Yet in response to ferocious pressure from trans activists, Guyatt disavowed his research team’s besieged funder; explicitly denounced the use of his work to justify bans of these controversial interventions; and contradicted his own findings about the evidence base. Given Guyatt’s academic prowess, his recent about-face has stunned critics of pediatric gender medicine. (Guyatt declined my requests for comment.)

Guyatt’s capitulation follows a concerted campaign by transgender activists to smear the trio of systematic reviews that his team recently published, suggesting Left-wing cancel culture still poses a threat to academic freedom and free inquiry where pediatric gender medicine is concerned. 

Evidence-based medicine is a revolutionary meta-scientific discipline that has sought to synthesize the analysis of research findings. The goal is to determine the quality of evidence about any particular medical practice, support more precise and transparent treatment guidelines, and ultimately improve clinical decision-making. The legitimacy of the field depends, at least in part, on academics’ independence and detachment from the political fray.

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This year, the McMaster team published the first three of five systematic reviews on gender-transition interventions for youths: on puberty blockers, cross-sex hormones, and gender-transition mastectomies. While the mastectomy review was the first of its kind, the others were but the latest in a solemn parade of such reviews by researchers across the Western world. McMaster concluded that the evidence in all three treatment areas was weak and uncertain. Similar findings from researchers across the Atlantic have prompted health authorities in a swath of European nations to sharply restrict minors’ access to gender-transition treatments. 

Guyatt’s research was funded by the US-based Society of Evidence-Based Gender Medicine, a group founded in 2019 with a mission to scrutinize the scientific evidence backing gender-transition interventions for youths. As determined by academics in a 2024 systematic review commissioned to support the Cass Review of pediatric gender medicine in Britain, this field is sorely lacking for guidelines that pass evidence-based muster. SEGM sought to help fill that void. In 2021, it commissioned the systematic reviews from Guyatt’s team at McMaster; the project was headed by Dr. Romina Brignardello-Peterson, an associate professor of health-research methods. 

In North America, SEGM has prompted skepticism about the safety, efficacy, and ethics of these interventions. Recognizing the nonprofit’s mounting influence, trans activists have campaigned to poison its reputation. In December 2023, the Southern Poverty Law Center released a report about a supposed “pseudoscientific” network of anti-LGBTQ groups, including SEGM, that sought to harm trans youth. The report sought to tie SEGM to funding streams that also back conservative anti-LGBT organizations. But the allegations were misleading, given that these were generic donor advisory funds that, as it happens, also channel millions of dollars in donations to SPLC itself; the SPLC officially designated SEGM a hate group in June 2024, which catalyzed the activist uprising against Guyatt’s team.

Guyatt caved. On Aug. 14, he and four of his colleagues published a statement on McMaster’s website in which they disavowed SEGM. “When the agreement started in 2021, the organization appeared,” they tersely wrote, “to be legitimately evidence-based.” They offered no evidence to back this cryptic take-down. The McMaster team also lamented how its own work was being “misused to harm trans youth,” calling it “unconscionable to forbid clinicians” to provide such interventions.

Dr. Steven Montante, a plastic surgeon in Richmond, Va., was among the four review-paper coauthors who didn’t sign the statement. “I don’t necessarily agree that he has the authority to dictate” how his work is used, he said of Guyatt. “To be so prescriptive waters down the notion of why we do these systematic reviews, and the notion of evidence-based medicine. There should be some level of detachment.”

“Why didn’t the institution defend the science?” said Dr. Paul Garner, an emeritus professor of evidence synthesis in global health at Liverpool School of Tropical Medicine. “I see this is an institutional failure.” He added: “This is obviously a toxic ideological area.” 

Montante and other sources with knowledge of Guyatt’s team told me that the statement was a direct response to activist pressure. The activist campaign was driven in part by an incendiary, anonymous Instagram account that targeted the researchers and their ties to SEGM and demanded retractions of the review papers. The social-media posts featured videos of activists confronting Guyatt and Brignardello-Peterson and, in a dubious reference to the SPLC report, claiming that SEGM “shares funding streams with US white-nationalist organizations and lobbies for discrimination against, and ultimately extermination of, trans people.” Eventually, the researchers came under mounting internal pressure, as well, from trans advocates at McMaster and university administrators, Montante and other sources told me. 

The pressure campaign spilled into broader view on July 12, when a group of physicians and academics, including one from McMaster, published an editorial in the university’s local paper denouncing the Guyatt team’s work as “pseudoscience,” absent any direct evidence. The editorial relied on the same brand of guilt-by-association that SPLC levied against SEGM’s supposed ties to anti-LGBTQ conservative groups. 

Speaking anonymously for fear of reputational harm, a number of evidence-based-medicine experts told me that by crumbling in the face of activist pressure, Guyatt in particular called into question his capacity to provide dispassionate analyses about any scientific subject. Critics also expressed astonishment that Guyatt’s team announced it had made a donation to Egale Canada, which calls itself “Canada’s leading organization for 2SLGBTQI people and issues” and calls gender-transition treatment “life-saving.” This is not an evidence-based claim, and some experts told me such tithing represents a brazen conflict of interest. Also egregious, experts told me, was the McMaster statement’s use of activist rhetoric. This includes characterizing gender-transition treatment as “medically necessary,” despite the team’s own conclusions that the efficacy of these treatments remains essentially unknown. 

In 2023, when Guyatt sat on a panel at SEGM’s conference in New York, he sounded a different note. Asked whether it was acceptable to call pediatric gender medicine “life-saving” and “medically necessary” when it’s backed only by low-quality evidence, he said: “Of course not.” The rational approach, he said, would be “not to say it’s medically necessary, it’s to say we are putting an extremely high value on autonomy.” Indeed, the recent statement from Guyatt’s team asserted that when a treatment is backed by low or very low certainty evidence then the “high respect for autonomy becomes particularly important.”

Conservative US policymakers have argued that if doctors fail to self-police and protect children from themselves, the state is justified in stepping in. On a July 30 call, according to Montante, Guyatt expressed his unhappiness that his team’s papers had been cited in a US Department of Health and Human Services report on pediatric gender medicine. Published in May, the report concluded that the known and potential harms of these medical interventions were so concerning that providing them was unethical. 

Another inside source said that administrators told Guyatt’s team that if they didn’t distance themselves from SEGM, they’d risk being branded unfriendly to LGBTQ interests and thus might lose funding opportunities from the Canadian Institutes of Health Research. 

Montante provided me with emails that Brignardello-Peterson, the leader of the SEGM-commissioned reviews, sent in February on her and Guyatt’s behalf to the review authors. Expressing unhappiness that “our work is being misused and may be causing harm,” the pair proposed adding a paragraph to all the reviews’ conclusions emphasizing the importance of patient autonomy and denouncing policies restricting medical interventions. When Montante’s objected that such a post-hoc edit “may undermine the research,” they scrapped that idea. Instead, they proposed sending a letter to the editor to the journals that had published their reviews, which Montante and three others declined to sign and that was similar to the statement ultimately published in August. 

More recently, Brignardello-Peterson and Guyatt have sought to divorce themselves from two reviews nearing publication. This includes a paper on social transitions (changing names, pronouns, style of dress), and another on binding breasts and “tucking” the penis and scrotum. Montante, who is a co-author of the latter pending paper, said the McMaster team wants a wholesale abandonment of authorship, leaving only him and one other co-author, an independent researcher. Such a sweeping disavowal of prominent, nearly published scholarship is extremely unusual in academia.

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According to sources close to the matter, McMaster also sought to cancel various independent commissions that individual university researchers received from SEGM. This has jettisoned, for example, years of work on an evaluation of the influential trans-care guidelines for adolescents published in 2022 by the World Professional Association for Transgender Health. The outstanding systematic reviews, Montante insisted, should be published. “Let the work stand for itself,” he said. Of his many dealings with SEGM, he said: “I’ve never gotten any kind of vibe or any kind of perception that this was some kind of anti-trans group.”

In a recent interview, Guyatt said he had evidence that SEGM at least effectively supported bans of pediatric gender medicine. But he failed to produce any such evidence. Otherwise, Guyatt made clear that he’d prioritized protecting his reputation in the eyes of one faction of the gender-medicine war rather than adhering to the principles of academic freedom. Regardless of the truth, he said, he had to cut ties with SEGM because associating with a group with such a toxic reputation meant getting “tarred and feathered.”

In a statement, SEGM co-founder Zhenya Abbruzzese said, “SEGM and Dr. Guyatt have had a longstanding but collegial debate about the role of child autonomy in gender medicine.” Nevertheless, the nonprofit’s collaboration with his team, she said, had been “grounded in mutual respect.” Expressing disappointment that the academics had yielded to activist pressure, Abbruzzese added: “Young people experiencing gender dysphoria deserve evidence-based care.”

Bringing Guyatt to heel is but the latest chapter in a history of campaigns to attack the reputations of academics who threaten trans activists’ ambitions where children are concerned. In one notable pile-on, Michael Bailey, a pioneering psychology professor at Northwestern University, saw his 2023 paper on “rapid-onset gender dysphoria” subjected to an avalanche of scorn from trans activists and activist-academics. They ultimately succeeded in getting the paper retracted due to what Bailey insisted was unwarranted censorship based on a mere pretext. 

“I have some regrets in life, but my unwillingness to buckle under ideological pressure like Dr. Guyatt did isn’t one of them,” said Bailey, who republished his paper elsewhere. “Indeed, it’s one of the things I’m proudest of.” Such bravery remains rare, and is invaluable to defend academic freedom in a field in desperate need of better research.