Canadian Gender Care Pioneer Calls for National Review on Youth Treatment
Dr. Karine Khatchadourian, a prominent pediatrician in Ottawa, has issued a compelling call for a national review to reassess Canada's approach to treating gender-distressed youth. During a recent virtual talk hosted by the University of Alberta's Women and Children's Health Research Institute, she delivered a candid appraisal of the evidence, highlighting significant uncertainties in the field.
Evolution of a Medical Perspective
Khatchadourian was one of the first doctors in Canada to provide hormone treatments to transgender-identifying and gender dysphoric youth, starting in 2014. Over the years, she has cared for an estimated 250 to 300 children and teens. However, after 12 years of experience, her perspective has shifted dramatically. "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," she stated in an interview. She emphasized that while she strongly believes in this care, it must be approached with rigour and caution due to the high stakes involved.
Uncertain Evidence and Changing Demographics
The doctor described the field as being in a highly consequential grey zone, with contradictory findings at best. She pointed out that the evidence does not allow doctors to confidently determine whether puberty suppression has psychological benefits or not. Additionally, today's rapidly changing demographics—predominantly biological females with complex mental health problems and no prior history of gender distress—make it difficult to impossible to predict if someone's gender dysphoria 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 urged.
Challenges in Gender-Affirming Care
Khatchadourian noted that gender-affirming care is uniquely turbulent and charged with emotion, leading providers to be reluctant to express doubts for fear of alienation by colleagues and condemnation by activists as transphobic. This makes her openness to share that her own messaging has changed all the more remarkable. Her assessment aligns with recent systematic reviews, including one by McMaster University researchers, which found the evidence supporting gender medicine interventions to be of low or very low certainty, making it impossible to conclude whether puberty blockers are helpful or harmful.
Broader Implications and Research Backlash
The McMaster study, led by Dr. Gordon Guyatt, faced persecution from both extremes of the trans debate. Activists criticized it over funding from the Society for Evidence-Based Gender Medicine, while others accused Guyatt of shirking his evidence-based approach. Khatchadourian's call for a national review underscores the need for objective scrutiny and a pivot where necessary, as echoed by the editor-in-chief of the British Medical Journal, who described the evidence as "threadbare, whichever research question you wish to consider."
In conclusion, Dr. Karine Khatchadourian's evolution from an early provider to a cautious advocate highlights the urgent need for a reassessment of Canada's gender care policies for youth, driven by emerging data and a commitment to patient safety.
