From the Frontier Centre for Public Policy

By Lee Harding

Do teens going through cross-gender hormones and surgeries know what they’re doing? A leak of internal conversations by the World Professional Association for Transgender Health shows even some doctors administering the procedures have serious doubts.

The U.S. advocacy organization Environmental Progress, led by president and founder Michael Shellenberger, made the leaks public.

“The WPATH Files show that what is called ‘gender medicine’ is neither science nor medicine,” Shellenberger said in a press release.

A short list of excerpts highlighted many telling comments.

Child psychologist Dianne Berg, who co-authored the child chapter of the 8th edition of WPATH Standards of Care, said young girls don’t understand what it means to get male hormones.

“[It is] out of their developmental range to understand the extent to which some of these medical interventions are impacting them. They’ll say they understand, but then they’ll say something else that makes you think, oh, they didn’t really understand that they are going to have facial hair.”

Canadian endocrinologist Dr. Daniel Metzger acknowledged, “We’re often explaining these sorts of things to people who haven’t even had biology in high school yet.”

Metzger said neither he nor his colleagues were surprised at a Dutch study that found some young post-transition adults regretted losing their fertility.

“It’s always a good theory that you talk about fertility preservation with a 14-year old, but I know I’m talking to a blank wall. They’d be like, ew, kids, babies, gross,” Metzger said.

“I think now that I follow a lot of kids into their mid-twenties, I’m like, ‘Oh, the dog isn’t doing it for you, is it?’ They’re like, ‘No, I just found this wonderful partner, and now want kids.’ … It doesn’t surprise me.

“Most of the kids are nowhere in any kind of a brain space to really talk about [fertility preservation] in a serious way.”

While youth keeps some from grasping the lifelong consequences of their actions, mental illness does the same for others. But that doesn’t always mean the doctors refuse to transition them.

One gender therapist administered cross-sex hormones to a patient with dissociative identity disorder. The therapist said asking the split personalities if they approved the treatment was ethical. Otherwise, a lawsuit could follow.

In one case, a nurse practitioner struggled with how to handle a patient with PTSD, major depressive disorder, observed dissociations, and schizoid typical traits who wanted to go on hormone therapy. Somehow the clear moral dilemma was lost on Dr. Dan Karasic, lead author of the mental health chapter of WPATH Standards of Care 8.

Karasic replied, “I’m missing why you are perplexed… The mere presence of psychiatric illness should not block a person’s ability to start hormones if they have persistent gender dysphoria, capacity to consent, and the benefits of starting hormones outweigh the risks…So why the internal struggle as to ‘the right thing to do?’”

Testosterone injections carry cancer risks for those born female. In one case, a doctor acknowledged a 16-year-old had two liver masses, one 11 cm by 11 cm, and another 7 cm by 7 cm, and “the oncologist and surgeon both have indicated that the likely offending agent(s) are the hormones.”

The friend and colleague of one doctor received close to ten years of male hormones, leading to hepatocarcinoma. “To the best of my knowledge, it was linked to his hormone treatment… it was so advanced that he opted for palliative care and died a couple of months later,” the doctor said.

Some female-born transitioning patients had terrible pain during orgasms, while males on estrogen complained of erections “feeling like broken glass.”

The future may be even stranger, according to one doctor.

“I think we are going to see a wave of non-binary affirming requests for surgery that will include non-standard procedures. I have worked with clients who identify as non-binary, agender, and Eunuchs who have wanted atypical surgical procedures, many of which either don’t exist in nature or represent the first of their kind and therefore probably have few examples of best practices,” the doctor said.

Unsurprisingly, some people regret their medical transitions and want to change back. Some WPATH members want to discount this altogether. WPATH President Marci Bowers admitted, “[A]cknowledgment that de-transition exists even to a minor extent is considered off limits for many in our community.”

An unnamed researcher thought it was just a matter of perspective, saying, “What is problematic is the idea of detransitioning, as it frames being cisgender as the default and reinforces transness as a pathology. It makes more sense to frame gender as something that can shift over time, and to figure out ways to support people making the choices they want to make in the moment, with the understanding that feelings around decisions [may] change over time.”

Should our physical being be substantially altered and re-altered according to our feelings? Is transitioning a matter of mental health or self-expression? At least Alberta is putting the brakes on these dubious practices for minors. Other provinces should follow.

Lee Harding is a research fellow for the Frontier Centre for Public Policy.

From the Frontier Centre for Public Policy

By Wendell Cox

The largest CMA, Toronto, had by far the most significant net internal migration loss at 402,600, Montreal lost 162,700, and Vancouver lost 49,700.

Canadians are fleeing overpriced cities to find more affordable housing. And restrictive urban planning policies are to blame.

Canadians may be solving the housing crisis on their own by moving away from more expensive areas to areas where housing is much more affordable. This trend is highlighted in the latest internal migration data from Statistics Canada.

The data covers 167 areas comprising the entire nation, including Census Metropolitan Areas (CMAs), which have populations from 100,000 to seven million. It also includes the smaller Census Agglomerations (CAs), which have a core population of at least 10,000, as well as areas outside CMAs and CAs in each province and territory, which are referred to as “largely rural areas.”

Long-standing migration trends have been virtually reversed. Larger cities (CMAs) now see the highest loss of net internal migrants, while smaller cities (CAs) are experiencing solid gains. Between 2019 and 2023, Canada’s CMAs lost 273,800 net internal migrants to smaller areas, including CAs and largely rural areas. This contrasts sharply with the previous five-year period (2014 to 2018) when CMAs saw only a 1,000-person loss.

So, where did these people go? A significant portion – 108,100 – moved to CAs, which captured 39 per cent of the CMA losses. This is triple that of the previous five years (2014 through 2018).

However, the most notable shift occurred in largely rural areas, which gained 165,700 net internal migrants, representing 61 per cent of CMA losses. This is a dramatic increase compared to the 33,700 net loss in the previous five years.

Among the 167 areas, the migration data is stunning.

The areas experiencing the greatest net internal migration are outside CMAs and CAs. The largely rural area of Ontario saw the biggest gain, with a net increase of 78,300 people – nearly 40 times the number from the previous five years. Meanwhile, rural Quebec placed second, with a net gain of 76,200 people, more than 10 times the increase in the prior five years. The Calgary CMA ranked third (and first among CMAs) at 42,600, followed by the Ottawa Gatineau CMA (Ontario and Quebec) at 36,700 and the Oshawa CMA at 34,900.

The largest CMA, Toronto, had by far the most significant net internal migration loss at 402,600, Montreal lost 162,700, and Vancouver lost 49,700. Outside these CMAs, nearly all areas posted net gains.

People have also started moving to the Maritimes. The Halifax CMA tripled its previous gain (21,300). In New Brunswick, Moncton nearly quadrupled its gain (7,000). Modest gains were also made in Fredericton and Saint John as well as in Charlottetown in Prince Edward Island.

Meanwhile, housing affordability in Canada’s largest CMAs has become grim. Toronto’s median house price to median household income has doubled in less than two decades. Vancouver’s prices have tripled relative to incomes in five decades. Montreal’s house prices nearly doubled relative to incomes over two decades.

These CMAs (and others) have housing policies typical of the international planning orthodoxy, which seeks to make cities denser. In effect, they have declared war against “urban sprawl,” trying to stop any material expansion of urbanization. These urban containment policies, which include greenbelts, agricultural reserves, urban growth boundaries and compact city strategies, are associated with the worst housing affordability. Land prices are skewed upward throughout the market. Demand continues to increase ahead of incomes, but the supply of low-cost suburban land, so crucial to controlling costs, is frozen.

Regrettably, some areas where people have fled are also subject to urban containment and housing affordability has deteriorated rapidly. Between 2015 and 2022, prices in Ontario CMAs London, Guelph, Brantford and St. Catharines have about doubled. BC’s Fraser Valley and Vancouver Island have seen similar increases. Those moving to these areas are ahead financially, but the rapidly rising house prices are closing opportunities.

There are proposals to restore housing affordability, though none tackle the urban containment policies associated with the price increases. Indeed, we have not found a single metropolitan area where housing affordability has been restored with the market distortions of the intensity that have developed in Toronto, Vancouver and Montreal (not in our Demographia International Housing Affordability report or elsewhere). Such markets have become unsustainable for most new entrant households because they cannot afford to live there.

Housing is not a commodity. Households have varying preferences, from ground-oriented housing (detached and townhomes) to high-rise condos. Indeed, a growing body of literature associates detached housing with higher total fertility rates. According to Statistics Canada, Canadians have favoured lower densities for decades, a trend that continued through the 2021 Census, a trend that continued through the 2021 Census, according to Statistics Canada.

With governments (virtually around the world) failing to maintain stable and affordable housing markets, it’s not surprising people are taking matters into their own hands. Until fundamental reforms can be implemented in the most expensive markets, those seeking a better quality of life will have no choice but to leave.

First published in the Financial Post.

Wendell Cox is a senior fellow at the Frontier Centre for Public Policy and the author of Demographia International Housing Affordability.