A coalition including Canadian Gender Report, Parents of ROGD Kids, Canadian Women’s Sex-based Rights and GNC Centric have submitted a complaint to the College of Physicians and Surgeons of Ontario about the McLean Clinic and two of its physicians: Dr Hugh McLean and Dr Giancarlo McEvenue. We urgently request the CPSO to review and understand the impact of social media and the current standard of care being applied to trans-identified youth. More information about the McLean Clinic usage of social media to promote gender-affirming surgery to minors can be found in this article: Young Canadians are being sold gender affirming top surgery on Instagram
Our letter to the CPSO and Schedule A with details of the complaint can be found below.
Dr Brenda Copps
President, College of Physicians and Surgeons of Ontario
80 College Street
Toronto, Ontario M5G 2E2
January 31, 2020
Re: Treatment of gender dysphoric youth and complaint against McLean Clinic
Dear Dr Copps,
We would like to bring your attention to a number of issues affecting children and youth who are experiencing gender dysphoria in Canada. We are a network of organizations working together to voice our concerns regarding the rapidly growing medicalization of such youth.
A prime example of this trend in identity medicine can be found at the McLean Clinic (Mississauga), where social media is used to promise new benefits of a trans-identity that can be achieved with medical treatments while denigrating natural physical characteristics such as breasts. Social media is attracting many teenagers to seek out irreversible medical treatments. At the same time, there are growing numbers of detransitioners in their early 20’s coming forward who are reporting regret.
We have filed a complaint with the CPSO against the McLean clinic due to privacy and ethical concerns for this vulnerable population of youth.
There is a several thousand percent increase in the number of youth seeking medical means to change their gender in Europe, Australia, and North America. In the past year, the Ministers of Health of the UK and Australia have ordered government inquiries to understand why the number of adolescents seeking gender transition is increasing so rapidly. The exponentially increasing rates of youth presenting as gender dysphoric, combined with the increasing numbers of detransitioners emphasize the need to take a more cautious approach in terms of intervention until more research has been conducted.
In particular, we would like you to know that detransitioners in Canada are reporting that they felt medical transition was “the only option” presented to them.
We hope that you share our concerns about vulnerable youth being fast-tracked down an irreversible medical pathway. We would like an opportunity to meet with you and others of the CPSO leadership team to discuss the latest research and present our concerns about the current treatment model.
Schedule A – Details of the Complaint
The McLean Clinic posts promotional material about gender-affirming surgeries primarily targeting elective mastectomies for adolescent and young adult females on their Instagram and YouTube social media properties and several websites. The nature of the promotional material and messaging used by the clinic was reviewed recently in an article written by Barbara Kay.
We assert that the McLean clinic is in breach of 2 important professional standards.
- The McLean Clinic is not complying with all legal and professional obligations to maintain patient privacy and confidentiality.
The McLean Clinic frequently posts photographs of patients post-surgery and thereby discloses many identifying variables including the individual’s photograph with fully-identifying facial features, biological sex, the surgical procedure, the date of the surgery and identifies the provider of health care, Dr McEvenue or Dr McLean and the location of the provision of healthcare, the McLean clinic.
The patient information disclosed on the McLean Instagram site is protected health information per Section 4 of the Personal Health Information Protection Act (PHIPA). In particular, the clinic is disclosing “identifying information” that identifies an individual or “for which it is reasonably foreseeable in the circumstances that it could be utilized, either alone or with other information, to identify an individual”. Per Section 4 of PHIPA this information relates to the providing of health care to the individual, including the identification of a person as a provider of health care to the individual.
The McLean clinic needs to comply with the Personal Health Information Protection Act. Their current social media usage does not comply and exposes this young and vulnerable patient group to a high risk of re-identification.
2. The McLean Clinic is posting content that could be viewed as unprofessional.
CPSO social media guidelines state that physicians should consider appropriate usage of technology to “Protect their own reputation, the reputation of the profession, and the public trust by not posting content that could be viewed as unprofessional.” In particular:
- The comments are open on their Instagram and YouTube accounts, so that others can post critical responses about the patients, or derogatory remarks.
- The patient’s amputated breasts and body tissue are not treated with dignity and respect in the pictures on Instagram.
- Many of the patients in the pictures appear to be minors. Also, many of the commenters on these sites are minors.
- Unrealistic results of surgery are promised, such as improved relationships with others, finding a partner, etc.
- The websites use stock pictures of muscular attractive male chests, which is unattainable for females because they will have visible scars.
- Elective mastectomy surgery is portrayed as a fun and easy procedure. The risks of surgery are not discussed on the Instagram and youtube sites, and only very briefly on their website.
- The clinic works on an informed consent basis, which may cause vulnerable females to be influenced by the McLean Clinic’s marketing material into having unnecessary surgery that they may later regret.
Rates of youth seeking gender transition are skyrocketing around the western world including Canada. The UK and Australia have ordered government inquiries to understand why the number of adolescents seeking gender transition is increasing so rapidly. New research highlights the heavy usage of social media among the “Rapid Onset Gender Dysphoria” population group and suggests that there may be a social contagion effect within peer groups. Also very recently, increasing numbers of detransitioners have started coming forward expressing regret with attempts to resolve gender dysphoria with gender-affirming surgical procedures, such as those provided by the McLean clinic. While the patients depicted on the McLean Instagram account seem very happy and excited about their surgery, CPSO should take into consideration the vulnerable nature of this young group and that some of these patients will later regret their surgery.
We ask the CPSO to seriously consider the professional responsibility of its members to protect patient privacy and utilize social media and the internet in a professional manner. In particular, we ask that the CPSO:
- Order Dr. McLean and Dr. McEvenue to stop posting material that violates PHIPA patient privacy requirements for this vulnerable population on their Instagram, Youtube, other social media accounts and websites.
- Develop clear ethical requirements for your members about marketing plastic surgery to minors including those who may be experiencing gender dysphoria or mental health issues.
Concerns about the Standard of Care
Royal College of General Practitioners position statement calls for independent research including “wait and see” policies https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2019/RCGP-position-statement-providing-care-for-gender-transgender-patients-june-2019.ashx?la=en
Daily Mail: GPs risk transgender storm after unprecedented warning over lack of evidence on treatments that pave the way for children to have a sex change, July 6, 2019 https://www.dailymail.co.uk/news/article-7220897/GPs-risk-transgender-storm-issuing-unprecedented-warning-lack-evidence-treatments.html
Lisa MacRichards, Bias, not evidence dominates WPATH transgender standard of care, https://genderreport.ca/bias-not-evidence-dominate-transgender-standard-of-care/
James Cantor, PhD American Academy of Pediatrics policy and trans- kids: Fact-checking https://www.tandfonline.com/doi/full/10.1080/0092623X.2019.1698481
Lisa Marchiano, LSW, The Ranks of Gender Detransitioners Are Growing. We Need to Understand Why
It Feels Like Conversion Therapy for Gay Children, say Clinicians https://www.thetimes.co.uk/article/it-feels-like-conversion-therapy-for-gay-children-say-clinicians-pvsckdvq2
Dr Lisa Littman, Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330
Telegraph UK: Minister orders inquiry into 4,000 percent rise in children wanting to change sex https://www.telegraph.co.uk/politics/2018/09/16/minister-orders-inquiry-4000-per-cent-rise-children-wanting/
Gender Inquiry: Australian Doctors Call For a Parliamentary Inquiry Into Childhood Gender Dysphoria https://genderinquiry.wordpress.com/