'We need to reassess': The evolution of one gender care doctor in Canada

Story by Sharon Kirkey


Dr. Karine Khatchadourian is calling for a national review to reassess how Canada treats gender-distressed youth.

During a recent talk at the invitation of the University of Alberta, Dr. Karine Khatchadourian offered a candid appraisal of the evidence underpinning Canada’s approach to treating gender-distressed youth.

The field is in a highly consequential grey zone with contradictory findings at best, the Ottawa doctor told a virtual audience. The evidence doesn’t allow doctors to say with confidence whether puberty suppression has psychological benefits or not and today’s rapidly changing demographics — predominantly biological females with accompanying complex mental health problems and no known history of gender distress when they were younger — make it difficult-to-impossible to predict if someone’s gender dysphoria or incongruence will persist.

“We have to constantly be reassessing what we’re doing, what we’re treating, based on new evidence that’s coming forward,” Khatchadourian said.

Doctors are encouraged to look at emerging data objectively, be open to scrutiny and pivot where necessary, she said. However, gender-affirming care is different; a field so turbulent and charged with emotion that providers are reluctant to express doubts for fear of being alienated by colleagues and condemned by activists as transphobic.

Which is what makes Khatchadourian’s openness to share that her own messaging has changed so remarkable.

“The message to patients, providers, the public has to include that what we’re seeing now with the data is this uncertainty of the evidence,” she told the February gathering hosted by the U of Alberta-based Women and Children’s Health Research Institute. Her assessment echoes the findings of a recent series of deep systematic dives into the literature that concluded the evidence supporting gender medicine interventions is, as the editor-in-chief of the influential British Medical Journal summarized, “threadbare, whichever research question you wish to consider.”

Khatchadourian was one of the first doctors in Canada to provide hormone treatments to transgender-identifying and gender dysphoric youth, in 2014. By her estimate, some 250 to 300 gender-distressed children and teens have been under her care over the years.

After 12 years of experience, she said she now understands the population more. “I can say that, with everything I now know, as of now, I would challenge medicalizing the majority of youth that are presenting to clinics,” Khatchadourian, an assistant professor of pediatrics at the University of Ottawa, said in an interview.

“I strongly believe in this care,” she stressed.

“But it must be approached with rigour and caution, given the high stakes in this field.”

McMaster University researchers faced persecution from both extremes of the trans debate last year after publishing two systematic reviews that found the evidence is of such low, or very low, certainty that it’s impossible to conclude whether puberty blockers are helpful or harmful.

Lead author and celebrated scientist Dr. Gordon Guyatt and colleagues faced backlash from activists on one side over a funding source (the Society for Evidence-Based Gender Medicine, a group concerned with low-evidenced interventions that’s been accused of being an anti-trans think tank by transgender rights groups) and, on the other side, critics who accused Guyatt of shirking his own evidence-based approach to science by later issuing a letter criticizing opponents for using his work to justify treatment bans.

“Everybody’s been kind of frightened,” Guyatt told National Post columnist Michael Higgins . “I was not as vividly aware as to what an extreme political environment it is.”

In their letter, Guyatt and four colleagues wrote that it’s misguided to cast medical interventions based on low-certainty evidence “as bad care or as care driven by ideology.”

However, under the GRADE scoring system co-developed by Guyatt, “very low certainty” means it’s hard to have confidence where the true effect lies.

Privately, other Canadian doctors like Khatchadourian are becoming more cautious.

Writing for healthydebate.ca, scientist, gastroenterologist and U of Toronto professor of medicine, Dr. Laura Targownik, who is a transgender woman, said several providers working in the field have shared that they’re becoming “more circumspect, recognizing that they can no longer function as enablers of transition in all cases.”

Public support for gender care for minors is in “free fall,” she wrote, “not only among conservative voters, but also among those who describe themselves as moderate or liberal.”

But the issue has become such a political minefield doctors fear that any expressed concern will be weaponized and used to shut down “and rob youth” of all care, even for those who would benefit, Targownik said in an interview.

Canadian physicians want what’s best for kids, she said. But they’re also concerned about leaving kids suffering from serious dysphoria with nothing.

Several European countries and American states are already pulling back. Puberty blockers have been banned indefinitely in Britain for under 18s after the country’s health service declared them an “unacceptable safety risk.” Alberta invoked the Charter’s notwithstanding clause to uphold its bill p rohibiting doctors from prescribing puberty blockers or cross-sex hormones to under 16s.

Meanwhile, numerous medical organizations, including the Canadian Paeditric Society, continue to endorse an affirming approach to gender dysphoria.


Dr. Karine Khatchadourian estimates some 250 to 300 gender-distressed children and teens have been under her care over the years.© HYUNGCHEOL PARK

Khatchadourian was one of the first pediatric endocrinologists to train in the field of pediatric gender medicine in Canada. She was the first author of the first Canadian study (and second paper in North America) on the medical management of youth with gender dysphoria, published in 2014. Between 2022 and 2024, she was co-medical lead of the Children’s Hospital of Eastern Ontario’s (CHEO) gender diversity clinic.

While still relatively small, the number of children and adolescents identifying as transgender or gender-diverse has grown dramatically over the last decade. Pediatricians and family doctors across Canada are seeing them in their practices. Kids are being treated not only in specialized hospital-based clinics, but also by primary care providers in the community, some after virtual assessments.

In an interview, Khatchadourian said she worries that the increase in teens (mostly natal females) identifying as non-binary — neither identifying as female nor male — may be socially driven. “We know social media and peers have greater influence during adolescence,” she said.

“I didn’t see anyone identifying as non-binary ten years ago when I was training.” She questions the influx now.

“It’s so hard to know when you see a patient how much of this story is really that person’s story and how much is based on the influence of peers and social media,” she said.

“We get to a point where we accept certain definitions and certain things, but we should continuously ask why: ‘Why is this happening? What are your theories? Does this warrant medical treatment?’”

In the pre-social media era, kids who might have struggled with low level dysphoria or transient feelings might have found other ways to deal with it or allowed it to pass, Targownik said.

“But now they’re connecting with people who are telling them, ‘Hey, I did this and it’s working for me. This may be why you’re feeling disconnected from society. Maybe the reason you’re having trouble fitting in with other girls is not because you’re autistic, or because you’re marching to your own beat. It’s because you are actually a boy inside.’”

Youth can instantly connect with dozens of others who feel the way they do and start down a medical transitioning path. But Khatchadourian worries “we’re changing trajectories for these youth” based on unconvincing and limited data, and with too few mental health assessments by psychologists or psychiatrists trained in the child and adolescent medicine space.

“The expertise has not kept pace with the demand, and that worries me,” said Khatchadourian. She’s advocating for a national review in Canada — one involving those working in the field, trans-identified individuals, parents and families and, as well, de-transitioners — to ensure practices are aligned with the best available evidence.

Targownik also supports getting better data because, whether a populist or pragmatist, government leaders “are going to start asking for receipts,” she said.

“Someone is going to come and say, ‘I know you believe this care works. If you believe so strongly in this, show me that it actually works. Show me your outcomes. Show me that the kids you’re transitioning are doing well a year later, two years, five years later. Give me your best estimate of what the detransition rate in the modern cohort actually is, and the risk factors.”

There’s been a reluctance to ask those questions in the past when the practice was completely unhindered and support for gender care at its peak, she said.

Now, more countries are questioning that blanket, blind “just affirm” approach.

Khatchadourian favours aligning with Sweden and Finland’s approach, where puberty blockers and cross-sex hormones are reserved for children and teens with a history of gender dysphoria that started in early childhood and has persisted for many years.

For others, she recommends a more holistic approach, supporting youth as they’re going through identity development. She rejects accusations that she’s against gender affirming care. “Gender care means I’m addressing the distress. Of course that is a concern. ‘You have needs. I’m here to support your needs.’ But we haven’t asked the right question: What is the best way to address your needs?’

“We need to take a high level of risk approach, given the uncertainty of the evidence” and medication risks, she said. For her, the biggest stake is irreversible infertility.

“The most challenging conversations are always around fertility,” she said. “Most of the time you’re going to hear youth say they don’t want children, they don’t want biological children, or if they do at some point, they will consider adoption. You have to ask yourself, is that a mature response? Have they really given it considerable thought? Have they truly demonstrated capacity to consent?”

Early in her training, Khatchadourian spent a month in the Netherlands, the origins of pediatric gender medicine and birthplace of the so-called “Dutch Protocol” that saw doctors begin offering medical transitions for gender dysphoric teens in the early 1990s.

Back then, most of the gender distressed Dutch kids were biological males with a history of childhood-onset gender dysphoria that persisted into late adolescence.

Since then, the sex ratio has shifted dramatically, with 70 per cent of children presenting at clinics now natal females, many with co-occurring conditions such as autism, depression and anxiety that make it crucial to separate gender-related distress from other sources of distress or trauma that might mimic or add to the gender incongruence, Khatchadourian said.

“You really need good mental health providers to assess and diagnose from that lens.”

However, one study found that only four of 10 gender clinics in Canada required a psychiatric or psychological assessment before blockers or hormones were started.

Medical transitioning can begin once puberty starts, with drugs that block the physical changes of puberty. Older teens can receive cross sex hormones so that they develop the physical features more in line with their gender identity. Gender reassignment surgeries in Canada are restricted to those 18 and older, though mastectomies have been performed on girls as young as 14.

Concerns have been raised that doctors are misusing the principle of autonomy by prioritizing affirming a child’s self-declared identity and giving children the treatments they want to change their physical body to align with their expressed gender. It prioritizes the child’s goals. “But what if those goals shift,” she said.

There’s no clear picture of the natural course of gender dysphoria among the cohort of kids seeking gender-affirming care today, she said. “It’s well accepted that gender incongruence in childhood is usually a sign of later emerging same-sex attraction,” she said.

She also worries about the risk of regret in, for example, a 15- or 16-year-old biological female who has identified as non-binary for a few years who now wants a mastectomy. “These are major decisions that require careful consideration.”

There’s sometimes an urgency of expectations from parents and youth as well, she said. Many are unnerved by the dominant and stark narrative that these kids have a high risk of suicide, but the weight of the evidence suggests blockers and hormones do not decrease suicidality, she said. “This is important for families to know.

“You need to identify and treat the mental health disorders in adolescents experiencing gender dysphoria to prevent suicide.”

Khatchadourian no longer sees many young people herself, though she still has a few she follows in clinic and acts as a consultant on gender care for primary care providers for the province of Ontario. She no longer helps lead CHEO’s gender diversity clinic. “It was deemed that my expertise would be better suited to focus on other clinical and academic responsibilities,” she said, including her diabetes patients.

Considerable research has been published since she first began in the field of gender medicine. It’s a field that’s evolving rapidly. What one might have believed even a year ago might not hold anymore, she said.

“I need to trust the data,” she said. “Trust what we’re doing. And there was a lot of confusion for me with understanding the evidence.

“If I didn’t trust the evidence, how could I instill confidence in my patients?”

National Post

StatCan seeking advice on how to share secret census data on transgender children 'O to 14'

'Ghosted by the one who did the mastectomy': Detransitioners face 'detransphobia,' study finds

US Supreme Court rules against ban on ‘conversion therapy’ for LGBTQ minors

8-1 MAJORITY


By AFP
March 31, 2026


The US Supreme Court ruled against a ban on 'conversion therapy' for LGBTQ youth, siding with a Christian therapist who said the law violated her free speech rights - Copyright AFP Alex WROBLEWSKI

The US Supreme Court ruled Tuesday against a Colorado state law banning “conversion therapy” for LGBTQ minors, siding with a Christian therapist who challenged it on the grounds of free speech.

At issue is the constitutionality of a 2019 Colorado law that prohibits licensed practitioners from conducting “conversion therapy” on patients under 18.

Proponents of the treatment claim to change the sexual orientation or gender identity of LGBTQ people.

The therapy has been discredited by major medical organizations, including the American Psychiatric Association and the American Medical Association, and is banned in more than 20 US states and much of Europe.

Research has shown that it is ineffective and even harmful, leading to depression and suicidal thoughts.

But in a 8-1 decision, the court ruled in favor of Kaley Chiles, a licensed mental health counselor who invoked her Christian faith and challenged the law, arguing that it violated her First Amendment right of free speech.

“Colorado’s law addressing conversion therapy does not just ban physical interventions. In cases like this, it censors speech based on viewpoint,” wrote conservative Justice Neil Gorsuch in the decision on behalf of the majority of the Court.

“As applied to Ms. Chiles, Colorado’s law regulates the content of her speech and goes further to prescribe what views she may and may not express, discriminating on the basis of viewpoint,” he argued.

The First Amendment, Gorsuch wrote, is a “shield against any effort to enforce orthodoxy in thought or speech in this country.”

As a result, the Supreme Court sent the case back to the lower courts to review their decisions in light of this ruling.



– ‘Can of worms’ –



Only the liberal Justice Ketanji Brown Jackson expressed dissent, accusing her colleagues of opening “a dangerous can of worms” by undermining states’ ability to regulate medical practices that “risks grave harm to Americans’ health and wellbeing.”

“The Constitution does not pose a barrier to reasonable regulation of harmful medical treatments just because substandard care comes via speech instead of scalpel,” she wrote.

Chiles’ lawyer, James Campbell, of the conservative Alliance Defending Freedom, hailed the ruling in a statement as “a significant win for free speech, common sense, and families desperate to help their children.”

After taking office for his second term in January, President Donald Trump said the US government would only recognize two genders — male and female — and signed an executive order restricting gender transition medical procedures for people under the age of 19.

In June, the Supreme Court voted 6-3 to uphold a Tennessee state law banning hormone therapy, puberty blockers and gender transition surgery for minors.

Conversion therapies are banned, at least partially, in many countries, with the support of health organizations such as the Royal College of Psychiatrists in Great Britain.

The UN has called for a global ban, describing them as discriminatory, humiliating and a violation of individuals’ bodily integrity.

‘Kids Will Suffer’: Supreme Court Axes Colorado’s Ban on Harmful LGBTQ+ ‘Conversion Therapy’

Young people are more than twice as likely to attempt suicide if they have been subject to conversion therapy, which LGBTQ+ rights advocates say is “proven to cause lasting psychological harm.”


Demonstrators with the Human Rights Campaign stand outside the United States Supreme Court on Capitol Hill on October 7, 2025, in Washington, DC.
(Photo by Jabin Botsford/The Washington Post via Getty Images)

Stephen Prager
Mar 31, 2026
COMMON DREAMS

The US Supreme Court on Tuesday struck down Colorado’s ban on “conversion therapy,” drawing warnings from LGBTQ+ groups that the ruling could expose children in dozens of states to the harmful practice.

Colorado’s law forbade licensed physicians and mental healthcare providers from attempting to “convert” or change a minor’s sexuality, a practice that the American Psychological Association has found to be both ineffective and dangerous, raising rates of depression, anxiety, and suicide in LGBTQ+ youth.

The law defined “conversion therapy” as any treatment that “attempts or purports to change an individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attraction or feelings toward individuals of the same sex.”

It allowed exemptions for pastors and religious organizations. It also allowed health professionals to engage in wide-ranging discussions with children about their sexual and gender identities, so long as they did not try to change the child’s orientation.



Nevertheless, on Tuesday, the high court sided 8-1 with Kaley Chiles, a Christian counselor who said she wished to offer talk therapy to children who want to reduce same-sex attraction and argued that the ban on this practice was in violation of her First Amendment rights.

Chiles was backed by the Trump administration, as well as the far-right Alliance Defending Freedom, a Christian nationalist legal group with a long history of seeking to outlaw same-sex conduct.

Most famously, the group argued in support of state laws criminalizing homosexuality in the 2003 Lawrence v. Texas case, and it has since gone on to back many other cases attacking birth control access, same-sex marriage, and transgender equality.

In the majority opinion, the conservative Justice Neil Gorsuch wrote that Colorado’s law “censors speech based on viewpoint” and therefore must be subject to strict scrutiny—the highest form of judicial review, which the court determined it did not pass.

The lone dissenting justice, Ketanji Brown Jackson, argued that Chiles’ treatment was not mere speech, but that it was acting in her capacity “as a licensed healthcare professional,” which formed the crux of Colorado’s defense of the ban.

She argued that the ruling “opens a dangerous can of worms” and “threatens to impair states’ ability to regulate the provision of medical care in any respect.”

“Because the majority plays with fire in this case, I fear that the people of this country will get burned,” Jackson said.

Two liberals, Justices Elena Kagan and Sonia Sotomayor, joined the conservatives in striking the law down. However, they argued in a concurring opinion that a full ban on therapy aimed at changing minors’ sexuality might be more lawful than the one Colorado passed, which included carveouts for specific circumstances.

Kagan also argued that allowing Colorado to outlaw conversion therapy could backfire and give red states the legal framework to also ban counselors from providing affirmative care to LGBTQ+ minors.



LGBTQ+ rights organizations have roundly condemned the court’s decision, which is expected to weaken bans on conversion therapy in the 23 states and the District of Columbia that currently have them.

“Today’s reckless decision means more American kids will suffer,” said Kelley Robinson, the president of the Human Rights Campaign. “The Court has weaponized free speech in order to prioritize anti-LGBTQ+ bias over the safety, health, and well-being of children.”

A 2024 mental health survey by the Trevor Project, an LGBTQ+ advocacy group, found that 13% of LGBTQ+ young people have been either threatened with or subject to conversion therapy—including about 1 in 6 transgender or nonbinary youth.

Previously, the group published peer-reviewed research in the American Journal of Public Health, showing that young people subject to conversion therapy were more than twice as likely to attempt suicide as their peers.

“These efforts, no matter what proponents call them, no matter what any court says, are still proven to cause lasting psychological harm,” said Trevor Project CEO Jaymes Black. “That’s why protections have been enacted in more than 20 states, and are supported by every major medical and mental health association in the country.”

Carl Charles, a senior attorney at Lambda Legal who joined more than a dozen survivors of the practice in a friend of the court brief in support of Colorado’s law, said, “I know firsthand the long-lasting harms of conversion therapy, having been subjected to it when I was 15 years old.”

“This practice did not change my sexual orientation or gender identity,” said Charles, a transgender man. “Instead, it destroyed important relationships and created shame and fear that took time and effort to undo. For many survivors, it is a reverberating life-long harm.”

“LGBTQ+ youth do not need to be changed,” Charles said. “Rather, like all youth, they need to be supported and celebrated for the unique and important people they are becoming.”



Colorado’s Democratic Gov. Jared Polis has said he will seek to pass new legislation that complies with the Supreme Court’s ruling.

“Conversion therapy doesn’t work, can seriously harm youth, and Coloradans should beware before turning over their hard-earned money to a scam,” Polis said. “I am evaluating the US Supreme Court ruling and working to figure out how to better protect LGBTQ youth and free speech in Colorado.”

In other states whose bans could be undermined by the ruling, efforts have already begun to ensure that providers who cause harm to children still face accountability.

In California, which has a similar ban on conversion therapy to Colorado’s, state Sen. Scott Weiner (D-11) introduced a bill proposing a longer statute of limitations and making it easier for LGBTQ+ individuals to bring malpractice claims against medical professionals who subject them to conversion therapy.

Weiner noted that the Supreme Court’s ruling “explicitly states that malpractice claims for conversion therapy are different than bans,” since they require a plaintiff to demonstrate injury caused by their treatment.

“You can’t ‘convert’ someone who’s LGBTQ—full stop—and people who think you can are peddling quackery,” Weiner said. “California will always have the community’s back.”


The 988 Suicide & Crisis Lifeline can be reached by calling or texting 988, or through chat at 988lifeline.org. The Trevor Project, which serves LGBTQ+ youth, can be reached at 1-866-488-7386, by texting “START” to 678-678, or through chat at TheTrevorProject.org. Both offer 24/7, free, and confidential support.

In the Face of Anti-Trans Escalation, We Need More Than Legal Strategies

The swiftness with which Trump dismantled decades of meager, hard-fought protections exposed the limits of legal work.

Op-Ed
By Chase Strangio ,

Truthout

December 31, 2025

People attend a Trans Day of Visibility rally in Washington, D.C., on March 31, 2025.BRENDAN SMIALOWSKI / AFP via Getty Images


In a year marked by escalating attacks on transgender people, the Trump administration has seemed to outdo its own cruelty at every turn. While the administration has led a series of attempts to curtail trans people’s rights, recognition, and safety, neither Congress nor the Supreme Court seem willing to provide a meaningful check on the administration’s brazen targeting of trans people and other demonized communities. Transgender people are rightly concerned about what the coming years will mean for our rights and survival opportunities. But as we close out 2025, I am convinced that this bleak moment offers us critical opportunities to build outside of the law and across movements for more transformative change.


The Anti-Trans Year in Review



On his first day in office, President Donald Trump made clear that he would follow through on his campaign promises to systematically target transgender people across law and government. He announced in his inaugural address that it would be the policy of the United States that there are only two sexes determined at conception and that being transgender is a “false claim.” To effectuate his declaration that transgender people do not exist, Trump has directed his administration to mandate discrimination against us in education, employment, housing, health care, the military, on our identification documents, and in carceral settings.

While attempting to upend legal protections via executive order and coercive funding threats, the administration has also used deliberately dehumanizing rhetoric to situate trans people as inherently fraudulent. The president has declared that being transgender is inconsistent with “an honorable, truthful, and disciplined life”; referred to medical treatment for transgender minors as “child abuse”; and consistently demeaned transgender life by referring to our very existence as “transgender insanity.”

The administration’s attacks on trans life have continued throughout this first year, culminating in the latest set of attacks by both the Justice Department and the Department of Health and Human Services.

Trump’s Anti-Trans Policies Embolden Far Right, But Our Existence Challenges It
Trans existence challenges the fundamental tenets of fascism and exposes the fragility of authoritarian power. By Zane McNeill , Truthout November 20, 2025

Earlier this month, the Justice Department announced a directive to abandon safety protocols for LGBTQ people in prison. In 2003, Congress passed and President George W. Bush signed the Prison Rape Elimination Act (PREA). PREA directed the Justice Department to address endemic sexual violence in custodial settings. Given the extensive data documenting that transgender people are uniquely vulnerable to sexual violence while in prison, the Justice Department’s PREA standards recommended specific protections to safeguard against violence targeted at individuals because of their LGBTQ status.

Now, the Trump administration is telling agencies to disregard those standards. It is hard to see this latest action as anything other than a command to increase violence against trans people in custody. Linda McFarlane, executive director of Just Detention International, an organization that has spent decades working to implement PREA, puts it plainly: “The Department of Justice would rather see incarcerated people, including children, be sexually abused than allow trans people to express their gender identity.”

In addition to the latest attacks on PREA standards, the administration also published two sets of proposed regulations that seek to block the provision of evidence-based, medically necessary care for transgender people under 18 — care that is supported by every major medical association in the United States, including the American Medical Association and the American Academy of Pediatrics. These rules threaten to cut off all federal Medicaid and Medicare funding to hospitals that treat transgender minors with puberty blockers, hormone therapy, or surgery to treat gender dysphoria. Though the regulations are not final, they reflect the administration’s far-reaching goal of limiting trans survival opportunities across all areas of life.

The swiftness with which the Trump administration has been able to do away with decades of meager but hard-fought protections exposes the limits of legal and policy work in securing meaningful protection.

Unfortunately, the administration has been helped considerably in its goal of targeting transgender people by a Supreme Court eager to undermine civil rights. While many of the administration’s actions transparently run afoul of longstanding statutory and constitutional protections, the Supreme Court has readily rubber-stamped them on its so-called emergency docket (the Supreme Court’s consideration of cases in a preliminary and “emergency” posture before it addresses the full merits). That has meant that lower court victories blocking the administration’s efforts to expel transgender people from openly serving in the United States military and to force transgender people to use passports that list our sex assigned at birth have been short-lived.

Even more troubling than the practical impact of allowing these sweeping policies to go into effect has been the Supreme Court’s apparent willingness to greenlight even more sweeping discrimination against transgender people. In an abbreviated and unsigned order in Trump v. Orr, the Supreme Court not only permitted the administration’s reversal of decades of policy across administrations that had allowed transgender people to update the sex designation on our passports, but it did so in a way that suggests that it may be impossible for transgender people to claim discrimination in many contexts moving forward. The court’s order reasoned: “Displaying passport holders’ sex at birth no more offends equal protection principles than displaying their country of birth — in both cases, the Government is merely attesting to a historical fact without subjecting anyone to differential treatment.” For this court, it appears that transgender people cannot claim discrimination when the government refuses to honor who we are.


Thinking Beyond Legal Advocacy



The swiftness with which the Trump administration has been able to do away with decades of meager but hard-fought protections exposes the limits of legal and policy work in securing meaningful protection.

Though the mainstream LGBTQ legal movement enjoyed a decade of success at the Supreme Court in cases challenging restrictions on marriage equality and clarifying that federal prohibitions on sex discrimination encompass prohibitions on anti-LGBTQ discrimination, the past year has shown how unstable even the clearest precedents against the pressures of a global movement to retrench norms around gender and sexuality.


Trans people have spent generations mapping possibility onto scarcity.

If we are to measure our prospects of future success solely on the metric of prevailing before the Supreme Court or convincing this administration to reduce its attacks, then there is little to be hopeful about for the coming year.

But if instead we look at this moment as a stark reminder of the limits of legal advocacy and as an opportunity to invest more in community and power-building, then we can begin to map out meaningful strategies for change.

That is not to say we give up on legal advocacy. Bringing challenges to discriminatory policies in state and federal court remains a vital tool for delay and harm reduction, but as the Supreme Court’s Orr order lays bare, it is temporary and limited. But alongside those challenges, those of us who have been fighting primarily on the legal terrain need to connect with broader movements for bodily autonomy, decriminalization, and disability justice, building power and cultural change.

Now is thus the time to dream and act outside of the confines of our legal advocacy. Trans people have spent generations mapping possibility onto scarcity. As just one example, the majority of trans people have had mismatching and inaccurate identification for part or all of our lives. We have a deep well of strategies for navigating around and through systems of governance that never contemplated our existence. And so now, we tap into and deepen that well.

In her recent press tour about her biography of the legendary Black trans leader Marsha P. Johnson, Tourmaline spoke often about problems and solutions. And she did so in the language of dreaming and manifesting, not in the language of law.


What we deserve is something bigger than the law offers us.

“We are in a moment with big, big problems, and we’re wanting to let in big, big solutions,” Tourmaline reflected to NPR. “And I think Marsha is someone who transmutes problems into solutions.”

Tourmaline went on: “And so I’m a big believer, just like Marsha was, in terms of the bigger the problem, the bigger the solution — right? — and that when we’re in these harsh conditions, that is the perfect time to imagine what is the world that we deserve.”

What we deserve is something bigger than the law offers us. While we are confronted with the law’s brutal and unimaginative limits, let’s move into 2026 with a dream for something more.

This article is licensed under Creative Commons (CC BY-NC-ND 4.0), and you are free to share and republish under the terms of the license.

Chase Strangio
Chase Strangio is a lawyer and trans activist in New York City. Follow him on Instagram: @chasestrangio.

Court lifts injunction on trans law after Alberta uses notwithstanding clause

This is a cruel and dangerous move by a government that will harm vulnerable young people,


Protestors take part in a Gay Straight Alliance rally at the Alberta Legislature in Edmonton 

THE CANADIAN PRESS/Jason Franson

The Canadian Press

EDMONTON — A judge has granted an Alberta government appeal and lifted an injunction on a law preventing youth from accessing gender-affirming care.

Two advocacy groups, Egale and Skipping Stone, launched earlier this year a challenge over the law, which prohibits doctors from prescribing puberty blockers and hormone therapy to those under 16.

A judge later granted the injunction, saying the law raised serious Charter issues that needed to be hashed out, and the province filed the appeal.

Earlier this month, Premier Danielle Smith's government invoked the notwithstanding clause to shield the law and two others affecting transgender people from court challenge.

Heather Jenkins, press secretary for Justice Minister Mickey Amery, says the United Conservative Party government is pleased the injunction has been removed.

The government has said the gender health-care law is necessary to protect youth from making potentially life-altering medical decisions they may later regret.

The advocacy groups said they plan to apply for another injunction based on criminal law, since doctors who don't comply could face fines or imprisonment.

"This is a cruel and dangerous move by a government that will harm vulnerable young people," the groups said in a statement Thursday.

The groups added the law is "not a total ban" on gender-affirming care, as some youth will still be eligible to receive puberty blockers and hormones.

The groups said they plan to continue their challenge against Alberta's law requiring parental consent for children under 16 to change their names or pronouns at school.

They said they're also committed to challenging a law banning transgender Albertans 12 and older from participating in amateur female sports.

This report by The Canadian Press was first published Dec. 18, 2025.

 

Brazilian researchers warn that healthcare for transgender people is under threat

Article published in Nature Medicine points to the risk of setbacks in research focused on this population. Experts question new rules in Brazil and other countries.

Fundação de Amparo à Pesquisa do Estado de São Paulo

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Recent restrictions on public policies and healthcare for transgender people in several countries, including Brazil, threaten to dismantle existing care structures for this population and could lead to setbacks. This warning is contained in an article published in the scientific journal Nature Medicine by a group of Brazilian researchers.

The text discusses the new resolution (No. 2,427), issued by the Federal Council of Medicine (CFM) in April. The resolution banned the use of hormone blockers for minors under 18 in Brazil, increased the minimum age for cross-sex hormone therapy from 16 to 18, and permitted gender transition surgeries only for individuals over 21.

In addition to prohibiting the clinical use of blockers in transgender youth, the Brazilian resolution also prevents research in this area. Hormone therapy involves administering sex hormones to promote physical changes compatible with gender identity. These procedures had been adopted based on the CFM’s previous resolution (No. 2,265) published in 2020.

According to the authors, these rules not only generate an intimidating effect among health professionals but also hinder the provision of adequate care. This can increase the risk of depression, social isolation, and even suicide among transgender youth – those who do not identify with their birth sex. The group also believes that science is being stifled by limits or prohibitions on research and treatments aimed specifically at this group.

The article also calls on professional entities and the academic community – including institutions, funding agencies, scientific journals, and researchers – to reaffirm their support for evidence-based care for transgender individuals.

“Public policies and health legislation need to be based on evidence and ethical principles, not ideology. Everyone, including transgender youth and their families, health professionals, and researchers, needs to participate, be heard, and understand what’s happening,” Alexandre Saadeh, a psychiatrist and one of the authors of the article, who has been working in the field for over 35 years, told Agência FAPESP.

Saadeh is the coordinator of the Transdisciplinary Outpatient Clinic for Gender Identity and Sexual Orientation (AMTIGOS), located at the Institute of Psychiatry of the Hospital das Clínicas, the hospital complex administered by the University of São Paulo. AMTIGOS is a pioneer in welcoming transgender youth in Brazil and is recognized for its care protocols for children and adolescents. Over the past ten years, approximately 120 children and over 350 adolescents have received treatment there, out of a total of 1,300 individuals who underwent screening.

When contacted by Agência FAPESP, the CFM cited Sweden, Norway, Finland, and England, as well as the United States, as “countries that have revised their guidelines in recent years and restricted the use of puberty blockers and hormone therapy for minors, reflecting the need for more research and a more cautious approach to prescribing these drugs.”

In a statement, the council said, “The Federal Council of Medicine respects opposing opinions and reiterates that one of the objectives of the changes proposed in the resolution, based on more than 100 scientific studies published in recent years, is to protect children and adolescents from procedures that are often completely irreversible and can cause lifelong problems and sequelae.” The council added that the standard was approved in a plenary session composed of 28 federal council members from all states “of different ideological hues.”

Principle of progressive autonomy

In Saadeh’s assessment, gender identity has always existed. “It isn’t a disease, it isn’t a disorder, it’s a variation that occurs in human beings in all cultures and in all countries. We have to look at these people, listen to them, and not try to prevent them from being who they are. It isn’t by restricting rights that we’ll protect children and adolescents,” the psychiatrist argues. 

The Statute of the Child and Adolescent (ECA) ensures that young people can participate in decisions about their health through the principle of progressive autonomy.

Bruno Gualano, professor and president of the Center for Lifestyle Medicine at USP and co-author of the article, believes that the new CFM standard hinders scientific production. “The resolution removes the possibility for doctors to prescribe, for example, hormone blockers, as was done under the council’s previous standard, which had specific rules. On the other hand, it demands more scientific evidence on the effects of this procedure on young people. But if it’s prohibited, how are we going to produce evidence?” he asks.

The researchers point out that the previous CFM resolution guided the care provided to 79 transgender adolescents with puberty blockers at AMTIGOS. “Adverse effects were rare, with few discontinuing the blockers and only one expressing a desire to detransition after hormone therapy, and this occurred without regret. These results are in line with international standards, showing detransition rates below 2% when appropriate assessment protocols are followed,” the group writes in Nature Medicine.

Gualano is currently the lead researcher on the project “Eating Behaviors, Symptoms of Eating Disorders, and Obesity in Transgender Youth: A Proposal for Assessment and Intervention,” developed by nutritionist Bruna Caruso Mazzolani, who is also a co-author of the text. Supported by FAPESP, the study aims to assess behaviors and possible eating disorders and to develop and implement a specific lifestyle intervention for this population.

Preliminary data obtained by Gualano’s team suggest that AMTIGOS patients and their guardians strongly oppose the major changes introduced by the new CFM resolution. “Naturally, any proposal to change the care of transgender people should take into account what they think,” the researcher argues, hoping that the new data will shed light on the discussion.

Brazil lacks official statistics on the transgender population and has few studies and research involving these individuals, especially young people. In 2021, a survey by the Botucatu School of Medicine at São Paulo State University (FMB-UNESP), published in Scientific Reports, showed that the country has 3 million people identified as transgender or non-binary, corresponding to approximately 2% of the adult population.

The 2023 National Demographic and Health Survey (PNDS), conducted by the Brazilian Institute of Geography and Statistics (IBGE) in partnership with the Ministry of Health, included the collection of data on the sexual orientation and gender identity of Brazilians aged 18 and over for the first time. However, the results have not yet been released.

Other cases

In the United Kingdom, the National Health Service (NHS) has restricted access to puberty blockers to research settings only.

Following an Executive Order by President Donald Trump’s administration (published in January this year) prohibiting gender-affirming care for minors under the age of 19, only 14 of the 50 states decided to maintain healthcare services for transgender people in the United States. The restriction was approved despite opposition from medical bodies such as the American Academy of Pediatrics and the American Medical Association, which support care for this population based on evidence-based protocols.

The new policies have serious ethical implications for researchers, compromising everything from the right to health – “when appropriate medical care is denied for political reasons” – to the possibility of transgender people seeking care from professionals who do not recognize their gender identity.

“In Brazil, the CFM resolution may lead these young people to seek out untrained doctors or even self-medicate, jeopardizing their health. In addition, these policies have a greater impact on low-income families, threatening important achievements in rights and health,” Saadeh says.

Care at AMTIGOS

The clinic receives individuals who seek health services on their own. They fill out a registration form and then undergo screening. Upon admission, the children and young people have access to follow-up care, including psychiatric evaluations and multidisciplinary teams specializing in speech therapy, social work, psychology, psychiatry, pediatrics, nutrition, physical education, and more. Families participate in the process and guidance. The clinic serves adolescents until they reach adulthood.

“This is a moment that tests medicine’s commitment to evidence over ideology. From AIDS to reproductive rights, the scientific community has defended equity in health and integrity. (...) Medical care is necessary, ethically grounded, and widely supported by evidence. Its rollback is unjustifiable,” the researchers conclude.

About São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe. 

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Journal

Nature Medicine

DOI

10.1038/s41591-025-03805-5 

Article Title

The global rollback of transgender care, science and rights

Trump vs gender care: President and his team ratchet up attacks as more young people identify as transgender

Kelly Rissman
Sun 24 August 2025 

THE INDEPENDENT

The Trump administration has ramped up its attacks on gender-affirming care as young people are identifying as transgender at a higher rate than their older counterparts.

Transgender Americans have been made a target of President Donald Trump’s second presidency since his first day in office, when he issued an executive order declaring the United States only recognizes two sexes: male and female. Since returning to the White House, the president has made more than 300 attacks against LGBTQ+ people, according to advocacy group GLAAD.

This week alone demonstrates the fervor with which the Trump administration has taken aim at transgender Americans across the country.

The Air Force ordered that military boards “must recommend separation” for transgender service members, circumventing the typical board review process that includes a “fair and impartial hearing.” A Yosemite National Park ranger who hung a trans pride flag at Yosemite’s El Capitan was terminated. MAGA world erupted when two students were suspended from a Virginia high school after a Title IX investigation found they sexually harassed a transgender student.

The Trump administration’s attacks against gender-affirming care, in particular, have ramped up this week amid a new analysis showing that 2.8 million Americans aged 13 and older identify as transgender.

Of that group, more than three-quarters are under 35 years old and one-quarter are between 13 and 17, suggesting more young people are likely to identify as transgender compared to their older counterparts, the Williams Institute, a UCLA Law think tank, found in an analysis released Wednesday.

“LGBTQ people, especially transgender youth, are more comfortable being themselves than ever before,” a GLAAD spokesperson told The Independent in an email. “No president or administration will ever censor us away.”

The Independent has reached out to the White House for comment.

The report relied on data from a CDC survey. In an apparent remark on the political climate, the authors noted that they’re unclear about what data sources will be available in the future and said it’s “also unclear whether individuals’ willingness to disclose on surveys that they identify as transgender will remain unchanged in the years to come.”

In a direct onslaught on transgender youth, the Justice Department issued a subpoena to the Children’s Hospital of Philadelphia demanding records related to minors’ gender-affirming care, filings made public this week reveal.

Attorney General Pam Bondi announced in July that the Justice Department had issued 20 subpoenas to doctors and clinics involved in providing gender-affirming care to minors (AP)

Last month, Attorney General Pam Bondi announced the DOJ had issued subpoenas to more than 20 doctors and clinics involved in providing gender-affirming care to minors. “Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,” Bondi said in a statement in July.

The subpoena asks the hospital to produce documents that identify which patients were prescribed puberty blockers or hormone therapy, records related to diagnoses that formed the basis for prescribing these treatments, and documents related to informed consent and parental authorization. The DOJ wants documents dating back to January 2020, when no state had banned gender-affirming care. Now, 27 states have placed limits on such care, according to KFF.

“The subpoena is a breathtakingly invasive government overreach,” Jennifer L. Levi, senior director of transgender and queer rights at legal advocacy group GLAD Law, told the Washington Post. “It’s specifically and strategically designed to intimidate health care providers and health care institutions into abandoning their patients.”

The GLAAD spokesperson suggested that the Justice Department instead “apply itself to exacting justice for the creeps in the Epstein files if they truly cared about keeping young people safe. Their energy is misdirected and intentional, and every American knows it.”

The Trump administration has been using different methods for months to try to seek such information.

A month before Bondi announced the subpoenas, the FBI urged the public to call in tips about any hospitals, clinics or providers performing gender affirming care.

President Donald Trump’s administration has ramped up its attacks against gender-affirming care (Middle East Images)

In May, the Centers for Medicare & Medicaid Services sent letters to hospitals asking for information about their policies and information related to gender-affirming care treatments. “Hospitals accepting federal funds are expected to meet rigorous quality standards and uphold the highest level of stewardship when it comes to public resources,” Dr. Mehmet Oz, CMS administrator, said.

The administration’s laser focus on the trans community — who make up just 1 percent of the population aged 13 and older, according to the analysis — extends far beyond collecting hospital data into policies.

Last Friday, the Office of Personnel Management issued a memo stating “chemical and surgical modification of an individual's sex traits through medical interventions (to include ‘gender transition’ services)” will no longer be covered under the Federal Employees Health Benefits Program in 2026.

The document notes that “counseling services for possible or diagnosed gender dysphoria must still be covered.”

Omar Gonzalez-Pagan, a lawyer and health care strategist at Lambda Legal, slammed the policy as “illegal.”

“This discriminatory policy denying medical care to government employees and their dependents is not only cruel—it is illegal,” he said in a statement. “The federal government cannot simply strip away essential healthcare coverage from transgender employees while providing comprehensive medical care to all other federal workers.”

This policy will also likely impact dependents of federal employees who may need access to such care.

The analysis revealed young people are more likely to identify as trans than adults. Among those aged 13 to 17 in the U.S., 3.3 percent identify as transgender, the analysis found; by contrast, of all U.S. adults, just 0.8 percent identify as transgender.

A new analysis showed that more young people are identifying as transgender compared to their older counterparts in the U.S. (Williams Institute)

On Thursday, the Trump administration unveiled its latest attack on trans minors by terminating the California State Personal Responsibility Education Program, a federal grant aiming to educate young people on both abstinence and contraception. The grant was worth $12 million, Reuters reported.

“California’s refusal to comply with federal law and remove egregious gender ideology from federally funded sex-ed materials is unacceptable,” Andrew Gradison, the acting assistant secretary at the Administration for Children and Families, said in a statement. “The Trump Administration will not allow taxpayer dollars to be used to indoctrinate children. Accountability is coming for every state that uses federal funds to teach children delusional gender ideology.”

Defunding the grant marks the latest salvo in the administration’s battle with California over transgender rights. Last month, the Trump administration sued California’s department of education over its policy to allow transgender athletes to compete in girls’ sports.

The Independent has reached out to the state’s department of education for comment.

“If it’s a day ending in y, President Trump is attacking kids’ safety, health, and access to education as part of his culture war,” a spokesperson from California Governor Gavin Newsom’s office told The Independent in a statement.