A prominent Canadian pediatrician, Natasha Johnson, has staked her career on the principles of diversity, equity, and inclusion. Accordingly, a decade ago she established a pediatric gender clinic at McMaster University at Hamilton, Ontario, to serve the needs of the fast-growing population of youth who are distressed about their gender or have otherwise adopted a transgender identity.
So when the Canadian Pediatric Society announced last month that it had appointed Dr. Johnson as its next president, this was widely interpreted by Canadian physicians as the medical association burnishing its own DEI bona fides and squaring itself against the Trump administration’s aggressive opposition to medicalized gender transitions for minors.
Amid roiling political conflicts south of the border about the safety, efficacy, ethics, and wisdom of providing puberty blockers, cross-sex hormones, and gender-transition surgeries to treat gender-related distress in adolescents, Dr. Johnson has maintained in public statements that young people’s satisfaction with these interventions in Canada is extraordinarily high.
And yet, while Dr. Johnson is on record pointing to at least some verifiable research to back up that assertion, The New York Sun spoke with three families who offered detailed accounts of their experiences at her gender clinic that sharply conflict with such a rosy portrayal of patient outcomes. It is, of course, entirely possible these families’ negative experiences with Dr. Johnson and her colleagues reflect only a small minority of those who have attended the McMaster gender clinic. Rare is the doctor with a 100 percent satisfaction rate. Nevertheless, the families collectively told the Sun they remained outraged that they did not receive from Dr. Johnson what they consider to be equitable and inclusive care for their particular needs.
One former patient of Dr. Johnson’s, Faith Groleau, said she was fast-tracked for testosterone treatment by Dr. Johnson as a teenager despite serious mental health conditions, proper attention to which Ms. Groleau later concluded should have overridden the impulse to medicalize her adolescent detour into a masculine identity. Ms. Groleau, 26, eventually stopped taking the powerful cross-sex hormone and detransitioned, meaning she reverted to presenting and identifying as her birth sex. Saddled, most noticeably, with a permanently masculinized voice as a consequence of her treatment, Ms. Groleau came to fault Dr. Johnson for what she characterized as “extreme negligence.”
“She didn’t do her job of vetting me at all,” said Ms. Groleau of Dr. Johnson’s care. “She just sent me onto a pipeline of destruction.”
The Sun also conducted interviews with two other families who asked to have their identities shielded — including a mother and daughter who requested to be known by first-name pseudonyms and a husband and wife who agreed for their child’s story only to be used as background reference for this article. All three families shared medical records, and in some cases email exchanges and other documents, that detailed their experiences at the McMaster gender clinic.
Centrally, the families all faulted Dr. Johnson, who is not a trained mental health professional, for engaging in what is known as diagnostic overshadowing: focusing myopically on a gender-related diagnosis at the expense of attention to what the families argued to the Sun were more pressing mental health concerns. Dr. Johnson, the families said, egregiously put these three adolescent patients on a fast track to receive gender-transition interventions. This included approving a biological girl, who at the time identified as male, for a double mastectomy just as she turned 16, even as her mental health rapidly deteriorated. The girl later detransitioned and came to bitterly regret the surgery.
Their stories offer testimony to the ongoing debate within the pediatric gender medicine discipline over whether minors seeking gender-transition interventions should undergo a comprehensive psychosocial assessment by a mental-health professional before being approved for irreversible modifications to their sex characteristics.
Dr. Johnson has made conflicting statements on the matter. All three families who spoke with the Sun about her gender clinic said that while a social worker was on staff, the adolescents in these families were not provided a formal assessment by a mental health professional before being approved for gender-transition medications.
The parents who spoke with the Sun uniformly expressed alarm and offense that, as they reported, their expressed concerns about the prudence of providing gender-transition interventions to their seriously mentally ill children were essentially dismissed and even stigmatized by Dr. Johnson. All three families reported that Dr. Johnson did not take kindly to having her authority challenged, and that in the face of pushback about her proposed or past gender-care plans, her typically pleasant demeanor could turn on a dime and become intimidatingly hostile and defensive.
In some cases, these families said, Dr. Johnson pitted children against their parents, and in one case, pitted divorced parents against one another when it came to fraught decision-making about initiating gender transition interventions. Her office even called child protection services to report one mother for merely expressing concerns about her daughter undergoing a mastectomy, the mother reported.
Dr. Johnson, who along with communications representatives from McMaster did not respond to repeated requests for comment, is on the record asserting that, as a matter of course, parents’ objections to their children receiving gender-transition drugs should at least generally not interfere with a child’s expressed desire for such medications. In a presentation she gave at the 2022 conference of the World Professional Association for Transgender Health, or WPATH, a video of which the Sun obtained, Dr. Johnson said that such feelings on the part of parents “should not be prioritized.”
Ms. Groleau said she took great offense to the suggestion. “My mother was absolutely correct in being concerned because I did detransition,” she said.
A Stand Against ‘Trumpism’
Compared to its behemoth U.S. counterpart, the American Academy of Pediatrics, the Canadian Pediatric Society is a fairly diminutive organization. But the Canadian society’s position statements on medical issues do hold considerable weight in Canadian pediatrics. This includes pediatric gender medicine.
In 2023, CPS published a detailed position statement supporting what’s known as the gender-affirming approach to caring for youth who identify as transgender. This method, which received an influential — and controversial — endorsement from the AAP in 2018, is anchored in the belief that even young children can be trusted to know their own gender and should essentially lead the way in their gender-related care, with care providers expected to affirm whatever gender a child presents.
The society’s position statement makes reference to WPATH’s widely followed transgender-care guidelines by indicating that a “comprehensive biopsychosocial assessment” is expected prior to putting minors on gender-transition drugs.
The position statement was coauthored by a pediatric endocrinologist at the B.C. Children’s Hospital in Vancouver, Daniel Metzger, a leading figure at the influential transgender medical-activist association. Dr. Metzger achieved notoriety in 2024 after the release of the so-called WPATH Files, a large dossier of leaked internal communications among leaders of the organization. In one leaked conversation, Dr. Metzger was brutally frank about what he characterized as adolescents’ common incapacity to anticipate their own future desires when making decisions about undergoing gender-transition interventions that could compromise or terminate their fertility.
“Oh, the dog isn’t doing it for you?” Dr. Metzger memorably quipped, paraphrasing his attitude toward young adults who had transitioned as minors coming to regret their inability to have biological children.
The Canadian Pediatric Society position statement also acknowledged that pediatricians, while routinely on the front line of caring for such youth, “often lack knowledge, training, and comfort in how to care for this population.”
As for the pediatric society’s decision to select Dr. Johnson for a one-year term, multiple Canadian physicians told the Sun that it has become common in the Canadian pediatric field to stake positions that operate as a protest vote against President Trump.
McMaster’s medical school is known — dating back decades — for its particularly liberal culture. Dr. Johnson, who also holds the title of chairperson of diversity and inclusion for McMaster’s undergraduate medical education program, founded the university’s gender clinic in 2016. Mr. Trump, meanwhile, has made attacking DEI in medicine and academia a cornerstone of his second administration and has sought to eliminate the entire field of pediatric gender medicine in the United States.
An article published in 2022 by TD Bank reported that patient demand for Dr. Johnson’s services had grown “exponentially,” and that the gender clinic was in the process of increasing its patient population from 60 to 70 new patients to 85 to 100 new minors seen each year, thanks to a $500,000 annual grant from the bank. At the time, the clinic had a two-year waiting list of about 150 young people.
“Dr. Johnson supports the gender-affirming care model and an apparent social justice view of gender dysphoria,” a psychiatrist at the University of British Columbia, Dr. Joanne Sinai, a public skeptic of pediatric gender medicine, told the Sun. Taking into consideration Dr. Johnson’s zeal for this field, Dr. Sinai said that the social justice perspective “seems to have inhibited her ability to think critically about the topic.”
Dr. Sinai pointed to an expanding compendium of systematic literature reviews — the gold standard of scientific evidence — finding the relevant evidence in support of pediatric gender medicine weak and uncertain. She criticized Dr. Johnson for failing, as she sees it, to take these reviews into consideration, along with the risk of harm from treatment and psychological models suggesting that identity, including related to gender, can prove malleable through childhood and adolescence.
Dr. Sinai said she twice emailed Dr. Metzger following the release of the pediatric society’s position statement on pediatric gender medicine to ask why the society had not included findings from the systematic reviews. He never replied.
Dr. Metzger did not respond to the Sun’s request for comment. Nor did representatives for CPS.
In an emailed statement, a Canadian former psychiatric care nurse with expertise in caring for gender dysphoric youth, Aaron Kimberly, pointed to other medical societies that “are now re-examining their guidance” on pediatric gender medicine in response to the systematic reviews.
Most notably, this includes the American Society of Plastic Surgeons, which earlier this year advised its members against performing gender surgeries for patients under age 19 and expressed concern about the use of gender-transition drugs for adolescents. A spokesperson for the American Medical Association subsequently told media outlets that the association generally agreed with the plastic surgeons society about youth gender surgeries. Later developments, however, revealed that the AMA board never authorized such a statement. Its release triggered a torrent of internal discord, which was indicative of how fractious this issue is within the medical field.
The Canadian Pediatric Society, Mr. Kimberly said, “is undoubtedly aware of those developments.” He added, “My hope is that the CPS, under Dr. Johnson’s leadership, will follow the evidence wherever it leads. That is how public confidence in the society’s medical authority is maintained.”
‘She Was Very Flippant’
Like many youths who present at gender clinics, Faith Groleau arrived in Dr. Johnson’s care just under a decade ago with a litany of psychiatric diagnoses. In her case, this included post-traumatic stress disorder, dissociative identity disorder, depression, and anxiety. Additionally, Ms. Groleau was on record telling physicians that as a young child, she had been sexually abused. Her McMaster medical records indicate her mother, Amy Groleau, believed this abuse was the source of her “gender issues.” She was also a child of divorce. Her father left the family in 2012 and died in 2021.
In the spring of 2024, Ms. Groleau submitted an official complaint about the care she had received from Dr. Johnson to the College of Physicians and Surgeons of Ontario. A response the following September from the organization’s complaints and reports committee, which Ms. Groleau provided to the Sun, detailed her objections. The document indicated that in December 2016, when she was 17, Ms. Groleau presented at the McMaster emergency department with suicidal ideations. Given she identified and presented as male at the time — Ms. Groleau told the Sun she was then about six months into this new public identity — she was subsequently referred to Dr. Johnson’s gender clinic.
As the college detailed in its response, Ms. Groleau complained to the organization that Dr. Johnson misdiagnosed her with gender dysphoria “after a 20-minute assessment and without adequately exploring or considering other diagnoses that could have been causing her symptoms.” This included, Ms. Groleau’s complaint asserted, failing “to consider the impact” of her other major mental health diagnoses. Dr. Johnson also ultimately “inappropriately recommended” Ms. Groleau for a mastectomy. Ms. Groleau told the Sun this recommendation came less than six months after her first appointment. Her medical records indicate that while she was once interested in the operation, she never went through with it. Additionally, according to the college’s response document, Ms. Groleau reported Dr. Johnson “dismissed and minimized” the concerns of Ms. Groleau’s mother “about the diagnosis and treatment.”
The Ontario college decided to take no further action on Ms. Groleau’s complaint. She is appealing the decision, which is pending. It found that the initial assessment appointment was 90 minutes — a length the committee considered “appropriate” — and that she met the criteria of gender dysphoria at the time of her care. The response document noted that Dr. Johnson had told the college that “there was nothing in the Patient’s history or medical records that suggested an alternative diagnosis that would result in her presentation of gender dysphoria.” Dr. Johnson also denied dismissing or minimizing the concerns of Ms. Groleau’s mother.
A representative for the college told the Sun that due to confidentiality policies, it could not comment on any complaints it might have received about a physician. The college, the representative said, “does not set clinical practice guidelines, which fall under the purview of professional medical associations and medical experts.” The college’s role, the representative continued, “is to set expectations for safe, ethical practice and to ensure physicians meet established standards.”
The response document reported that Dr. Johnson said she “closely follows” WPATH’s guidelines in caring for youth with gender dysphoria. However, Ms. Groleau’s reported experience calls this into question.
The version of WPATH’s guidelines in place when Ms. Groleau saw Dr. Johnson recommended a “psychodiagnostic and psychiatric assessment” prior to initiating gender-transition treatment in a minor. “Before any physical interventions are considered for adolescents,” the guideline stated, “extensive exploration of psychological, family, and social issues should be undertaken.” The guidelines referred to the assessment process as a “phase,” implying it should extend over time.
Like the two other families who spoke with the Sun, Ms. Groleau said she was provided no such comprehensive mental health assessment; the clinic never connected her with a psychologist or psychiatrist. Dr. Johnson referred Ms. Groleau to the clinic’s endocrinologist, Dr. John VanderMeulin, for puberty blockers soon after her first appointment. Dr. VanderMeulin then prescribed her testosterone around the time she turned 18. Dr. VanderMeulin did not reply to requests for comment.
Ms. Groleau said she stopped taking testosterone in her early 20s, partly due to financial reasons. But she had also become disenchanted with the treatment. She detransitioned at age 24, after reading the WPATH Files and, she said, feeling betrayed by a medical field she felt had misrepresented itself. In addition to her masculinized voice, she said she deals with chronic problems with her pelvic floor muscles and incontinence, although it remains uncertain whether testosterone impacted these issues. She said she is also concerned about how the hormone may have impacted her fertility; she said Dr. Johnson’s clinic never offered her fertility preservation.
One of the principal arguments for medically transitioning minors stems from transgender people who medically transitioned as adults saying they believe they would have been better off had they transitioned earlier in life and, ideally, through opposite-sex puberty. Ms. Groleau is far from alone in arguing that this premise collides with the intrinsic naïveté of youth. “You can’t put that type of distinction on a child,” she said, “by assuming that they’re going to be able to make that type of decision and that you’re going to be able to properly vet them.”
Recalling her appointments at age 17 with Dr. Johnson, Ms. Groleau said: “She was very flippant about a lot of it. She was talking to me like I was a mini-adult, like I understood all of what she was saying.”
Dr. Johnson gave an interview to Canadian Television in 2022 in which she insisted that detransitioning is rare and that focusing on the phenomenon distracts from the high effectiveness of gender treatments for minors. She referred to a Canadian study of “about 500 people” who have medically transitioned. “Ninety-six percent report that they are satisfied,” she said. Experts who spoke with the Sun could not identify any such study published by 2022.
In the interview, Dr. Johnson also responded to claims that minors lack the capacity to consent to irreversible gender-transition interventions. “To assume that, in general, 13-year-olds have no knowledge of the future or the consequences of decisions, I think, would be an overstatement,” she said. “I think that each young person needs to be assessed. It would be also important to share stories of the thousands of people who are satisfied with transition.”
In an interview, Faith Groleau’s mother, Amy, said Dr. Johnson had not properly assessed her child. “I feel that Dr. Johnson did not holistically look at Faith and her entirety, from top to bottom.” Referring to her daughter’s myriad other psychiatric diagnoses, she said, “It’s not like those things went away. Dr. Johnson or her residents did not address those issues, just to touch base, to check in.”
‘Parents’ Feelings Should Not Be Prioritized’
In a video of a presentation she gave at WPATH’s 2022 conference, Dr. Johnson argued that parents’ concerns about gender transition treatment should take a back seat to their child’s desires. She presented survey data from a study of 174 adolescents presenting at 10 gender clinics across Canada, including her own, before age 16. Only a tiny percentage of these adolescents’ parents expressed concern about their children starting gender-transition treatment.
None of the youth who underwent such treatment reported substantially regretting doing so two years after their first appointment, she added. This meant that there was no link between parental concern and treatment regret at the two-year mark.
“This suggests parents’ feelings should not be prioritized over the youths’ experiences” when considering whether to heed the adolescents’ desires for such treatment, Dr. Johnson concluded.
Dr. Johnson might have asserted to the College of Physicians and Surgeons of Ontario that she followed WPATH’s trans-care guidelines. In this presentation, however, she took aim at them, suggesting that WPATH’s recommendation for a comprehensive assessment of youths seeking gender treatments was unduly burdensome. To back up this assertion, she noted that the Canadian clinics in the study did not provide “a battery of psychological testing to verify” each youth’s gender identity; and yet still there was no treatment regret in the study.
Dr. Sinai pushed back against Dr. Johnson’s suggestion in her presentation that primary-care physicians such as herself were well-equipped to assess youth for gender-transition medications. “Non-psychiatrists or psychologists do not have the training to do the type of detailed mental health assessments that these vulnerable youth deserve,” Dr. Sinai said.
Dr. Sinai further expressed concern that the study Dr. Johnson presented did not follow the youth long enough to properly detect emerging regret. Research on youth detransitioning is sparse, but experts have estimated that those who detransition often do not do so until several years after they first began a medicalized gender transition.
That includes Ms. Groleau. At the age she arrived at Dr. Johnson’s clinic, she would have been too old to be included in the study in question. That fact aside, her mother did express concerns about her starting gender treatments. Dr. Johnson’s notes from the period when Faith started starting blockers stated Amy Groleau “reports ongoing distress” about the transition. The case notes added that Faith and Amy reported “they are happy with the opportunity to ask questions.” Regardless, Ms. Groleau did wind up regretting receiving testosterone, but regret about this did not surface until about seven years had passed since her first appointment.
Dr. Sinai said that Dr. Johnson’s assertion that she doesn’t want to respect what parents think about their children is “problematic.”
“Dr. Johnson would give me vocabulary to bring back home to completely demoralize my mother as my parent,” Ms. Groleau said about how Dr. Johnson pitted her against her mother. This included, Ms. Groleau said, instilling in her the premise that she would commit suicide if she didn’t undergo the medical transition. “They gave me a way to weaponize my suicidal ideations,” she said of the clinic staff.
“I felt that my feelings were not validated, and I felt that I was not being heard as a parent,” Amy Groleau said of her experiences at the clinic.
‘I Was Really Hurt.’
Another family who spoke with the Sun about Dr. Johnson’s treatment of them expressed such alarm about the prospect of being identified in print that they requested their story only be told in broad strokes and use first-name pseudonyms. The daughter, “Clara,” now in early adulthood, repeatedly expressed fear that Dr. Johnson herself would target her for speaking out. Clara’s mother, “Elaine,” said she feared that transgender activists might dox her and wreck her career if she were identified.
Elaine shared a draft of an account of their experience with Dr. Johnson that she is considering sending to Canadian lawmakers in an effort to raise, she said, what she sees as necessary alarm about how this medical field cares for emotionally troubled children such as Clara.
Clara suffered from a complex web of serious mental illnesses and was diagnosed with autism and a learning disability. She said she was sexually assaulted as a child. A report by a mental health professional, which Elaine shared with the Sun, called the incident “sexual harassment,” but then stated the perpetrator “touched her inappropriately.”
Clara had a difficult time entering puberty and, after socially transitioning to nonbinary, was first referred to Dr. Johnson’s clinic as a tween. As she and her mother were inquiring about a first appointment, a social worker from the clinic called to begin the process of setting Clara up with puberty blockers. Elaine and Clara declined and never attended that appointment.
Clara then reverted to identifying as her biological sex for a few years. “I really struggled with my identity,” she said of her overall adolescence. “I had a really unstable sense of self.”
The disruptions of the Covid-19 pandemic sent Clara into a mental health spiral that led her back to Dr. Johnson’s clinic when she was in her early teens, at which point she’d been identifying as male for a few months. About two months after her first appointment, she was put on puberty blockers followed about two months later by testosterone therapy. Medical records confirmed the two-month gap between the blockers and hormones.
“They never mentioned or brought up my autism or learning disability or past trauma,” Clara recalled of any assessment process she underwent at the gender clinic.
Despite assurances from the clinic staff that medically transitioning would help, her mental health continued to decline. Soon after starting testosterone, she attempted suicide and was hospitalized. Nevertheless, Dr. Johnson and others in the gender clinic ultimately recommended she undergo a mastectomy.
“It was still not seen as a red flag that my mental health was getting significantly worse during the transition and not better,” Clara said. On top of that, she said, Dr. Johnson and her colleagues “created a huge rift between my family. My mom saw how fast things were going and she wanted things to slow down.”
Elaine recalled that Dr. Johnson and her colleagues routinely informed her that her child had the right to make her own medical decisions. Ontario has no age minimum for medical autonomy; a health care provider need only deem a patient is capable of consenting. “I was, in effect, positioned as a bystander to permanent decisions about my child’s body,” Elaine wrote in the draft of her letter to lawmakers.
After Elaine expressed concern about a potential mastectomy, the clinic’s social worker called child protection services to report her as potentially abusive, prompting an investigation. Additionally, while Elaine was Clara’s primary caregiver, she shared custody of her child. Dr. Johnson and her colleagues advocated for Clara to be sent to live with her father, given he was more supportive of the medical transition.
Ultimately, Elaine cleared the investigation and retained primary custody. But she said she remained in a state of peril, believing if she failed to comply with the gender clinic’s demands for Clara to continue undergoing modifications to her sex characteristics, she could lose her child.
“I was scared to lose my kid,” Elaine said. Recalling a common mantra that pediatric gender medicine doctors have told numerous wary parents, Elaine said Dr. Johnson “made it very clear: ‘You either want a son or you want a dead daughter.’”
“I just believed what the doctors said because that’s their job, right?” Clara said of Dr. Johnson and her colleagues’ encouragement to stay on the gender-transition path. “They’re supposed to help me and know everything. I was diagnosed, so I thought that I had a male brain in a girl’s body. I thought if I didn’t become a boy I would kill myself.” She continued, “It kind of felt like just being on a conveyor belt I couldn’t get off of.”
Clara underwent the mastectomy. But her mental health worsened. She developed severe anorexia, dwindled to a life-threatening weight, and by Dr. Johnson’s referral, was hospitalized. Finally, Clara broke down and told her mother that the gender transition had been a mistake.
Clara returned to the clinic to tell Dr. Johnson she was detransitioning. She asked for support in the process, including breast reconstruction.
Dr. Johnson, Clara said, refused to observe Clara’s request to switch to referring to her with female pronouns and by her birth name. Dr. Johnson said that Clara needed to be consistent, insistent, and persistent in re-identifying as her birth sex before she would support her in detransitioning. As it happens, these are three criteria for a child’s cross-sex identity that when pediatric gender medicine was first established in the Netherlands in the 1990s and 2000s, were considered necessary to justify a transition to the opposite sex.
Dr. Johnson, Elaine and Clara reported, never demanded this of the child to transition to male. She said it was only necessary for a detransition.
“She looked very, very angry,” Clara said of Dr. Johnson’s demeanor during that appointment. “She seemed kind of taken aback.”
Elaine recalled that Dr. Johnson said she did “not feel safe” continuing to work with Clara. Elaine said she nervously laughed in response “because I was so stunned she would say such a thing. (Clara), 87 pounds at the time, was very weak and didn’t even raise her voice. She was crying.”
“I had my head in my hands,” Clara recalled. The clinic dropped Clara as a patient. Clara felt abandoned and betrayed. Elaine was furious, and remains so.
Clara, Elaine wrote in her letter draft, “continues to struggle with her mental health and with grief over the loss of her breasts. She lives with chronic pain, anxiety, depression, and recurring suicidal thoughts.” She continued, “Nothing she was promised was resolved by transition.”
“It sounds so stupid, but I didn’t know that it was permanent,” Clara said of the mastectomy. “I didn’t understand that if you got it, you wouldn’t be able to breastfeed.”
The dynamic Dr. Johnson’s clinic established, Elaine said, egregiously drove a wedge between her and her child and left her muzzled. She said that Dr. Johnson would often refer to her as “Mom,” rather than by her name, which Elaine found demeaning and condescending.
“She’s intimidating,” Elaine said of Dr. Johnson. “Whenever I challenged anything, it was, ‘Well, Mom, it’s not your decision. Your child is competent.’”
“That is not a free and informed environment in which to make life-altering medical choices,” Elaine wrote in her draft. “Not for a struggling teenager, and not for her mother.”
“My mom is fine with trans people, she just knew I wasn’t trans and that I was mentally ill and that I was young and didn’t understand,” Clara said.
Adamant Opposition
All the families who spoke for this article said they adamantly opposed Dr. Johnson’s recent appointment as president of the Canadian Pediatric Society.
In an email, Amy Groleau said of the care Dr. Johnson provided her child: “It is imperative that the truth comes out so our country will start to wake up and realize the detriment that is afforded through ‘affirmed care’ upon our children. By allowing Dr. Johnson to be the president of the Canadian Pediatric Society, she will continue the atrocities to our kids’ health — now and for generations to come.”
“My life has been turned upside down,” Clara said. “I wake up and I can’t believe that it happened. It’s like waking up from a nightmare, but it’s real.”
“I was really hurt,” Clara said of Dr. Johnson’s care. “It’s important for people to know.”
