,” confesses that for children and adolescents it’s “out of their developmental range to understand the extent to which some of these medical interventions are impacting them.” And worse, even parents aren’t sufficiently health-literate to comprehend the effects of treatment protocols proposed for their gender-confused children.

Per Dr. Berg: “What really disturbs me is when the parents can’t tell me what they need to know about a medical intervention that apparently they signed off for. … [This is] not what we need to be doing ethically.”

Yet a lack of ethics is on full display. Gender transition of children with coexisting autism, developmental delay, or other mental health challenges is openly encouraged. Fertility concerns are downplayed or dismissed. The long-term harms of puberty blockers, cross-sex hormones, and irreversible surgeries are shunted aside.

WPATH has been long considered the leading authority on the care and treatment of individuals with gender dysphoria, and is frequently cited by organizations like the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and the Canadian Pediatric Society as the basis for their policies of “gender affirming care.” WPATH, in turn, points to these organizations as lending credence to their own Standards of Care.

It’s the very definition of circular reasoning.

Except that in this case it’s a circular firing squad—and it’s kids who are taking the bullets. If that isn’t wicked, I don’t know what it is.

Dr. J. Edward Les, M.D., is a pediatrician in Calgary and a senior fellow at the Aristotle Foundation for Public Policy.

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14 Comments

  1. Allen Markle says:

    So who in the previous comments actually speaks credibly and unbiased with full mental and medical backgrounds? Who possesses the definitive answers to the whole question? We deal in opinions here. After eight decades of reading, observing, and formulating opinions on a lot of things, this subject leaves me at a loss. I can be sympathetic and attentive but can’t offer much in the line of understanding (I don’t understand) or advice, as some here profess the ability.

    As to the ‘science’ in the matter? If there is any it’s nebulous or being developed and untested. The children and the parents of such children are where the science will develop. On the real people. That’s a troubling certainty.

    For me, the Steve Bodrug comment is rational and logical. Maybe it wouldn’t help either a parent or child. Even the ‘experts’ are at odds as to a path to follow. Possible there is a developing science but no definitive solution yet. As there may never be with a lot of mental and physical problems. And individual circumstance throws curves.

    We are encouraged to ‘never judge ’til we’ve walked a mile in other (their) boots”. Tough standard and likely why we just offer opinions.

    But for sure if I’m asked a financial question I could offer the name of an accountant. Ulcer? I know a doctor. Legal woes. There is this certain lawyer. But if the question is : what pill to take, or food to eat, or where to cut, and just how deep? In regards to body modification for youth. No comment. And no matter how sympathetic or well meaning they may present, I won’t be recommending a councilor for the town of Huntsville either.

    I hope the children and the parents of these children find a solution that fits them. We all hope for that.

  2. Tamara de la Vega says:

    Ms. Tanaka, it was shared with permission from the Aristotle Foundation for Public Policy. Please note that the commentary is simply addressing medical intervention in children. That is the topic here.
    Please stick to the topic on hand.

  3. Joanne Tanaka says:

    Mr Mackenzie, thanks for sharing your personal family connection to LGBTQ plus issues. However, for your ethical, journalistic transparency, I would like to know what Foundation sent you the item from Dr Les and why you think they are credible. As you must be aware and sensitive to, there is an antiLGBTQplus movement that is even showing up in Pierre Polievre’s agenda about “biological gender” restrictions. Muskoka Canadians for Truth organized the very loud, hostile “Walk” that challenged the much smaller, very brave group of local young people, their families and supporters. I learned much by standing with them. Your presence would have been very welcome.
    Mr Bodrug, please look to your soul and try to feel that Love is Love is not an argument but a prayer for all to connect as our best selves. Peace be with you.

  4. Steven Bodrug says:

    There are some repeated themes in these comments such as the hackneyed “love is love” slogan. This is an example of circular reasoning. When one says love is love, that is analogous to saying purple is purple. That does nothing to tell anyone what love or purple are. All that does is reveal that they exist. One cannot define a word by using it in the definition; that is logically incoherent.

    Secondly, some people in the comments argued that Dr. J. Edward Les is biased, and implied that those who share a contrary disposition to him are objective. I hate to break it to you, but everyone is biased — the laity and the experts — regardless of the discipline or topic being addressed. Every photo is taken from a particular angle. It is naive to presuppose that anyone is entirely objective in their thinking. We are not entirely rational beings; we are motivated by other factors such as our respective environments, emotions, and worldviews. To pretend otherwise is ignorant.

    In response to Jeff Robertson’s comment about the American Psychological Association, according to their views before 1973, homosexuality was a mental illness. Were they wrong in their original conclusion? You cited them as a credible source of information, but I assume that you would disagree with their original findings, which ought to make you more cautious to accept what they and others say out of hand.

    How do you know that they won’t change their minds on this issue in the coming years, as cultural opinion on it becomes even more critical? This seems inevitable. Clinics have been closing down in Europe, and as affirming views toward the trans issue fall out of vogue, and it no longer wields political leverage, nor remains lucrative for those who are exploiting confused children, I imagine that we’ll see a 180 from the APA and others when they have exhausted their last lines of defense. It is also imperative to know that the APA has been heavily politicized by the left for decades, so they are hardly the bastion of objectively minded experts that you seem to be suggesting.

    Dr. Sarah McKinnon: “As a family doctor in the area, I provide primary care for transgender patients, including gender-affirming care when it is requested.”

    There is no such thing in medicine as affirming care; that is a contradiction. It is not the duty of a doctor to affirm a patient’s problems or disorders, rather, they are there to offer them treatment with compassion. You don’t affirm someone who believes that the voices in their head are real; you devise a plan to remedy the problem, not exacerbate it.

    A doctor is not supposed to tell their patient what they want to hear, nor are they to impose their personal beliefs on them, rather, they are to help navigate their patient through their problems and toward a resolution (even if that requires some uncomfortable questions, along the way). This does not mean acquiescing to the desires and or demands of the patient. If a doctor just does whatever their patient says or wants, then what good is the former to the latter? That’s not actually proving help, rather, that is affirming and reinforcing whatever their issues are.

    Scott Morrison: “Shocked to see that the Doppler is sharing an opinion piece by a known transphobic doctor from a different province.”

    Define “transphobic.”

    This leftist term is a bullying tactic used as cudgel to quash dissent. Moreover, it is an example of the ad hominem logical fallacy. You have done nothing to demonstrate why you think the views of the doctor in question are wrong; all you have done is try to discredit him by lazily resorting to name-calling, thereby conveniently freeing you from the burden of carefully examining what he believes and mounting a countervailing argument.

    Did you merely type his name into Google, see the word ‘demented,’ and thus come to the conclusion that he is “transphobic” (whatever you mean by that)?

    You telling others to do their research when you evidently haven’t even done on your own, is hypocritical. You literally once told me in the comments of another Doppler article, last year, that the science around gender is “settled,” and in defense of this claim, you cited a video featuring Bill Nye, of all people; a man who isn’t even a scientist, but a mechanical engineer and television presenter.

    Additionally, that comment of yours betrayed a fundamental misunderstanding of the nature of science, which is never settled, rather, it is tentative. For example, prior to when the Big Bang theory was posited, it was believed that the universe was eternal, but current cosmological evidence strongly points it have a beginning a finite time ago in the past.

    With respect, Scott, I believe that you are out of your depth defending a position that you seemingly have no basic understanding of in terms of its dubious and nefarious origins, based on your past statements. I would gently encourage you to do rigorous research on this topic, as opposed to referring to a television star who is unequipped to speak authoritatively on the matter. Here are some helpful resources for you and others to examine the motives and faulty methods used by the pioneers of this movement.

    The DARK Story Behind Gender Theory | feat. Dr. Miriam Grossman: https://www.youtube.com/watch?v=8-GgKTkmFO4

    Lost in Trans Nation: A Child Psychiatrist’s Guide Out of the Madness by Miriam Grossman MD: https://www.amazon.ca/Lost-Trans-Nation-Psychiatrists-Madness/dp/1510777741

    The Rise and Triumph of the Modern Self: Cultural Amnesia, Expressive Individualism, and the Road to Sexual Revolution by Carl R. Trueman: https://www.amazon.ca/Rise-Triumph-Modern-Self-Individualism/dp/1433556332

    Jennifer Bilek | Who is Behind the Trans Angenda?: https://www.youtube.com/watch?v=tLXdoqXbC6k

    I would also recommend reading/listening to Camille Paglia, a trans historian, who notes that the embrace and lionization of transgenderism is a sign of cultural/societal collapse.

    Lesson from History: Transgender Mania is Sign of Cultural Collapse – Camille Paglia: https://www.youtube.com/watch?v=I8BRdwgPChQ&list=PLq9fLrYRm0z7f-gEA1zur-KvALWGj87sX

    “I’m all for having different points of view shared but this situation is not that. Come on Doppler, you can do better than this.”

    If this is not a different point of view being shared, then what is it? Is it fair game for anyone to be critical of the trans narrative that we have been force-fed by the legacy media and their cohorts in academia, Hollywood, etc? If your answer is no, then your sentiment seems disingenuous.

  5. Laura Sundy says:

    Yikes. I am shocked your outlet chose to publish this piece. This doctor is considered an outlier among paediatricians in Canada and he has said some very dangerous and even hateful things.
    He’s definitely not considered to be an expert in this topic.

    For those who would actually like to know what the Canadian Padiatric Society’s position is around gender affirming care, you can read a recent letter they sent to the Alberta Premier:

    https://cps.ca/uploads/advocacy/Gender-affirming_care_in_AB_Public.pdf

    It can be easily found on CPS’s website under “advocacy”.

    A message for trans youth and parents of trans youth here in Muskoka: you are loved and supported. And though it might not feel like it right now, things ARE changing. Throughout history, every social justice movement receives this kind of backlash, unfortunately. But things always move forward despite it. It just takes time. Sending big love and support!

  6. Dr. Sarah MacKinnon says:

    Like a previous commenter, Joanne Tanaka, I look forward to a balanced article from the Doppler with information from credible and unbiased medical and mental health professionals.

    As a family doctor in the area, I provide primary care for transgender patients, including gender-affirming care when it is requested.

    When a patient comes to see their doctor or nurse practitioner for gender-affirming care, on their own or with the support of their family or caregiver(s), Ontario primary care providers have the choice to provide gender-affirming care or to provide an effective referral for care. Then there is an extensive process of engagement, education, and support for the patient, family, and/or caregiver(s). Through this process, the patient and their supporters can choose what form of gender-affirming care they require.

    Unlike Dr. Les, I believe that older children, teenagers, and parents can understand the risks and benefits of the various treatments involved in gender-affirming care. I believe that families, with the support of their healthcare practitioner(s), make appropriate choices. Bans on gender-affirming care can cause significant harm to the mental and physical health of a transgender person.

    I hope that our society can work towards supporting the transgender community, and allow these people to make the choices that are right for them. I encourage the values of love, support, respect, and non-judgment, as they lead to a better community for us all.

  7. Hugh Mackenzie says:

    The comments above are appreciated. We knew this article would be controversial which is why we decided not to put it on social media. On the other hand, having received the article and checked out the Foundation that sent it to us, we believed it to be a legitimate point of view as to whether children should receive life altering drugs, therapy or surgery related to their sexual orientation before they reach the legal age of consent. I agree totally with the comment from Joanne Tanaka that love is love. We have two members in our family who are in same sex relationships and they are not only a joy but they enrich us. But sometimes love requires tough discussions and decisions. It is our belief that the single question as to whether children under the legal age of consent should receive life changing treatment related to their sexual orientation, which as an adult they might regret, is one of those times.

  8. Scott Morrison says:

    To be fair, I have had a really good conversation with Tamara and she had no idea that this guy had made some rather controversial comments. The blog posts that he had made them on have been pulled down.

    Tamara was simply trying to show a balanced view of a very important issue. The platform that she gained the information from was credible. But it didn’t delve into the background of the writer. Nor did it mention that the author of the WPATH files has been discredited on a number of fronts. And he quotes the WPATH files as being a big basis for his argument.

    Discussing opposing viewpoints is very important and I believe that this was the intention of the Doppler with posting this opinion piece. We just have to be very careful with misinformation when it comes to divisive issues.

    Thanks for the chat today Tamara.

    Cheers

  9. Joanne Tanaka says:

    Looking forward to Doppler ‘s balancing next article from credible, unbiased, medical and mental health professionals supporting current gender affirming care practice available to Canadian families. Ironically, despite what Dr Les states as his purpose, publishing this item stirs up unnecessary controversy about a health care issue that is ultimately very personal to families and their young people in need of solid empathetic, clinical advice and supportive counsel, not biased anti- trans presentations that try to make political hay out of sensitive personal issues.(like the Canadians for Truth) And as for the “science” – not really different than so called scientific research establishing Asians as more intelligent than white or black students, or women as incapable of being doctors etc.
    We live in a very cis- gendered biased culture.
    Love is Love.

  10. Kathryn Henderson says:

    I think the doppler did not take sides but shared information that is relevant to us all. I think children should have to wait for puberty blockers and surgeries until they have been through puberty. There are a lot of kids who think they are a different sex but after puberty some change their minds. I know of one girl who acted as a boy and associated with being a boy but after puberty was glad to stay a girl. She is married with children. Im not against trans but think children should have to wait until 18 years.

  11. Anna-Lise Kear says:

    Thank you for this article, I appreciate the information summarized here.
    It is wise to admit the limitations of our own/my own knowledge -rather than to jump on the bandwagon of one viewpoint.
    There are many instances where/when we await for the science to catch-up to new pronouncements.
    In addition, we must remain sceptical of fast-developing “facts” delivered by social media.

  12. Doug Beiers says:

    Very good article. Sadly, children are the victims.

  13. Scott Morrison says:

    Shocked to see that the Doppler is sharing an opinion piece by a known transphobic doctor from a different province. Research into this man could have given you a bit of clarity before posting. For instance, this article shows a little bit about the guy whose opinion you are sharing.

    https://medium.com/@SiobhanFTB/calgary-physician-calls-transgender-people-demented-distorted-4d97b0121fb1

    I’m all for having different points of view shared but this situation is not that. Come on Doppler, you can do better than this.

  14. Jeff Robertson says:

    Isn’t it odd for the Doppler to point out that we must reach all the way to Calgary to find a doctor who wants to share these views?

    Instead, see the consensus reached recently by the American Psychological Association (APA) – the largest professional organization of its kind in the world – which concluded that trans care bans must end, and that misinformation around gender affirming care should be rejected.

    Link: https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care

    Their statement concludes that spreading misinformation around gender affirming care “[creates] a distorted perception of the psychological and medical support necessary for these youth and creating a hostile environment that adversely affects their mental health and wellbeing.” Their description of this misinformation seems, to me, to match what’s we see in this article.

    So – as concluded by experts on the subject – is creating a hostile environment for these youth now what the Doppler stands for? I notice there are no local names listed here at all. Please explain how this editorial was selected for publication.