Canada has not ignored the evidence on gender-affirming care for trans young people: it has read the same body of international research as every major medical organisation and reached the same conclusion. The Canadian Paediatric Society's position aligns with the World Health Organisation, the Endocrine Society, WPATH, and the American Academy of Pediatrics. A Quillette essay is not a systematic review, and Canada holding its ground is a sign of clinical rigour, not recklessness.

What Quillette is actually saying

A piece published in Quillette in late June 2026 presents Canada as a rogue nation, stubbornly clinging to discredited practice while enlightened countries roll back gender-affirming care in the wake of the Cass Review. The writer is frustrated that the Canadian Paediatric Society appointed a new president who supports the existing evidence-based approach, and frames that appointment as proof that Canada has "jumped the rails".

Quillette is an opinion publication with a well-documented editorial position: sceptical of trans identities, hostile to gender-affirming care, and reliably enthusiastic about any research that can be marshalled against it. Publishing an essay there is not equivalent to publishing a peer-reviewed systematic review. Citing a Quillette piece as though it carries the weight of clinical evidence is a category error, and one the article itself makes repeatedly.

The Cass Review is not the final word

The Quillette piece treats the Cass Review as though it settled the science. It did not. Hilary Cass produced a report that has been the subject of substantial and serious international criticism, not from activists, but from researchers, clinicians, and medical bodies who examined its methodology and found it wanting. The review's evidence standards were applied asymmetrically: studies supporting gender-affirming care were held to a higher bar than studies questioning it. Its reliance on SEGM-linked sources, a network that functions as a gatekeeping advocacy group rather than independent research, has been documented in detail by those who have examined its citations carefully.

The British Medical Association's position is cited in the Quillette piece as though it represents a dramatic vindication of Cass. What actually happened is more complicated. The BMA has been reviewing its own position through a long internal process, and the outcome of that process does not amount to an endorsement of everything the Cass Review concluded. The framing in the Quillette piece, and in the Jonathan Turley tweet it reproduces, runs well ahead of what the BMA actually said.

More fundamentally: one contested national review, however thorough its author, does not overturn the accumulated clinical experience and published guidelines of the WHO, the Endocrine Society, WPATH, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the World Medical Association. The AACAP reaffirmed its support for evidence-based gender-affirming care in 2025, explicitly in response to political pressure. These organisations have not been asleep. They have read the same literature. They have reached a different conclusion from the one Quillette wants them to reach.

The pattern I have been watching

I wrote recently about what has been happening in Australia, where Queensland banned gender-affirming puberty blockers and hormones for trans young people in public healthcare, citing concerns shaped by the UK experience, while its own independent clinical evaluation had found the care was safe. The Northern Territory followed two days later. Each ban handed the next government a precedent. The clinical evidence was set aside; the political momentum was not.

Canada is being pressured to follow the same path. The Quillette essay is part of that pressure. The argument is essentially: enough countries have restricted this care that Canada looks like an outlier, and outliers are suspicious. But the number of governments that have made a political decision is not the same as the weight of clinical evidence. Counting jurisdictions is not epidemiology.

What the Quillette piece does not grapple with honestly is the harm that delays and restrictions cause. Trans young people who cannot access care do not simply wait comfortably until the science is resolved to a columnist's satisfaction. They go through unwanted puberty changes that cause real, lasting distress. They face greater risk of the very mental health outcomes that opponents claim to be concerned about. Delay is not a neutral holding position. It is a decision with consequences, and those consequences fall on specific young people with specific lives.

On the framing of trans young people

The Quillette article describes trans-identified adolescents, particularly those assigned female at birth, as girls suffering from autism, trauma, and internalised homophobia who have been "convinced" their distress comes from being in the wrong body. This framing does several things at once, none of them honest. It treats trans identity as a symptom of something else rather than as a genuine identity. It implies that clinicians and families have been credulous or reckless. And it centres the assumption that these young people are mistaken about themselves.

Many trans young people do have co-occurring mental health difficulties. So do many non-trans young people. The presence of anxiety or autism does not invalidate a person's gender identity, and the clinical guidelines I respect do not treat it as doing so. The question good clinicians ask is not "could this be something other than trans?" but "what does this young person need, and how can we support them to flourish?". That is what good care looks like in any area of medicine.

The Quillette piece also deploys the suicide framing in a particularly revealing way: it acknowledges the documented elevated risk of suicide among trans young people and then, rather than treating that as a reason to support care, uses it to argue that the claim of elevated risk has been weaponised. The risk is real. Trans young people do face higher rates of suicidal ideation and attempts. That does not mean every clinical decision should be made on the basis of suicide panic, but dismissing the risk in the way this article does is not dispassionate analysis. It is motivated reasoning.

What Canada getting this right actually looks like

The Canadian Paediatric Society has published a position statement that reflects the international clinical consensus. It has been criticised in peer-reviewed form, as the Quillette essay notes, and it has reviewed that criticism and maintained its position. That is how science is supposed to work. A position that has been challenged and survives scrutiny is stronger, not weaker, for having faced it.

Canada's refusal to follow a wave of politically driven restrictions is not evidence that it has jumped the rails. It is evidence that it is doing something harder and more important: reading the evidence carefully, listening to the clinicians who work with trans young people, and holding a position that serves those young people rather than the political moment. I hope it holds.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a Gender Specialist, Medical Educator, and advocate for trans rights and gender diversity.