Frontier Centre for Public Policy
Transition Troubles: Medical Risks and Regret Among Trans Teens

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.
Business
It Took Trump To Get Canada Serious About Free Trade With Itself

From the Frontier Centre for Public Policy
By Lee Harding
Trump’s protectionism has jolted Canada into finally beginning to tear down interprovincial trade barriers
The threat of Donald Trump’s tariffs and the potential collapse of North American free trade have prompted Canada to look inward. With international trade under pressure, the country is—at last—taking meaningful steps to improve trade within its borders.
Canada’s Constitution gives provinces control over many key economic levers. While Ottawa manages international trade, the provinces regulate licensing, certification and procurement rules. These fragmented regulations have long acted as internal trade barriers, forcing companies and professionals to navigate duplicate approval processes when operating across provincial lines.
These restrictions increase costs, delay projects and limit job opportunities for businesses and workers. For consumers, they mean higher prices and fewer choices. Economists estimate that these barriers hold back up to $200 billion of Canada’s economy annually, roughly eight per cent of the country’s GDP.
Ironically, it wasn’t until after Canada signed the North American Free Trade Agreement that it began to address domestic trade restrictions. In 1994, the first ministers signed the Agreement on Internal Trade (AIT), committing to equal treatment of bidders on provincial and municipal contracts. Subsequent regional agreements, such as Alberta and British Columbia’s Trade, Investment and Labour Mobility Agreement in 2007, and the New West Partnership that followed, expanded cooperation to include broader credential recognition and enforceable dispute resolution.
In 2017, the Canadian Free Trade Agreement (CFTA) replaced the AIT to streamline trade among provinces and territories. While more ambitious in scope, the CFTA’s effectiveness has been limited by a patchwork of exemptions and slow implementation.
Now, however, Trump’s protectionism has reignited momentum to fix the problem. In recent months, provincial and territorial labour market ministers met with their federal counterpart to strengthen the CFTA. Their goal: to remove longstanding barriers and unlock the full potential of Canada’s internal market.
According to a March 5 CFTA press release, five governments have agreed to eliminate 40 exemptions they previously claimed for themselves. A June 1 deadline has been set to produce an action plan for nationwide mutual recognition of professional credentials. Ministers are also working on the mutual recognition of consumer goods, excluding food, so that if a product is approved for sale in one province, it can be sold anywhere in Canada without added red tape.
Ontario Premier Doug Ford has signalled that his province won’t wait for consensus. Ontario is dropping all its CFTA exemptions, allowing medical professionals to begin practising while awaiting registration with provincial regulators.
Ontario has partnered with Nova Scotia and New Brunswick to implement mutual recognition of goods, services and registered workers. These provinces have also enabled direct-to-consumer alcohol sales, letting individuals purchase alcohol directly from producers for personal consumption.
A joint CFTA statement says other provinces intend to follow suit, except Prince Edward Island and Newfoundland and Labrador.
These developments are long overdue. Confederation happened more than 150 years ago, and prohibition ended more than a century ago, yet Canadians still face barriers when trying to buy a bottle of wine from another province or find work across a provincial line.
Perhaps now, Canada will finally become the economic union it was always meant to be. Few would thank Donald Trump, but without his tariffs, this renewed urgency to break down internal trade barriers might never have emerged.
Lee Harding is a research fellow with the Frontier Centre for Public Policy.
2025 Federal Election
The Cost of Underselling Canadian Oil and Gas to the USA

From the Frontier Centre for Public Policy
Canadians can now track in real time how much revenue the country is forfeiting to the United States by selling its oil at discounted prices, thanks to a new online tracker from the Frontier Centre for Public Policy. The tracker shows the billions in revenue lost due to limited access to distribution for Canadian oil.
At a time of economic troubles and commercial tensions with the United States, selling our oil at a discount to U.S. middlemen who then sell it in the open markets at full price will rob Canada of nearly $19 billion this year, said Marco Navarro-Genie, the VP of Research at the Frontier Centre for Public Policy.
Navarro-Genie led the team that designed the counter.
The gap between world market prices and what Canada receives is due to the lack of Canadian infrastructure.
According to a recent analysis by Ian Madsen, senior policy analyst at the Frontier Centre, the lack of international export options forces Canadian producers to accept prices far below the world average. Each day this continues, the country loses hundreds of millions in potential revenue. This is a problem with a straightforward remedy, said David Leis, the Centre’s President. More pipelines need to be approved and built.
While the Trans Mountain Expansion (TMX) pipeline has helped, more is needed. It commenced commercial operations on May 1, 2024, nearly tripling Canada’s oil export capacity westward from 300,000 to 890,000 barrels daily. This expansion gives Canadian oil producers access to broader global markets, including Asia and the U.S. West Coast, potentially reducing the price discount on Canadian crude.
This is more than an oil story. While our oil price differential has long been recognized, there’s growing urgency around our natural gas exports. The global demand for cleaner energy, including Canadian natural gas, is climbing. Canada exports an average of 12.3 million GJ of gas daily. Yet, we can still not get the full value due to infrastructure bottlenecks, with losses of over $7.3 billion (2024). A dedicated counter reflecting these mounting gas losses underscores how critical this issue is.
“The losses are not theoretical numbers,” said Madsen. “This is real money, and Canadians can now see it slipping away, second by second.”
The Frontier Centre urges policymakers and industry leaders to recognize the economic urgency and ensure that infrastructure projects like TMX are fully supported and efficiently utilized to maximize Canada’s oil export potential. The webpage hosting the counter offers several examples of what the lost revenue could buy for Canadians. A similar counter for gas revenue lost through similarly discounted gas exports will be added in the coming days.
What Could Canada Do With $25.6 Billion a Year?
Without greater pipeline capacity, Canada loses an estimated (2025) $25.6 billion by selling our oil and gas to the U.S. at a steep discount. That money could be used in our communities — funding national defence, hiring nurses, supporting seniors, building schools, and improving infrastructure. Here’s what we’re giving up by underselling these natural resources.

342,000 Nurses
The average annual salary for a registered nurse in Canada is about $74,958. These funds could address staffing shortages and improve patient care nationwide.
Source

39,000 New Housing Units
At an estimated $472,000 per unit (excluding land costs, based on Toronto averages), $25.6 billion could fund nearly 94,000 affordable housing units.
Source
About the Frontier Centre for Public Policy
The Frontier Centre for Public Policy is an independent Canadian think-tank that researches and analyzes public policy issues, including energy, economics and governance.
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