Quebec Re-examines Gender Identity

A review of the report of the Comité de sages on gender identity

The report of the Quebec Comité de sages sur l'identité de genre[1] was released on May 30, 2025. It was greeted with a noisy protest by transgender activists, who objected to the absence of any trans or non-binary people on the committee, but activists have little to worry about, just yet. The recommendations in the report are cautious and are often little more than calls for further study. Nevertheless, the report makes a valuable contribution by taking seriously concerns which most Canadian governments and the media have either dismissed or ignored.

The committee was created in the fall of 2023 in response to parent protests over the issues of gender identity in schools. The chair, Diane Lavallée, is a registered nurse with a background in healthcare administration. She is a former president of Fédération Interprofessionnelle de la santé du Québec (FIQ) and the Conseil du statut de la femme. Bernard Trudeau is a family doctor with extensive experience in healthcare administration and a former director of the College of Physicians of Quebec. Patrick Taillon is a professor at the University of Laval who teaches constitutional and administrative law.

When the committee was first announced, I noted that its mandate directed it to work with the Conseil québécois LGBT, which represents over 70 LGBTQ2+ organizations around the province. This suggested to me that while the committee might raise some questions about the dominant gender ideology, they would not push them very far. This is generally what the report does.

Sex and Gender Identity

The report gets off to a bad start with a section on the binary nature of sex which ignores what defines sex as binary. Instead of defining sex as a reproductive function based on whether an organism is developed to support the production of large or small gametes, the report quotes a definition from the Health Research Institute of Canada, which reads:

Sex: "The term ‘sex’ refers to a set of biological attributes found in humans and animals. It is related primarily to physical and physiological characteristics, such as chromosomes, gene expression, hormone levels and the anatomy of the reproductive system." / Sexe : « Le terme “sexe” renvoie à un ensemble d’attributs biologiques retrouvés chez les humains et les animaux. Il est lié principalement à des caractéristiques physiques et physiologiques, par exemple les chromosomes, l’expression génique, les niveaux d’hormones et l’anatomie du système reproducteur. » [2]

This confused definition leads to a confusing discussion of “intersex” conditions. The committee seems unaware that the term intersex has now largely been replaced by the Differences of Sexual development.

However, the committee does understand the essential point that sex is not simply a spectrum of characteristics. The report discusses ideological conflict around the term “sex assigned at birth” and agrees that, with the exception of so-called intersex cases, sex is ascertained based on observable biological criteria and not arbitrarily assigned. The report concludes:

Indeed, as long as we agree that there is a conceptual difference between sex and gender identity, we have to admit that sex is a fact, not a feeling. / En effet, du moment où l’on convient qu’il existe une différence conceptuelle entre le sexe et l’identité de genre, force est d’admettre que le sexe se constate et qu’il n’est pas un ressenti.

The report gets better when it acknowledges the importance of maintaining a distinction between sex and gender both in data collection and in human rights law. This is a crucial point, because is enables to committee, in later chapters, to argue that certain spaces should be separated by sex.

The discussion of gender identity refers to Lisa Littman’s work on social contagion and discusses the various factors such as the influence or social media and the impact of pornography that may be contributing to the rise of transgender identification in adolescents. The committee notes that there are opposing views and does not reach any conclusions, but the fact that it is willing to take the social contagion hypothesis seriously will infuriate trans activists.

The committee heard a range of views from lesbian, gays and bisexuals and acknowledges that there is a split in the LGB community over transgender rights. In particular, there is concern about the change in the definition of sexual orientation from attraction based on sex to attraction based on gender. The report also acknowledges the divisions in the feminist community over the impact on women and girls of replacing sex with gender.

The report also considers the issue of language and the inclusion of non-binary people. This is a more complex issue for francophones as French is a much more gendered language than English. However, the committee makes one point that is applicable to any language:

Respecting the gender identity of non-binary people requires an individualized effort to accommodate, not a systematic transformation of language. / Le respect de l’identité de genre des personnes non binaires commande un effort individualisé d’accommodement et non pas une transformation systématique du langage.

The “Tense Climate” in Gender Debate

The report discusses the “tense climate” around the gender debate which has developed on various settings. Fear and divergent positions have led to mutual distrust which is not conducive to dialogue.

In women’s groups there is a division between those who consider that treating the struggles of trans or non-binary people in the same way as those of women erases the reality of half the population and sets back their struggle for equality. Another group has an intersectional vision which argues that the inclusion of trans and non-binary people in feminism is part of a broader struggle against patriarchy.

In the health sector the committee heard from two different perspectives. On one hand, professionals involved in gender-affirming care were concerned that criticism of their work was associated with a political vision or “moral panic.” On the other hand, professionals who were critical of the gender-affirming model said that they were afraid to speak out for fear of damaging their careers. There were similar problems in universities where a vocal minority were intimidating professors, cancelling conferences and generally undermining the conditions for healthy debate.

The committee recommends action to combat the polarization of the debate and self-censorship in professional and scientific settings but offers no specifics. This is not surprising because the committee has fallen into the both-sides fallacy. It is not willing to acknowledge that the vocal minority which engages in harassment, intimidation and censorship of opposing views is made up of transgender activists. It is a truism that there are extremists on both sides of every debate but, in the gender debate, it is the transgender activists who have received unquestioning deference from leaders in government, the universities, professional associations and the media.

Health Care

The chapter on health care is a disappointment. The committee shows no understanding of the concept of evidence-based medicine or the findings of multiple systematic reviews that gender affirming treatments are based on low-certainty evidence. The report discusses the Cass Review but notes that the American Academy of Pediatrics and the British Medical Association rejected its conclusions. (In fact, the British Medical Association, after protests from members, adopted a neutral position.) Rather than considering the arguments in detail, the committee says:

Faced with so many divergent points of view, it is difficult for our committee to distinguish well-founded analyses from statements that are more opinion than science. On both the Cass report and the WPATH standards, we were presented with arguments concerning both the methodological quality of the documents and the presence of potential role conflicts, or even conflicts of interest. Clearly, more in-depth assessments would be required to reach a more definitive conclusion on the documents mentioned above, or on other studies cited as references. / Devant autant de points de vue divergents, il est difficile pour notre comité de discriminer les analyses fondées des propos qui relèvent plus de l’opinion que de la science. De part et d’autre, tant pour le rapport Cass que pour les standards de la WPATH, on nous a fait valoir des arguments concernant à la fois la qualité méthodologique des documents et la présence de potentiels conflits de rôle, voire de conflits d’intérêts. De toute évidence, des évaluations plus poussées seraient nécessaires pour se prononcer plus avant sur les documents précédemment évoqués, ou sur d’autres études citées en référence.

The committee does not refer to the questionable ethical practices on the part of WPATH clinicians exposed in the WPATH Files or the bias and political interference that were involved in the creation of the latest edition of the WPATH SOC8. It is likely that the committee completed its work before the U.S. Health and Human Services report was published.

In the result, the committee accepts the standard of care of the World Professional Association for Transgender Health as a reliable authority and the opinions of unnamed specialists in gender affirming care that hormones and puberty blockers are safe and effective.

The report does better on the subject of detransition. It acknowledges that the actual rate of detransition is unknown but that it appears to be increasing. The recommendations include a call for further research and better services for detransitioners.

Some submissions to the committee argued for a self-determination model of care which does not require a psycho social assessment prior to medical transition. However, the committee followed the WPATH standards of care and concluded that a psycho social assessment and a diagnosis are necessary.

Conversion therapy directed at both sexual orientation and gender identity is banned under both a Quebec law and the Criminal Code of Canada. The committee considered the problem of distinguishing between conversion therapy and exploratory psychotherapy but did not reach any conclusions. However, it did recommend that complaints of conversion therapy against health care professionals should be dealt with through professional discipline tribunals rather than criminal prosecutions.

The committee is concerned about professionalism and ethics in gender affirming care. It refers to the "Trans express" episode of Radio-Canada's Enquête where investigators found that a 14-year-old girl could get a prescription for testosterone in a 15-minute appointment. The committee recommends better training and supervision for doctors providing gender affirming care. What the committee fails to see is that more training in the WPATH model will not do any good. If doctors are constrained from exploring the roots of a patient’s distress and from considering alternatives other than medical transition, there is little value in a longer assessment.

Fortunately, the committee also recognizes the need for more rigorous research. It calls for better lifelong longitudinal studies on gender affirming care. Quebec is in a good position to conduct this type of research, as it has a population of nearly 9 million and a single payer health system. The committee also recommends that the Minister of Health and Social Services direct the Institut national d'excellence en santé et en services sociaux (INESSS) conduct an assessment of the state of knowledge on trans affirmative care for all age groups and develop best practice guides and reference tools on trans affirmative care pathways in Quebec. This could be a major opportunity for reform not only in Quebec, but in all of Canada, provided that it is conducted in accordance with evidence-based principles, including the management of conflicts of interest.

It is not clear that the committee understands these principles. They were impressed by the dedication and concern shown by the clinicians working in gender clinics, but they fail to see that dedication informed by ideology rather than sound science is dangerous.

Gender Identity in Schools

The chapter on education is generally good. The committee has listened to parents and teachers who are critical of the promotion of gender ideology in schools. The report endorses comprehensive gender and sexuality education which includes discussion of gender diversity. However, they also agree that teaching tools such as the Gender Unicorn (La licorne du genre) promote the scientifically unsound idea that sex is a spectrum and assigned rather than observed at birth. The report concludes:

The relevance of the discourse on gender diversity and the gender continuum remains. However, this notion must be taught in conjunction with that of sex as a biological and reproductive characteristic established at birth. This coexistence, though complex, seems to us essential to offer students a complete and balanced understanding of these concepts and of observable reality. However, this presupposes that a clear conceptual distinction is made between sex and gender, and that teaching is based on objective, factual data. The current lack of clarity is leading to counter-productive confusion and unnecessary controversy. / La pertinence du discours sur la diversité de genre et le continuum de genre demeure. Cette notion doit toutefois être enseignée en concomitance avec celle du sexe en tant que caractéristique biologique et reproductrice constatée à la naissance. Cette coexistence, bien que complexe, nous semble essentielle pour offrir aux élèves une compréhension complète et équilibrée de ces concepts et de la réalité observable. Cela suppose toutefois d’assurer une distinction conceptuelle claire entre le sexe et le genre et de faire en sorte que les enseignements prennent appui sur des données objectives et factuelles. Le flou actuel entraîne effectivement une confusion contre-productive qui nourrit inutilement bien des controverses.

This chapter of the report has a number of quotations from an unidentified academic and a parents’ group. At least three of these quotations come from a video by professor emeritus in biology François Chapleau, who has produced an excellent series of videos explaining the (real) science of sex differences. The parents’s group is likely the Réseau éducation, sexe et identité.

The committee notes that while the compulsory content of the sex education curriculum is set by the Ministry of Education, teachers are free to chose the teaching materials they use. This led to disparities in teaching which have created controversies and undermined public confidence in the program. The report gives an example of teachers asking students to engage in classroom exercises where they reflect on their gender identity even though this practice is contrary to Ministry policy. There are also concerns that some teachers are offloading their responsibilities for teaching about sexuality to civil society groups from the LGBT community. The committee recommends more uniform and better supported content, including Ministry of Education approval of teaching materials.

However, many problematic materials have been approved by the Ministry of Education. The Gender Unicorn was included in a toolkit that the government prepared for schools. The Ministry of Education list of recommended materials includes books like Le rose, le bleu et toi! (Pink, blue and you!) which talks to elementary school children about gender identity and then asks the question, “Toi, comment te sens-tu à l'intérieur de toi?” (You, how do you feel inside?).

Making change will be difficult. False beliefs about the the nature of sex have become deeply entrenched in universities, teacher’s unions, text book publishers and the government itself. Scientifically accurate materials are becoming harder to find as many excellent sex education books for young people are have been revised to incorporate gender dogma.

Social Transition in Schools

The discussion of social transition in schools suffers from the same underlying flaw as the chapter on medical treatments. The committee assumes that when a student wants to transition socially, the school has no choice except to support it. The report does recommend that the when a child desires social transition, the school should arrange for an assessment by a qualified professional such as a psychologists, psychiatrist and or social worker, but the purpose of the assessment is to determine how to support the child and not to consider whether social transition is advisable.

The report emphasizes the importance of supportive parents but seems to assume that this means parents who are supportive of their child’s decision to transition. Social transition is often the first step to medical transition and the Cass Review said that it should be regarded as a psychosocial intervention. Parents may have good reasons, which the school does not fully understand, for questioning whether social transition is in the best interest of their child.

Under Quebec law, children have a right to change their name and gender markers without parental consent at the age of 14. The report deals primarily with the problems of children 14 or over. The committee agrees, in principle, that it is in the best interests of children to have their parents involved in social transition but is constrained by the requirements of the law. The final recommendation reads:

Make more explicit the school's duty to encourage students to inform their parents of their social transition. When such parental involvement is impossible or deemed detrimental, clearly establish the school's obligation to have the trans or non-binary student evaluated by competent professionals and to accompany him/her in this process, in order to protect his/her psychological and physical safety. If necessary, explicitly involve the Direction de la protection de la jeunesse (Ministry of Education, school service centers, school principals, Direction de la protection de la jeunesse). / Rendre plus explicite le devoir de l’école d’encourager l’élève à informer ses parents de sa démarche de transition sociale. Lorsqu’une telle implication parentale est impossible ou jugée préjudiciable, établir clairement l’obligation pour l’école de faire évaluer l'élève trans ou non binaire par des professionnelles et professionnels compétents et de l’accompagner dans ce processus, afin de protéger sa sécurité psychologique et physique. Si nécessaire, prévoir explicitement l’implication de la Direction de la protection de la jeunesse (ministère de l’Éducation, centres de services scolaires, directions d’école, Direction de la protection de la jeunesse).

These recommendations leave key questions unanswered. For example, how far should the school go in withholding information from the parents? What should the school say if the parents ask a direct question? Should the school keep any information on the student’s new name and pronouns separate from the official records which the parent is entitled to see? What about other students who might inform their parents? The recommendations for professional support are good, but it is questionable whether schools have access to suitably qualified mental health professionals.

Toilets and Change rooms

A decision by a Quebec high school to introduced co-ed washrooms was one of the factors that led the government to set up the committee. The committee noted the discomfort that trans and non-binary people frequently experience in using sex-segregated toilets. Often, they did not feel comfortable in either the male or female space. However, unlike almost every other Canadian government body outside of Alberta, it also paid serious attention to the concerns of women about the effects of trans inclusion on their privacy.

The report considered the option of universal facilities where there would be individual spaces for toilets, showers or changing with ceiling to floor walls and doors and a common area for hand washing. Nudity would be prohibited in common areas. The committee concluded that proper design of a universal space was essential and recommended against simply converting single sex spaces to universal spaces without prior renovations. The committee also noted that many women’s groups objected to the loss of women only spaces and that this objection is particularly strong among religious and cultural minorities.

Another option the committee considered was combining single sex spaces with universal spaces for individual use. However, the committee noted that this would require that universal spaces be provided in sufficient numbers.

Schools raise different considerations. During adolescence young people are going through a period of intense transformation and their need for privacy is more pronounced girls in particular have a need for the security of female only toilets. The committee recommends retaining single sex facilities in schools and accommodating trans and non-binary students through single use universal facilities. The committee also raises the question of shared accommodation on school trips but does not offer any recommendations.

Shelters

The report discusses the need for social services for trans and non-binary people. They often experience homelessness, addiction and violence and struggle to find services that understand their reality. However, the committee found that this does not mean that transwomen should be admitted to shelters for female victims of domestic violence and sexual trauma. These women are often in a very fragile state and the presence of transwomen on staff or as residents could re-traumatize them.

This part of the report is likely to arouse controversy. The committee asked for submissions from organizations representing women’s shelters in the province but these groups did not respond.

Prisons

The report recommends following the federal government policy of assigning prisoners to facilities on the basis of self-identified gender, subject to a risk assessment. However, it recognizes the problem that some men will fake transition in order to be transferred to a women’s prison. The solution the report proposes is a sincerity test similar to the test of sincerity of belief which the courts sometimes apply in freedom of religion cases. This is ironic because it effectively concedes the point often made by critics of gender ideology that gender identity is a form of religious belief.

Sports

The section on sports participation says a great deal on equity and encouraging the participation of trans and non-binary people in sports, but avoids the main issue which is whether trans-identified males should be permitted in the female category. The report talks in general terms about safety and fairness but never clearly acknowledges that male bodies, especially after puberty, have a huge advantage over female bodies in strength and speed. Elite high school boys outperform women Olympians in most track and field and swimming events.

The report does recommend maintaining a female category alongside mixed or open categories and calls for further research and individualized approaches to eligibility. In fact, this research has been done. The report notes that while organizations such as England Rugby, British Cycling, World Athletics and World Aquatics have adopted a restrictive approach which excludes anyone who has undergone male puberty from the female category, Hockey Canada and Canada Soccer follow an inclusive approach which allows people to compete according to gender identity. The committee fails to see that the restrictive approach is based on an extensive review of the research which confirms that male puberty provides a large competitive advantage which is maintained even after taking female hormones.

The report provides two examples of transgender participation in sport which in fact illustrate the real problem. One is Rebecca Catherine Quinn, who is described as the first transgender athlete to win a gold medal at the Olympics. In fact, Quinn (as they wish to be known) is a female who identifies as non-binary and refrained from taking testosterone so that they could qualify for the Canadian women’s team. The other example is New Zealand weightlifter Laurel Hubbard, who competed in the 2020 Olympics. Hubbard was a 43 year old male who did not begin medical transition until age 34. Hubbard took an Olympic spot from a young female from the small nation of Nauru but failed to complete a successful lift at the Olympics.

The committee suggests that it is possible to distinguish between recreational activities and elite competitions. However, this distinction is not meaningful. The safety issues resulting from males playing on female teams are the same, regardless of the level of the team. Fairness is a concern because recreational sports provide the initial training for children who may become elite athletes.

In the case of elite competition, the committee acknowledges that the rules will be set by international sports federations. In fact, international sports associations are considering the science and one by one they are taking steps to protect the female category. World Boxing announced that it would be introducing mandatory sex testing for all boxers on the same day that the committee released its report.

Summing Up

Reaction to the report has been mixed. The Quebec minister for the family, Suzanne Roy, describes the report as a tool the government will use over the next months and years without making any specific commitments. An editorial in Le Devoir says that the report is mainly a series of suggestions inspired by what is already being done in Quebec. The CBC reports that a women’s group opposes the recommendation to exclude transwomen from women’s shelters.

Any criticism of the report should allow for the scope of the committee’s mandate. The committee was asked to cover all aspects of the debate around gender identity while the Cass Review in the United Kingdom and the Health and Human Services report in the U.S.A. were limited to pediatric gender medicine. It is therefore not surprising that the quality of the report is uneven.

The endorsement of WPATH in the chapter on health is a disappointment and the recommendations on education are vague. On the other hand, the committee agrees that there is a distinction between sex and gender identity and that, in some circumstances, rights based on sex should be given priority. The committee listened to concerns from women’s groups and parents without dismissing them as bigots or transphobes. Some of the statements in the report about the binary nature of sex are close to the comments that got Amy Hamm in trouble with the B.C. College of Nurses and Nurse Midwives.

The report is not available in English so it is not likely to spark much debate outside of Quebec. This is unfortunate because, although the report has serious flaws, it does show what a real debate should look like.

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[1] The term Comité de sages is awkward to translate. The English word “sage” is an exact translation of the French but it is not commonly used in contemporary English. Automatic translators usually use “wise men / persons” or “elders”.

[2] The report is available in French only. All quotations were translated using Deepl.com and will be provided along with the original French.