The Evolution of Care: Why “Reassessment” is Not a Collapse

Image: Spatted Screenshot of National Post story

My honest read of the recent National Post article by Sharon Kirkey on Dr. Karine Khatchadourian is that it presents a discussion within medicine about improving care, but the framing—beginning with the headline—makes it sound as though the entire field is collapsing.

A common rhetorical move in journalism is to frame a complex debate through the voice of a single expert who appears to represent a broader shift. By highlighting one physician who is reassessing aspects of care, the story gives the impression that the whole field is moving in the same direction. In reality, while Dr. Khatchadourian’s call for "rigour" echoes the recent McMaster University systematic reviews regarding evidence certainty, major bodies like the Canadian Pediatric Society (CPS) continue to support the existing affirming model as a vital standard of care.

The framing makes the change seem much larger than it actually is. My concern is not with Dr. Khatchadourian or the questions she raises; medicine should always be willing to reassess itself as new evidence emerges. What worries me is that many readers may weaponize this conversation to justify banning care, ignoring the fact that organizations like Children’s Healthcare Canada view such bans as a direct threat to youth safety.

What is missing from the article is the voice of the many parents and young people who have found stability through supportive care. Their stories are backed by research from Trans PULSE Canada and UBC’s SARAVYC, which shows that access to this care is linked to a 73% reduction in suicidality. These aren't just "medicalized" kids; they are youth who, with support, have a significantly higher chance of reporting good or excellent mental health.

There is also an important piece of context missing: reassessment in this field is not new. It has been happening continuously for decades. Ever since the earliest protocols developed by Dr. Harry Benjamin, clinicians have revised their approaches. I experienced that evolution personally.

When I first went through assessment at a gender clinic in 1999, the diagnostic language still included “Gender Identity Disorder.” The roadmap required me to begin living publicly as Lisa before I was even prescribed hormones—a “Real Life Experience” requirement intended to prove I was "serious."

I told the psychiatrist I wasn’t ready. I had heavy facial hair and sensitive skin; presenting publicly without hormones would have felt like a billboard announcing “transgender person.” I worried about the impact on my wife, my three sons, and my professional clients. I walked out thinking, I can’t do this.

Because of that rigid requirement, it took me another eight years to return. During that time, the field evolved. When I reconnected with the clinic, the doctor chuckled when I asked if I still had to present as Lisa to get a prescription.

“That used to be a requirement,” he said. “Not anymore, take all the time you need—we’ll work at your pace.” He explained the new focus was on baseline health—kidney and liver function, and PSA levels before starting you on hormones. “Things have changed in eight years,” he added.

And that really is the point. These protocols have always evolved as clinicians learn more. From the removal of "Gender Identity Disorder" in the DSM to the move away from "gatekeeping," reassessment has historically led to more compassionate, evidence-based care.

Seen in this light, the current debate is not evidence that the system is broken. It is the continuation of a process that has been happening for decades. Whether it is the CPS defending the right to thrive or researchers calling for more "certainty" in data, the goal remains the same: improving the lives of the people at the heart of the care.

And that really is the point. These protocols have always evolved as clinicians learn more. From the removal of "Gender Identity Disorder" in the DSM to the move away from "gatekeeping" requirements like the one that sidelined me for eight years, reassessment has historically led to more compassionate, evidence-based care.

Seen in this light, the current debate is not evidence that the system is broken. It is the continuation of a process that has been happening for decades. Whether it is the CPS defending the "right to thrive" or researchers like those at McMaster calling for higher-certainty data, the goal remains the same: improving the lives of the people at the heart of the care.

A more accurate headline for Sharon Kirkey’s article wouldn't be about a "collapsing" field; it would be: “How Canadian Gender Care is Evolving to Meet New Evidence.” But accuracy doesn't always drive clicks.

News outlets like the National Post need to do better than inflame an already volatile situation—one where the rhetoric has real-world consequences and where, quite literally, lives are hanging in the balance. Instead of framing medical progress as a scandal, we should be protecting the clinical space where doctors and families can do the quiet, rigorous work of ensuring every young person has the chance to survive and, eventually, to thrive.