Activist-biased medicine?

A Canadian university famed for rigour appears to have traded its reputation for the esteem of trans rights activists

Professor Gordon Guyatt coined the term “evidence-based medicine” and was a pioneer of the GRADE system for rating the quality of research data

Contradictions on campus

Canada’s McMaster University offers “gender-affirming care and support for 2SLGBTQIA+ students” at its Student Wellness Centre.

And yet McMaster is also a famous centre for evidence-based medicine.

The Faculty of Health Sciences declares itself the “birthplace” of this discipline, noting on its webpage that the British Medical Journal regards evidence-based medicine to be “one of the most important medical advances in the past 150 years.”

More recently, the faculty celebrated the advance of a newly launched Equity and Inclusion Office.

The inaugural leader, Saroo Sharda, a medically-trained associate dean who champions “anti-oppressive care” and “cultural safety” for “2SLGBTQI+ communities”, issued a Pride Month message on June 1—

“The good news is that as faculty, learners and staff … our actions can make a difference.

“For example, recent research underscores what many have long known: gender-affirming care saves lives. A 2022 study published in JAMA Pediatrics found that trans youth who accessed gender-affirming hormone therapy experienced 40 per cent lower odds of depression and suicidal ideation compared to those who did not.

“Affirming care improves engagement, reduces mental health distress, and strengthens long-term health outcomes.”

That 2022 study by Tordoff et al was rated low-quality in systematic reviews of the evidence for puberty blockers and cross-sex hormones commissioned by England’s landmark Cass inquiry into gender dysphoria care.

The robust results of systematic reviews, the gold standard tool used by evidence-based medicine to assess the quality of research data claimed to favour health interventions, were pivotal in the conclusions of paediatrician Hilary Cass, who stated in her 2024 report—

“It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.”

Baroness Cass has warned that gender dysphoria treatment suffers from “remarkably weak evidence,” even by comparison with the often poorly evidenced interventions in the field of paediatrics.

Since 2018, systematic reviews in health jurisdictions as different as Finland, Florida, Sweden, Australia and Germany have found no good evidence for the dogmatic claim of gender clinicians that blockers and hormones improve the mental health of minors distressed over their birth sex.

In the UK and some Nordic countries, the result was a shift away from these medical interventions as first-line treatments, and a return to broader, psychological and psychiatric responses to distress.

It’s not surprising that McMaster University, one of the world’s leading centres for evidence-based medicine, should enter this scientific debate.

And the predictable result of its three systematic reviews, published since January this year, was to further undermine the “transition or suicide” narrative used to push the hormonal and surgical interventions of “gender-affirming care”.

“There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing [gender dysphoria],” says the McMaster review of the puberty suppression drugs used to block the natural sex hormones of children.

“While originally considered fully reversible, concerns have emerged about the potential long-term effects and partial irreversibility. The use of puberty blockers in gender dysphoria remains controversial due to the methodological limitations of previously published evidence syntheses and individual studies.”

Findings and observations such as these were neither inflammatory nor especially newsworthy.

But these systematic reviews bore the imprimatur of Gordon Guyatt, the father of evidence-based medicine and a Distinguished Professor in McMaster’s Faculty of Health Sciences.

The research work had been carried out under a contract with the Society for Evidence-based Gender Medicine (SEGM). This international scientific group, whose very name suggests that “gender-affirming care” has little to do with evidence, has long been a target of trans activists.

And the McMaster-SEGM review of puberty blockers was cited by US Supreme Court Justice Clarence Thomas in June’s Skrmetti case, where the bench held by majority that the Constitution did not prevent a state from banning paediatric gender medicalisation.

All this has proved a combustible mix.

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Activism: a post from the segm_x_mcmaster social media account targeting the university

A bankable apology

Earlier this month, the McMaster faculty’s Department of Health Research Methods, Evidence and Impact—home to most of the authors of the SEGM reviews—issued a mea culpa, acknowledging a disgruntled nudge from “2SLGBTQIA+ communities”.

“We are concerned our [systematic review] findings will be used to justify denying care such as puberty blockers and hormone replacement therapy to [trans and gender-diverse] individuals,” Professor Guyatt and colleagues are quoted as saying in McMaster’s August 14 statement.

“It is unconscionable to forbid clinicians from delivering gender-affirming care. 

“Moreover, following the principles of evidence-based decision-making, clinicians should always have a high respect for the autonomy of patients and their advocates.

“The high respect for autonomy becomes particularly important when the certainty of the evidence is low or very low. In such circumstances, clinicians should work with patients to ensure that care reflects the experience, goals, and priorities of those needing care—that is, their values and preferences.”

As for SEGM, the Guyatt statement implies it is a “hate group”—not by offering proof for an explicit claim but by citing a journal letter from a trans advocate psychiatrist who in turn relied on a list of “Anti-LGBTQ+ Hate Groups” compiled by a US activist group, which dismisses concerns about puberty blockers as “pseudoscientific” and has litigated to keep these off-label drugs available to children.¹

As if a funding source can corrupt a McMaster systematic review, Professor Guyatt and colleagues declare in their statement that they will no longer do work for SEGM. And they announce they have made a penitential donation to the lobby group Egale Canada, which equates evidence-based critiques of paediatric medical transition with “anti-2SLGBTQI hate”.

This lobby group contributes to the chorus of complaint about trans health “mis/disinformation” while pushing confident claims about puberty blockers directly at odds with the profound scientific uncertainty confirmed by the McMaster-SEGM systematic reviews.

Egale Canada says “puberty blockers offer tremendous mental health benefits to a young person”; that they “have no known irreversible effects and are considered very safe overall”; and that “upon stopping puberty blockers, puberty continues as it would have without them.” No good quality evidence exists in support of these assertions.

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Video: Neuropsychology Professor Sallie Baxendale discusses puberty blockers at SEGM’s first official conference in New York in 2023

Own goal

Of course, those who crafted McMaster’s August 14 statement did not set out to damage the university’s reputation as a benchmark for evidence-based medicine.

Although SEGM was the “sponsor” of the three inconvenient systematic reviews, the two papers on puberty blockers and cross-sex hormones state that the research work was also commissioned by McMaster itself.

The third, dealing with mastectomy and perhaps the most newsworthy, says: “The manuscript was drafted by the [McMaster] methods team and approved by all authors, and the sponsor did not have any say in its content.” The three-year contract with SEGM ended in 2024.

“When the agreement started in 2021, [SEGM] appeared to us as non-trans, cis-gender researchers to be legitimately evidence-based,” says the statement by Professor Guyatt and colleagues.

SEGM’s account of itself certainly seems to align with McMaster’s mission of evidence-based medicine.

“Our objectives include critically appraising primary studies, translating, analyzing, and disseminating international practice guidelines and society position statements, and, importantly, developing new quality systematic reviews of evidence in partnership with major research universities,” the SEGM website says.

“In addition to evaluating the endocrine and surgical intervention pathways (known as ‘gender-affirming care’), we support the development of non-invasive approaches for the care of young people with gender dysphoria.”

And yet, during three years of collaboration, the McMaster evidence gurus supposedly had no idea they were in league with a “hate group”, a state of affairs they only recently realised thanks to “members and allies of 2SLGBTQIA+ communities”?

How long before McMaster realises that its new allies care little for evidence?

The August 14 statement has not placated some trans rights activists. Campaigners behind the social media account “segm_x_mcmaster” want nothing less than retraction of the systematic review papers.

This account has made deplorable but absurd personal attacks on Professor Guyatt, his colleagues and faculty vice-dean Dina Brooks, whose record as a “diversity and inclusion” champion has not spared her.

A more serious challenge focuses on the implication of the McMaster-Guyatt statement that minors should be allowed access to puberty blockers and cross-sex hormones precisely because the evidence for these treatments is so threadbare.

It’s true that, as a general principle, Professor Guyatt has maintained that patient autonomy comes into play especially when scientific understanding of treatment outcomes is tentative. Articulated in McMaster’s activist-scripted statement, however, the weight given a distressed child’s desire for unproven and potentially harmful gender medicine seems off-kilter.

The recent gender dysphoria report issued by the US Department of Health and Human Services (HHS) applies a broader ethical analysis entirely missing from the McMaster statement.

The HHS report says: “The principle of autonomy in medicine establishes a moral and legal right of competent patients to refuse any medical intervention. However, there is no corollary right to receive interventions that are not beneficial. Respect for patient autonomy does not negate clinicians’ professional and ethical obligation to protect and promote their patients’ health.”

In an interview this week with The National Post in Canada Professor Guyatt himself recommended some of the real-world caution absent from his August 14 endorsement of “medically necessary care for gender-diverse youth,” an activist formula created to garner insurance cover for poorly evidenced gender treatment.

The journalist, Michael Higgins, noted that “Guyatt said judgment had to be used when weighing the possible benefits and harms [of paediatric medical transition], particularly when it concerns children and adolescents.”

“It seems to me that this is something where one must be very cautious and there should be professional teams evaluating, as we do in other situations,” Professor Guyatt told the Post.

“You’d have to have very careful evaluation to ensure that the patients, and presumably their family, are very well informed about their decision, that somebody assesses the psychological status and the understanding of the individuals involved and so on. So, it would have to be done carefully and cautiously given the possible harms.”

However, these are potential safeguards often ignored as “gatekeeping” in the identity politics-driven practice of gender-affirming care, according to ample media reports and the worried accounts of cautious health practitioners.

And Professor Guyatt seems to have forgotten his role in a 2023 British Medical Journal investigation of the key treatment guidelines invoked by gender clinicians as guarantors of good quality care.

He found “serious problems” in the Endocrine Society guideline and rejected the spurious claim by the World Professional Association for Transgender Health that the scarcity of research data prevented a systematic review of outcomes for adolescents given gender medicine.

This week he told the Post he didn’t “worry too much about the content” of a field of medicine submitted to systematic review and had been “naive” about the trans controversy and unaware of its extreme politics, although he dismissed as “nonsense” any suggestion he had bent the knee to activists.

Even so, after a long career, he has chosen the field of sex changes for children to enunciate a new doctrine of evidence-based medicine: that systematic reviewers must attend to the political outcomes of their work.

“Legislators have unconscionably misused our systematic reviews of gender transition interventions to deny patients’ care,” he tweeted on August 25.

“Formerly, I thought my job ended with conducting and reporting high-quality research. I now realize I have an additional responsibility to address how my work is used.”

In line with trans rights orthodoxy, Professor Guyatt implies that the only possible “patient care” is gender-affirming hormonal and surgical intervention. Psychological and psychiatric treatments are unfettered by US state bans on trans medicine, while these non-invasive and ethical responses to gender distress have been denied to patients elsewhere under gender-affirming bans on “conversion therapy”.

But what of the new dictum that systematic review data is not politically innocent?

It’s come as a surprise to Susan Bewley, Professor Emeritus of Obstetrics and Women’s Health at King’s College London, who was among Professor Guyatt’s co-authors on a 2017 British Medical Journal paper using systematic reviews to give guidance on antiretroviral therapy in pregnant women with HIV.

“What made Guyatt (a highly respected scientist) realize this extra responsibility [for how his data is used]?,” Professor Bewley tweeted on August 26.

“Why step ‘out of lane’ and out of academic fora to discharge it now and opine to policymakers (a kind of global call of ‘how to mark my homework’)? He didn’t before.

“I don’t understand the generic, i.e. ‘pre-specified’ rule that all scientists should follow as to ‘when to break impartiality’ and condemn a funder or policymaker for misusing their work after they and [the] university must have done due diligence? It happens often but isn’t our fault.”

Also puzzled was Erica Anderson, a former president of the US Professional Association for Transgender Health and a clinical psychologist who has endured activist attacks for her criticism of reckless practices in the field of paediatric medical transition.

On X/Twitter, Dr Anderson said she was “surprised by the actions and words recently coming from Guyatt who has contributed so much to [evidence-based medicine] and his group specifically to the pediatric gender medicine debates. Canada and the USA have become toxically politicized. I also don’t understand why he would step into the fray this way.”

“There are three principles that define evidence-based medicine. First is that some evidence is more trustworthy than others.”—Professor Gordon Guyatt, interview with McGill University Health e-News, 4 October 2023

“Second is that to make optimal health care decisions, one needs systematic reviews, because if you don’t have it all there, you pick and choose and that’s problematic. And third is that evidence itself never makes decisions. Evidence is always in the context of values and preferences.”

Hate and freedom

McMaster University’s August 14 statement directs readers not only to trans activist groups but also to its Equity and Inclusion Office led by Dr Sharda who preaches “anti-oppressive care”.

As an exercise in “thought leadership,” this office showcases Dr Sharda’s participation in a 2024 podcast on “Countering Anti-Trans Hate for Health Care Providers” hosted by the 2SLGBTQ+ lobby group Rainbow Health Ontario.

Asked about “disinformation in the climate for trans-affirming health care,” Dr Sharda says—

“I think that we’re definitely seeing that… What’s challenging about that is sort of, you know, what tends to be, I think, sometimes the pushback to some of that disinformation is this idea of academic freedom and this idea of free speech.

“And I think trying to disentangle kind of what is academic freedom and free speech versus what is actually just hateful and what is actually denying people the right to be who they are, is really where I try and think about that.”

She mentions the corrective of “a recent training for program directors at McMaster on trans health”.

“We had clinicians who provide gender-affirming care. We had folks with lived experience. We had a human rights lawyer. We had one of the equity leads from one of the hospitals,” she says.

“And people being in that room together and just listening and just hearing the stories of people who have had to interact with the health care system and who have been harmed was an incredibly powerful experience.”

Was there any space in that room for the cautionary results of systematic reviews of gender medicine?

In the podcast, Dr Sharda, an anaesthetist, deplores the “artificial separation of medical expertise versus providing culturally safe, anti-oppressive care”—a seemingly politicised form of care she says physicians are obliged to provide.

Meanwhile, Paul O’Byrne, dean and vice-president of McMaster’s Faculty of Health Sciences, is helping to promote something quicker and politically more pointed than a systematic review.

In a June 2025 video, Professor O’Byrne interviews Michael Wilson (he/him), a colleague of Professor Guyatt’s in the Department of Health Research Methods, Evidence and Impact.

Dr Wilson, whose academic background includes political science as well as research methodology, was responsible for a project of the McMaster Health Forum cited in the August 14 statement as “supportive to the 2SLGBTQI+ community.”

In the video, Professor O’Byrne serves up a Dorothy Dixer question: “Health misinformation continues to be a widespread challenge, especially for equity-deserving groups. How is the Health Forum helping to address this?”

Part of Dr Wilson’s answer is the aforementioned forum project entitled “Rapid Synthesis on Health impacts of 2SLGBTQI+ social policies and practices”. (Nothing to agitate trans activists there.)

But McMaster gets more rapid than rapid, as Dr Wilson explains to his dean.

“We’re one of the only groups who, in addition to producing full evidence syntheses and rapid syntheses, commits to conducting what we call ultra-rapid evidence syntheses in as little as days,” he says. “We found that this approach is essential to get evidence into policy windows before they close.”

Is the window closing on evidence-based medicine at McMaster as research provokes outrage in identity politics?

GCN sought comment from Professor Guyatt, McMaster University and SEGM.

Disclosure: I first reported the emergence of SEGM in March 2020 for The Australian newspaper and have never detected an iota of “hate” in their operations. To my mind, SEGM appears to be driven by concern about the potential harm to vulnerable young people exposed to poorly evidenced medicalisation. It seems perverse to frame this as “hate”. I had a brief, productive email exchange with Professor Guyatt in 2023.

Postscript: After I finished this article, journalist Jesse Singal published an interview with Professor Guyatt, who insisted he had only recently learned of McMaster’s contract with SEGM, which he claimed was in favour of legislative bans on paediatric medical transition. Mr Singal noted SEGM’s denial of this.

Although Professor Guyatt said he felt “invulnerable” in a reputational sense, he appeared to concede in the Singal interview that he had compromised his independence because the SEGM connection was “going to upset people I care about and with whom I work closely”. He said his university was “upset about the controversy about McMaster being labeled as this big anti-trans [organisation]”. He had offered to remove his name from two SEGM-commissioned systematic reviews yet to be published.

Professor Guyatt said that even if his negative view of SEGM were wrong, McMaster should not partner with this organisation because the university would “get tarred and feathered” and “discredited,” presumably by trans activists and their allies. As for the “local trans community”, he said they were “in ecstasy” over the McMaster-Guyatt statement of August 14. Asked by Mr Singal if he believed SEGM to be a “hate group,” he said he did not know what that term meant. He claimed the organisation had “no respect for [patient] autonomy”.

1. The wild assertions of this group, the Southern Poverty Law Center, have been picked apart here by journalist Jesse Singal. I sought comment from the center.