Unconscionable Cowardice
From Defending Science to Endorsing Pseudoscience
On April 14, 2016, Dr. Gordon Guyatt, the man known as the “godfather” of evidence-based medicine, was inducted into the Canadian Medical Hall of Fame. On September 8, 2025, he earned a very different kind of distinction: induction into the Gender War Hall of Fame, thanks to an astonishing admission during an interview on the Beyond Gender podcast.
When pressed about why he had recently signed a statement declaring “gender-affirming care” for youth “medically necessary,” he snapped. “How ridiculous! I would never say that…I never use the term medically necessary…if you can find it in my statement, I’ll have to jump off a bridge.” But when read the passage that clearly states the interventions to be “medically necessary,” he laughed and admitted he hadn’t read the statement carefully: “That was not my paragraph. I didn’t read it…apparently…I only paid attention to the part I wrote.”
To be clear: this was no minor slip. The importance of the creator of evidence-based medicine endorsing paediatric gender medicine cannot be overstated. His name added in support of this experiment will be cited by activists to justify the continuation of unevidenced treatments; it will mislead parents into signing consent forms for irreversible interventions; it will be invoked in court to block legislation designed to protect children from a medical world that has lost its way. To the average person, if one of the most decorated and distinguished doctors of our time says this protocol is medically necessary, then it must be so.
But we now know Guyatt believes no such thing. He simply didn’t bother to read the statement to which he put his name.
The Saga Begins
When Evidence-Based Medicine (EBM) was first introduced in the early 1990s, the goal was to ground clinical practice in evidence rather than deference to expert opinion. The concept acknowledged a simple truth: doctors are human, and experts often get things wrong. EBM was designed to bring discipline to medicine, to minimize human bias, and to protect patients from medical fads and unproven enthusiasms.
Thus, it was a bitter irony when Guyatt recently caved to pressure from trans activists, coming out in defense of paediatric gender medicine—a medical field built not on robust evidence but on ideological bias, populated by experts who place activism above science and whose practices subject healthy children to irreversible harms without any proof of benefit.
The already widely-covered story began in 2021 when the Society for Evidence-based Gender Medicine (SEGM) commissioned McMaster Department of Health Research Methods, Evidence, and Impact (HEI) to conduct a series of systematic reviews to examine the evidence base for paediatric gender medicine. As the birthplace of EBM, McMaster HEI is one of the most respected centres in the world for conducting such reviews.
Earlier this year, three out of five of the reviews—those that assessed the evidence for puberty blockers, cross-sex hormones, and bilateral mastectomies—were published, and, like every other systematic review conducted thus far, the conclusion was that the evidence for these interventions is low to very low quality.
Cue the predictable trans-activist temper tantrum, the unhinged social media campaign against the university and the research team, and the harassment of Guyatt and his colleagues at their place of work. So far, nothing out of the ordinary.
But McMaster’s response to this standard trans activist tactic has been nothing short of astonishing. A textbook example of how not to handle bullies.
Capitulation 101
On August 14, five of the nine researchers involved in the reviews—Guyatt included—issued the statement that reads like a hostage note written in a desperate bid to save one’s skin. And of course, that’s not very far from the truth at all.
From the now infamous part calling unproven interventions for healthy adolescents “medically necessary,” to the baffling talk of denying medical care to nonbinary youth, to the excruciating embarrassment of witnessing one of the world’s most distinguished doctors refer to himself as a “non-trans cis-gender” researcher, the statement almost defies belief. Worst of all was the disgraceful betrayal of denouncing SEGM on the basis of spurious “hate group” smears from the Southern Poverty Law Center, while simultaneously announcing personal donations to “2SLGBTQ+” charity Egale.
It’s still not clear who wrote the “medically necessary” part of the statement, nor whether the remaining four signatories bothered to read the one-page statement in full before signing.
However, two elements of the bizarre declaration demand closer scrutiny: that when evidence is weak, physicians should defer more heavily to patient autonomy and “values and preferences,” and that it is “unconscionable” to deny trans-identified youth access to puberty blockers, cross-sex hormones, and elective double mastectomies.
Gender-Affirming Care Demolishes the Pillars of Evidence-Based Medicine
Guyatt has long maintained that when evidence for an intervention is weak, greater weight should be placed on patient values and preferences. In our interview, he extended this logic to defending adolescent autonomy in making decisions that entail permanent fertility loss. This is an indefensible position that contradicts all existing knowledge on adolescent identity development and capacity to consider long-term consequences.
Apart from his seemingly near-total ignorance of the decades of research into child and adolescent development, Guyatt’s problem is also that he considers the field of “gender-affirming care” to be like any other field of medicine.
Evidence-based medicine rests on three pillars: evidence, clinical expertise, and patient values and preferences. The McMaster reviews found the first pillar—evidence—was low to very low quality. But what Guyatt fails to understand is that, like a wrecking ball, gender medicine also demolishes the remaining two.
As he said in the Beyond Gender interview, EBM “is built on the assumption of clinical expertise.” Only someone with either no knowledge of the complete ideological capture of the field of gender medicine or who has chosen to remain wilfully ignorant of it could ever assume that experts in this area are trustworthy.
In truth, clinical expertise has been replaced by ideological activism. Practitioners on the ground have no clear idea of what they are treating, but instead simply affirm a young person’s self-declared identity and then present medicalization as the only option. The official diagnoses of gender dysphoria and gender incongruence are activist inventions that overlap with autism, trauma, depression, and the ordinary turbulence of adolescence—yet doctors act as if they describe a discrete, well-understood disorder. These “experts” are also—like Guyatt—somehow oblivious to a fact everyone in the real world understands perfectly well: that not a single adolescent possesses the maturity to make irreversible decisions about fertility or the ability to breastfeed.
Then, the depsychopathologization campaign by the World Professional Association for Transgender Health (WPATH) throws yet more confusion into the mix, rebranding transgender identities as natural and healthy, rather than the result of a variety of psychiatric issues. Under this ideological framework, ethical psychotherapy aimed at helping young people reconcile body and mind is recast as “conversion therapy,” while the option of doing nothing is reframed as a human rights violation. This erases the reality—long documented in research—that most adolescents would outgrow their distress if given time to mature and settle into their sexual identities.
To make matters even worse, the leading “experts” in the field bury negative findings, suppress unfavourable systematic reviews, and craft guidelines based on activism rather than science.
The final pillar, patient values and preferences, is equally compromised. Gender-affirming medicine prioritizes autonomy over the ethical principle of “do no harm.” Yet, autonomy only has meaning when it rests on true informed consent. That requires a clear understanding of the condition, an honest presentation of every treatment option—including no treatment—and a patient’s capacity to comprehend long-term consequences. In the field of paediatric gender medicine, none of these conditions are met.
If practitioners cannot even define the condition they are treating, refuse to acknowledge the natural course of resolution, and deny patients the choice of psychotherapy or watchful waiting, then informed consent is impossible.
But there’s a deeper problem. As the US Department of Health and Human Services report on “pediatric gender dysphoria” stated, the first ethical question isn’t about informed consent at all—it’s about risk versus benefit. Only if a treatment shows a favourable balance should the treatment be offered. In the case of the interventions in question, no such balance exists. There is no high-quality evidence of benefit, while the evidence of harm is far stronger. That makes the risk/benefit analysis decisively negative. And here’s the crucial point: autonomy in medical ethics means a patient may refuse treatment. It does not mean a patient has the right to demand interventions that are ineffective—or worse, harmful.
Finally, there’s the danger of deferring to the “values and preferences” of a generation of youth swept up in a culture-bound madness. Today’s adolescents live in an environment saturated with the messaging of trans activism: influencers online extol the joys of medicalization, schools present gender identity ideology as scientific fact, and activists brand blockers, hormones, and surgeries as “life-saving” and a “human right.” As a result, vulnerable young people are seduced into believing that irreversible medical interventions are their only path to happiness. Their values and preferences are not independent or stable, but distorted by a powerful cultural force.
Yet Guyatt refuses to acknowledge that the health authorities and lawmakers around the world who have restricted or banned these unproven interventions for minors have spent years investigating the medical, cultural, and developmental elements of this scandal. The very idea that age restrictions are being enacted, for “nefarious” reasons, solely based on the low-quality evidence, is patently absurd. Not one of the three pillars of EBM is on solid ground, and the activist-driven field of gender medicine refuses to self-correct; therefore, shielding young people from this reckless medical experiment is not unconscionable—what is unconscionable is failing to take action.
Abandoning Neutrality
When Guyatt talks about having a responsibility to present the findings of the reviews in a way to avoid their misuse, he uncannily echoes WPATH when the group suppressed publication of independent systematic reviews conducted by Johns Hopkins. Unsealed documents in Boe v Marshall revealed WPATH’s explicit goal was to “ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense.”
It goes without saying that this is just not how independent reviews work. It’s not scientific neutrality; it’s political advocacy. The job of an evidence review is to describe the evidence—its strength, its gaps, its limits—not to shape its presentation so it cannot be cited in ways deemed politically inconvenient. Once reviewers begin tailoring their work to ensure it aligns with a particular ideological outcome, they have abandoned the central safeguard that makes systematic reviews trustworthy in the first place. Of course, such behaviour is nothing less than what one would expect from the fanatics inside WPATH, but coming from the creator of evidence-based medicine, it is simply beyond comprehension.
Tooth Fairy Science Meets Evidence-Based Medicine
As Helen Joyce has pointed out, paediatric gender medicine is an example of what Dr. Harriet Hall called Tooth Fairy Science—the practice of meticulously studying a phenomenon without ever questioning whether the phenomenon itself is real.
According to Hall, a researcher could amass reliable data that are reproducible, consistent, and statistically significant on how much money the Tooth Fairy leaves, what kinds of coins she prefers, whether she pays more for molars or when the child leaves a note—but without stopping to ask whether the Tooth Fairy exists, all that research is meaningless. “You think you have learned something about the Tooth Fairy. But you haven’t,” explained Hall. “Your data has another explanation, parental behavior, that you haven’t even considered. You have deceived yourself by trying to do research on something that doesn’t exist.”
Paediatric gender medicine is Tooth Fairy Science in its purest form. Researchers study the psychological effects of blocking puberty, track satisfaction with the cosmetic changes of cross-sex hormones, measure levels of dysphoria in adolescent girls in the months after bilateral mastectomy, monitor bone density, and record fertility preservation uptake rates in children slated for sterilization. To be sure, the data are far from reliable, but nevertheless, these researchers come away thinking they’ve learned something about their patient population. Yet all of it is meaningless, because no one asks the most important question: Do transgender youth exist?
The answer, of course, is that they do not. The young people making sense of their lives through the label of transgender today are simply gender-nonconforming future homosexual adults, kids on the autism spectrum, or those going through various adolescent struggles who’ve mistaken their distress and social difficulties as a sign they are transgender after colliding with the messaging of trans activism in society. But gender-affirming researchers refuse to consider this far more plausible explanation, marching forth as true believers in the fantasy that the 21st century has unveiled an entirely new kind of human.
A major limitation of evidence-based medicine is its inability to detect Tooth Fairy Science. Instead, its framework permits countless hours and enormous amounts of funding to be poured into grading pointless research, which then diverts everyone’s attention away from the most important questions.
Terrified and Traumatized
“They’re all terrified. They’re all traumatized,” said Guyatt of his younger colleagues, in what appears to be an attempt to justify kowtowing to the activist bullies. Claiming to feel invulnerable, he says he felt immense pressure from friends to whom he owed “considerable loyalty,” and it was “not much skin off [his] back to accommodate them.”
It’s a breathtakingly myopic stance that demonstrates just how little Guyatt understands the medical scandal that he has unwittingly endorsed.
Traumatized and terrified happen to be words frequently used by the parents of adolescents caught up in today’s psychiatric epidemic as they watch their beloved child become all-consumed by a false belief while knowing that an entire field of medicine exists to permanently imprint that folly onto their healthy body.
These parents are terrified by the prospect of their child undergoing irreversible treatments for which there is no good-quality evidence. They are traumatized by the experience of watching their child’s health be needlessly destroyed and their futures drastically impaired, all while society cheers on the carnage from the sidelines.
It may not be any skin off Guyatt’s back to appease his frightened colleagues and spineless institution, but in doing so, he has discredited the very systematic reviews that took years of painstaking work to produce. Worse still, he has handed fresh ammunition to reality-denying activists who thrive on misinformation, and whose standard tactic is to fling baseless accusations of hate at anyone who dares question this medical treatment. These extremists now have (or perhaps had, before his disastrous appearance on our podcast) the weight of Guyatt’s name in their arsenal.
The scandal of paediatric gender medicine rests heavily on the appeal to authority—the error of assuming something is true simply because experts or institutions endorse it. When WPATH and nearly every major medical association promote these interventions, the unsuspecting public naturally assumes they must be safe and ethical. And when the founder of evidence-based medicine brands bans as unconscionable and signs a statement declaring the treatments ‘medically necessary,’ it cements the illusion. To those unaware of the colossal medical scandal currently unfolding, these dangerous falsehoods become accepted facts.
Defend the Science
There is a simple lesson most children learn in the schoolyard: never show weakness to bullies. It only invites more bullying. McMaster’s cowardice and Guyatt’s capitulation have proven the rule. Far from appeasing the mob, their abject surrender has emboldened it. The same activists who Guyatt claimed were “in ecstasy” over the grovelling statement have wasted no time publishing an open letter—signed by a large number of McMaster faculty and trans activists— demanding further punishment and a retraction of the published reviews, denouncing McMaster for collaborating with “a known hate group,” and claiming that SEGM’s research itself was designed with the objective of harm.
In a pathetic attempt to placate bullies who will never be satisfied, McMaster has destroyed its prestigious reputation as the birthplace of evidence-based medicine, and Guyatt has irreparably damaged his own legacy. The man who once sought to insulate medicine from bias and ideology has ended up embracing both. Even worse, the founder of evidence-based medicine has disavowed an organization whose sole purpose is to demand that gender medicine be evidence-based, while aligning himself with Egale—a lobby group that peddles pseudoscientific misinformation.
Aside from fighting for a “nonbinary” man’s legal right to have a surgically created second set of genitals covered by the Ontario taxpayer, Egale has also spent years proclaiming that “puberty blockers offer tremendous mental health benefits,” that “gender-affirming care is medically necessary and lifesaving,” and that bans on puberty blockers “will cost lives”—all without a shred of evidence.
But the consequences extend far beyond the halls of McMaster. This abysmal capitulation all but guarantees that more young people are funnelled into irreversible harm: girls denied the beautiful experience of breastfeeding any future babies, boys rendered anorgasmic before their first sexual encounter, adolescents robbed of their fertility and all the possible versions of themselves they have yet to discover. And it condemns more parents to be left terrified and traumatized as they watch a medical world that has lost its ethical compass claim their healthy children as its victims.
Sadly, Guyatt’s careless endorsement of Egale’s pseudoscientific messaging is a microcosm of society in the era of trans rights, in which legions of people, in a quest to be tolerant and inclusive, have thrown their support behind a medical scandal that they do not understand, resulting in untold numbers of innocent youth being harmed.
If Guyatt has any shred of integrity left, he must demand that the phrase “medically necessary” be struck from the statement—or remove his name from it entirely—and he must do so with at least the same fanfare as the statement’s release. And McMaster must now do what it should have done from the start: defend the science and defend neutrality. Because, by surrendering to intimidation, the institution has not resolved the conflict; it has only prolonged a destructive medical fad that will haunt society for generations to come.
Mia Hughes is the author of The WPATH Files, and director of Genspect Canada.
Join Mia at the Bigger Picture Conference, where she will be speaking on the false beliefs fueling medical harm.
Tickets selling fast - secure your seat now.
You and Stella were amazing, Mia! What a gentle and effective coup it was! So lovely to see women disarm the so-called father of EBM. See you in NM!!
This was an astonishing interview. I thought this man discredited himself over and over with his equivocations and frank ignorance. His final statements revealing that he did not read what he signed, and his excuse of being too busy and important to do so was breathtaking arrogance. Thanks for this article putting it in perspective, Mia. I hope Guyatt makes a public retraction and McMaster stands up for these researchers and their work in preparing the reviews.