MacDonald Laurier Institute
Are gender interventions helpful? First do no harm!: David Zitner for Inside Policy

From the Macdonald Laurier Institute
By David Zitner
Canadian public health bodies are lagging far behind peer nations in calling for evidenced-based approach to gender-affirming care.
Public health bodies in Europe and the United States are sounding the alarm, calling for serious research into the safety and benefits of youth gender transition interventions. On August 12, the American Society of Plastic Surgeons became the first major US medical association to challenge the consensus of medical groups over “gender-affirming care” for minors.
Meanwhile, systematic reviews of evidence conducted by public health authorities in Finland, Sweden, and the United Kingdom concluded that the risk/benefit ratio of youth gender transition ranges from unknown to unfavourable.
According to a US study, each stage of gender affirming treatment – social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery – poses harms and risks that are not fully disclosed to minors and families.
Regulators in Europe and the UK have already reacted accordingly, with more emphasis on psychosocial support over medical interventions.
Canadian regulators, on the other hand, have been mum on the need for evidence-based treatment and they have not even insisted that proponents of aggressive treatments track the long-term physical and mental health outcomes of gender-affirming interventions.
Doctors and parents trying to support children with gender issues are faced with important, sometimes conflicting, moral and ethical dilemmas as they try to help distressed children while avoiding harm.
For most established treatments across the various areas of medicine, researchers have studied the chances and types of benefits and harms, the research is accessible, and patients can choose based on their own values and subjective assessment the anticipated benefits and risks. It is entirely different for those who consider gender-affirming interventions.
Parents acting as agents for children with gender identity issues are in a particularly desperate situation because of the absence of reliable research identifying those children who will someday detransition. Too many parents will likely feel deeply aggrieved when they realize that what might have been a passing fancy of childhood or adolescence produced permanent, irreversible harms.
In pursuing gender-affirming care, doctors and parents simply cannot avoid harm because the evidence is insufficient to identify those who might benefit from aggressive therapies and those who will be harmed.
Unfortunately, this absence of reliable scientific research does not prevent people, including Canadian regulators, from expressing strong opinions in favour of aggressive gender interventions.
Some adolescents experience gender fluidity and uncertainty as they grow. From time to time, a person might change how they feel, expressing their identity one way and subsequently another. Such persons might dress and accept the identity compatible with their genetic identity (male or female) at one period of their life, and at other times identify with or express an identity incompatible with their genetics. Like other emotional preferences, they can change over time.
A British Medical Journal article commenting on the Cass Review emphasized that anyone who genuinely cares for children should recognize that “gender medicine is built on shaky foundations.” Citing numerous articles in peer-reviewed pediatric journals, it concludes: “The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider — from social transition to hormone treatment. Of more than one hundred studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality…. Intervention studies — particularly of drug and surgical interventions — should be designed to evaluate relevant outcomes with adequate follow-up.”
Despite the opinion of some professional gender-modification advocates, evidence of benefit is scant. On the other hand, the risk of aggressive gender-transition interventions include changes to fertility, bone, and cardiovascular health, and growth. It simply must be said that tampering with a young person’s hormone levels and appearance leads to dramatic, and often permanent, harmful biologic changes.
Canada’s peers are waking up to the dangers of gender-affirming care for minors and the threadbare evidence on which it has progressed thus far. Where is Canada?
Canadian public health bodies and regulators should follow other international bodies and insist on evidence-based care following the systematic study of the benefits and harms of aggressive gender interventions. Until that study is complete, we must insist that doctors remember their obligation to “do no harm.”
David Zitner is a senior fellow at the Macdonald-Laurier Institute. He has participated at every level of Canadian health care including clinical practice, research, administration, governance and patient and professional education.
Immigration
Mass immigration can cause enormous shifts in local culture, national identity, and community cohesion

By Geoff Russ for Inside Policy
It matters where immigrants come from, why they choose Canada, and how many are arriving from any single country. When it comes to countries of origin, immigration streams into Canada have become wildly unbalanced over the last decade.
Few topics have animated Canadians more than immigration in the past year.
There is broad consensus among the public that the annual intake of newcomers must fall, and polling shows both native-born and immigrant citizens agree on this. In Ottawa, the Conservative opposition has called for lower numbers, and the Liberal government ostensibly concurs.
While much of the discussion surrounding immigration has focused on economic factors like affordability and the shrinking housing supply, less attention has been paid to the cultural and political changes of welcoming more than 5 million people into the country since 2014.
Specifically, attention must be paid to the possible outcomes of importing hundreds of thousands of people from regions embroiled by war or prone to conflict. This is a necessity as digital technology proliferates and guarantees the world will be interconnected, but not united.
Mass immigration brings in far more than just people. It can cause enormous shifts in local culture, national identity, political allegiances, and community cohesion.
It matters where immigrants come from, why they choose Canada, and how many are arriving from any single country. When it comes to countries of origin, immigration streams into Canada have become wildly unbalanced over the last decade.
In 2023, almost 140,000 people immigrated to Canada from India, while the second-largest intake came from China, with 31,770 people.
This new trend is at odds with Canada’s historical immigration policies, which were more evenly weighted by country. In 2010, the top three national pools of immigration were the Philippines at 38,300 newcomers, India with 33,500, and China with 31,800.
Other countries that Canada has received increasing numbers of migrants from includes Syria, Pakistan, and Nigeria.
Past federal governments took consideration for details like economic needs and capacity for integration. Canadian immigration policy in 2025 should take into account modern communications and conflicts within certain regions as well.
21st century technology continues to advance and innovate at dizzying speeds, giving rise to immersive social platforms and instant messaging platforms like WhatsApp or Signal. This has brought the world closer together, but rather than promoting peace and understanding, it has amplified foreign conflicts and brought them to our own backyards.
Tens of thousands of migrants from the Levant have arrived since 2015, a region where anti-Zionism is deeply ingrained in the cultures, as well as full-blown antisemitism.
Since the outbreak of the Israel-Hamas War in 2023, the entire West has borne witness to antisemitic violence in Europe and North America, often perpetrated by ideologically motivated migrants.
Earlier this year, a Syrian migrant in Germany went on a stabbing spree with the intent of murdering Jews, while last September, Canadian police foiled the plot of a Pakistani man in Ontario who had planned to commit a mass killing of Jews in New York City.
Canada’s political culture has been profoundly affected by these same waves, with demographic changes forcing the federal government to alter its longstanding foreign policy positions. For example, the newly-minted Minister of Industry Mélanie Joly allegedly remarked last year that her shifting stance on the Israel-Hamas war was due to the “demographics” of her Montreal riding.
Montreal itself has become a hotbed of anti-Israeli and anti-semitic violence. Riots, property damage, and the storming of the McGill University campus have been carried out by radicals inspired by Hamas and their allies.
In 1968, the great Canadian thinker Marshall McLuhan co-authored War and Peace in the Global Village, which warned of the consequences of modern technologies erasing the boundaries of the world. McLuhan explicitly cautioned that technology would make the world smaller, and lead to conflict in his theorized global village.
Today, that village is one where Jewish students are routinely harassed on college campuses in Vancouver and Toronto, while synagogues are burnt to the ground in Melbourne. It does not matter whether the victims are Israeli or not. They are seen by their assailants as legitimate targets as part of an enemy tribe.
On May 21, two staffers at the Israeli embassy in Washington DC were shot dead by a man shouting pro-Palestinian slogans.
These sorts of imported feuds go beyond the Middle East. Global tensions in regions like the Indian subcontinent present another threat of foreign-inspired and funded violence, as well as undue political shifts.
India and Pakistan are locked in a long running standoff over the disputed territory of Kashmir.
Last month, several tourists were murdered in Kashmir by militants that India accused Pakistan of backing, leading to several low-level exchanges between the Indian and Pakistani militaries before a ceasefire was brokered. Tensions are far from dissipated, and the possibility of a full-scale confrontation between India and Pakistan remains high.
Considering those two rivals have massive diasporas in the West, a potential war on the subcontinent could radically change domestic politics in countries in Canada, Australia, and Britain.
In 2022, violent clashes broke out between Hindu and Muslim youths in the British city of Leicester following a cricket match between India and Pakistan. The street battles lasted for weeks, and threatened to restart later that year following an escalation in India and Pakistan’s clash over Kashmir. In London, demonstrators from the Pakistani and Indian communities came close to violence.
If a sporting rivalry can inspire hooliganism, a war will spark something far worse, and the globalization of the Israel-Gaza conflict is a glimpse into what that might look like.
There is historical precedent in Canada for how overseas conflicts affect domestic politics.
During the 19th century, hundreds of thousands of Irish—both Catholic and Protestant—emigrated to Canada before and after Confederation in 1867. They brought their religious feuds with them.
The militantly anti-Catholic Orange Order, run by Protestants, became one of the most powerful political forces in Ontario. They held a virtual monopoly on municipal politics in Toronto, excluded Catholics from jobs in the public service, and took part in brawls with the city’s Irish Catholic community for more than 100 years.
Thomas D’Arcy McGee, one of the Fathers of Confederation and an Irish Catholic migrant, was murdered for speaking out against the republican Fenian Brotherhood, which had infiltrated politics both in Canada and the United States.
Integration throughout successive generations mitigates and even practically eliminates the impact of imported conflicts. This was the case with the Irish sectarian divide, though it took over a century to fade away.
Worth noting is that roughly 300,000 Ukrainian refugees currently reside in Canada, having been admitted under a special visa program following the Russian invasion in 2022. It is intended to be temporary, with the expectation of repatriation once a stable peace returns to Ukraine.
Similarly to Irish-Canadians, the vast majority of the established Ukrainian-Canadian community has its roots in pre-modern Canada, and is largely well-integrated into the country’s social fabric. To date, there has been no major violence or anti-social harms inflicted upon their Russian-Canadian counterparts despite the war, or vice-versa.
Furthermore, the Canadian government has a longstanding close relationship with Kyiv, and there is far more trust and transparency regarding intent and collaboration. This is not the case with governments like China and India, the former of whom actively interferes in our elections, and the latter of which has been accused of assassinating dissidents on Canadian soil.
The existence of the iPhone, the internet, and opportunistic foreign governments makes it incredibly dangerous to not change course. That is not to imply that the average migrant is an active foreign agent. But the sheer quantity makes vetting them all a challenge.
Mitigating these threats requires strategic planning when crafting immigration policy.
Other parts of the world like Southeast Asia, Southern Europe, and Latin America are relatively stable and peaceful and are potential sources of newcomers with far lower risk of foreign interference and diasporic violence.
At-play is the stability, unity, and integrity of our political system. Canadian politics must remain fully Canadian in its focus and priorities. That cannot happen if we sleepwalk into becoming a battleground for the rest of the world.
Geoff Russ is a writer and policy analyst, and a contributor for the Macdonald-Laurier Institute.
Health
Medical organizations and media let Canadians believe gender medicine is safe and universally accepted. It’s not

The Macdonald Laurier Institute
14 physicians sign statement for Inside Policy
Many Canadians are likely unaware that several other medically advanced countries—like Britain and multiple EU member states—have restricted hormone therapies and surgical interventions which have documented harms and no clear benefits, writes a group of Canadian doctors.
Following similar actions by peer countries around the world, United States President Donald Trump signed a Jan. 28 executive order declaring his administration will not “fund, sponsor, promote, assist, or support” so-called “gender-affirming” medical treatment for minors—which prescribes hormone therapies and surgical interventions that change sex-determined physical characteristics. Now, a recent report from the U.S. Department of Health and Human Services confirms what many other medical bodies and advanced countries have already recognized: the science and reasoning behind this form of medicine is deeply flawed.
This news appears shocking to many ordinary Canadians, as well as legacy media outlets like The Globe and Mail. That’s largely because Canadian medical organizations and governing bodies—presumed by the public to speak for physicians—have vocally supported “affirmation”: an approach that unquestioningly supports the choice of patients to undergo these treatments. This has left the public with the false impression that such treatments are safe, effective, and universally accepted by physicians. We, a group of 14 Canadian physicians, feel it is vital for the public to know that many—and perhaps most—physicians believe there must be restrictions on gender therapies that permanently change a minor’s body.
Many Canadians are likely unaware that similar restrictive policies are already in place in other medically advanced countries, like Britain and several EU member states.
Most notably, the U.K. government commissioned Dr. Hilary Cass to produce what has become known as the Cass Report, a thorough review of the literature around the treatment for gender dysphoria. Cass investigated whether there is actually proof that these therapies “save lives,” as many activists will insist, or if there is evidence that such interventions make patients’ lives better? Dr. Cass concluded that although medical treatments for gender dysphoria can cause significant harm (as is the case with any medical intervention), there is no conclusive proof of benefit. Hormone therapy and surgeries can lead to chronic pain, incontinence, sterility, and more. They are permanent and irreversible. Therefore, Britain and many other countries restrict most of these treatments for minors.
Here in Canada, Alberta has been the leader in following the evidence. In 2024, the province introduced legislation mandating a minimum age before children could consent to make these permanent, life-altering changes to their bodies. Many physicians were involved with drafting the well-considered legislation. Many more applauded it—some publicly, others quietly.
Despite that, the usual suspects leapt forward to pillory Premier Danielle Smith’s government. The CBC, Globe and Mail, and other legacy media outlets ran headlines like: “Medical experts warn Danielle Smith’s restrictions on gender affirming care will harm vulnerable youth in Alberta.” Most articles quoted bodies such as the Alberta Medical Association (AMA), Canadian Pediatric Society (CPS), and the venerable Canadian Medical Association (CMA), all of which very quickly released statements decrying Alberta’s stance. Such articles give the public the impression that these organizations speak for physicians, expressing a majority, if not unanimous, view.
These organizations do not speak for all physicians. It is hard to know what percentage of physicians oppose “gender-affirming care” for minors because many are afraid to speak their minds in a climate where any dissent is couched as “transphobia.” Physicians who speak out have been subject to investigations and penalties by regulatory organizations, particularly after the passing of federal Bill C-4 in 2022, which potentially makes it a criminal offence to refuse support of a child’s belief that he or she is transgender.
In 2025, one needs to take statements from physicians’ groups with a grain of salt.
Engagement with the CMA is in decline. In 2018 (when membership remained mandatory for doctors in many provinces), the association claimed 87,000 members. By 2024, membership dropped to 75,000 despite an increase in the number of physicians in Canada. Many are members only in a nominal sense, and have little meaningful involvement with the CMA. Rather than taking the pulse of the medical profession as a whole, seeking diverse viewpoints, and making statements that represent this range of views, the CMA is captured and directed by a radical progressive fringe. Unfortunately, this fringe retains the historical imprimatur of being the “voice of physicians” in Canada.
The same phenomenon has occurred with provincial physicians’ organizations like the AMA, which collect mandatory dues but seek minimal engagement from members. Activists have exploited this vacuum to take the helm of these organizations.
This same phenomenon can be seen in organizations like the CPS, CMA, and similar specialty bodies. Their mission statements and missives increasingly read like Marxist screeds rather than wise and measured comment. Just one such example is the CMA’s “ReconciliACTION Plan,” which “challenges anti-Indigenous structures in the health care system.” When physicians with more conservative and scientifically-based views attempt to engage these groups, they have often been met with indifference or hostility, and are systematically prevented from holding positions within these organizations.
This shows that these organizations do not speak for all physicians. When mainstream media rely on such organizations as their sole source for “expert” comment, they miss the real story and avoid engaging with facts. Legacy media portrays this as a battle between science-denying right-wing bigots on one side, and empathetic experts on the other. This could not be further from the truth.
The science is not “settled” by any means. So-called “gender-affirming care” has proven risks and harms, but unproven benefits. It is not “life-saving,” but it is permanently life-altering. We are 14 of the many physicians who strongly believe that minors should not be allowed to make such decisions. The self-proclaimed “experts” do not speak for us.
Written and signed by,
Dr. Arney Lange MSc, MD, FRCPC
Dr. Brent McGrath, MD, FRCPC
Dr. Chris Millburn MD
Dr. David Zitner MD
Dr. Dion Davidson MD, FRCSC, FACS
Dr. Duncan Veasey MD
Dr. Julie Curwin MD FRCPC
Dr. Lori Regenstreif MD, CCFP (AM), FCFP
Dr. Mark D’Souza MD, CCFP (EM), FCFP
Dr. Martha Fulford MD, FRCPC
Dr. M.J. Ackermann MD
Dr. Richard Gibson MD, FCFP
Dr. Roy Eappen MDCM, FRCP (C)
Dr. Shawn Whatley MD, FCFP (EM)
This statement is an initiative of the Macdonald-Laurier Institute, written and signed by concerned physicians from across Canada who are calling for a more careful, evidence-based, and ethically responsible approach to the treatment of gender issues.
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