If you listen to Canadian politicians, the solution to our housing crisis seems to be some combination of immigration reform and a herculean countrywide building effort.

But Paul Kershaw, a public policy professor at the University of British Columbia and founder of the affordability advocacy group Generation Squeeze, says the emphasis on increasing housing supply obscures an issue politicians are less likely to address.

Namely, that we, as a country, have become addicted to ever-rising home prices, largely because we've been conditioned to see our homes as financial assets.

"There are multiple things we need to do [to reduce prices], and more supply is one of them," said Kershaw. But funding announcements for building projects are a "way to organize our concern about the housing system so that we don't have to … look in the mirror — particularly homeowners who have been homeowners for a long time — and say: 'How are we entangled?'"

He said the current system incentivizes extracting profit from real estate, rather than prioritizing that everyone has access to affordable shelter.

"We need clarity about what we want from housing," said Kershaw. "And it has to start with: 'We don't want these prices to rise any more.'"

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Speculative effect

The trajectory of home prices is well-known to most Canadians. According to the Canadian Real Estate Association, the average home in January 2005 sold for $241,000. By February 2022, it had more than tripled, before easing somewhat to $719,400 in February 2024.

On Friday, Royal LePage released a forecast that suggested the aggregate price of a home in Canada will increase nine per cent year-over-year in the fourth quarter of this year.

Meanwhile, earnings in Canada have lagged significantly behind housing costs, such that the ownership costs on an average home consume more than 60 per cent of median household income, according to a recent RBC report.

On the face of it, the lack of affordable housing seems like an issue of supply — just build more to meet demand and prices will come down. 

But part of the problem is the source of that demand: it's increasingly investors. 

The Bank of Canada found that investors were responsible for 30 per cent of home purchases in the first three months of 2023. That's up from 28 per cent in the same period in 2022 and 22 per cent in the same period in 2020. 

That report also found the percentage of first-time homebuyers dropped to 43 per cent in the first quarter of 2023 from 48 per cent in the same three months in 2020.

"What's been happening over the last 10 years is that the share of homes bought by first-time buyers has been declining, and their market share has largely been taken over by investors," said John Pasalis, president of Toronto-based Realosophy Realty.

The Bank of Canada's definition of an investor is a buyer who took out a mortgage to purchase a property while maintaining a mortgage on another home.

The central bank has said that "during housing booms, greater demand from investors can add to bidding pressures and intensify price increases."

Who's investing?

Early in the COVID-19 pandemic, we saw an uptick in people buying second properties. 

Robert Hogue, assistant chief economist at RBC, says a combination of low interest rates at the time and many people sitting on large savings "encouraged speculative activity."

But he doesn't see current high prices "as only being a problem of speculative activity."

House-flippers and foreign buyers are often singled out as major drivers of real estate speculation, and various jurisdictions in Canada have introduced legislation to neutralize those kinds of investments.

But Pasalis said those types of buyers aren't having a major influence on prices. Domestic investors in the low-rise housing market are having a much greater impact.

He said they generally fall into two categories: those who buy directly from developers and those who are moving but decide to hold on to their first residence.

"If they're upsizing or moving out of the province or country, the first question we get is: 'Can we keep our current home as a rental?'" said Pasalis. 

"They're not like active investors. They're just looking at the market, they're looking at how quickly home prices are going up. Everyone sees housing as a decent investment, so everyone's mindset is: Why should I sell it?"

It's one reason there's less housing supply for first-timers.

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A historic problem

Purchasing a home has a variety of benefits. It gives many people a sense of accomplishment and the security of knowing they can't be evicted. It also allows them to build up equity, which can help fund renovations, a move to another residence and even retirement. 

Many families pass properties on to subsequent generations, which also makes home ownership something of an emotional investment.

Higher prices help existing homeowners tap more home equity and reap greater profits if and when they do decide to sell. 

Governments also have an interest in high property values because they translate to larger tax revenue, said Diana Mok, associate professor of real estate at the Lang School of Business and Economics at the University of Guelph in southern Ontario.

Not only that, but real estate is the single-biggest contributor to Canadian GDP, according to Statistics Canada.

"The housing market encompasses a very large variety of sectors — think about realtors, think about lawyers, think about construction," said Mok. It's not just "all the buying and selling, but it's all the labour that contributes to the economy."

While Prime Minister Justin Trudeau has publicly lamented high prices, Hogue said he can't imagine "any government that would intervene to lower home prices as an objective. I don't think that would be a winner from a political point of view."

Priced out

Naama Blonder, an architect and urban planner with the Toronto-based firm Smart Density, says part of the problem is a societal obsession with home ownership.

"I think many Canadians think that when we are talking about the affordability crisis, we are talking about their ability to own a house with a backyard. 

"For them, 'We are priced out of owning a house, therefore, we have an affordability crisis that we need to solve.' I have news for you … what worked for our parents is not going to be the model for us," said Blonder.

"We don't have politicians who are bold enough to say: 'It's more than OK to rent.'"

The upcoming federal budget on Tuesday will undoubtedly contain a number of measures to address the housing shortage. Recent funding announcements have responded to the desire for more rental housing, but the scale of the need is daunting.

In a 2024 report, the Canada Mortgage and Housing Corporation said despite a record number of projects started between 2021 and 2023, "this increase will not meet the growing demand. As a result, rental markets will remain tight, particularly in the pricier areas of Canada."

Pasalis said that for all the hand-wringing over housing prices, he doesn't see there being any political will to rein in investors. And he's skeptical of the federal government's recently announced financial incentives to help first-time buyers get into the market.

Putting young people further in debt "is not a way to make housing more affordable," he said. 

Kershaw of Generation Squeeze says a broader "tax shift" is required. He advocates an annual tax on "housing wealth" aimed at the owners of the most valuable 10 per cent of homes in Canada as one way to dampen housing prices, while also raising funds to invest in affordable housing.

"What started happening in B.C. and spread throughout the country is that we weren't just satisfied with paying off our mortgage to build equity. We're like: 'You know what? I want this home price to double, triple, quadruple.'"

When existing homeowners want prices to rise faster than earnings in the local economy "is the moment you want a wealth windfall for those who are owners now that will come, by definition mathematically, at the expense of affordability for those who follow," Kershaw said.

"That's the trouble we've gotten ourselves into. And if we cannot have that conversation, we will never solve the crisis of housing affordability."

A long-anticipated — and contentious — national review of gender-affirming care for youth in England was released last week, resulting in headlines across the U.K. saying that gender medicine is "built on shaky foundations."

The Cass Review, chaired by pediatrician Hilary Cass, was commissioned by England's National Health Service (NHS) in 2020. 

Even before the final report was published, the review has led to significant changes for youth gender medicine in England, where the debate over transgender care has become increasingly heated, with complaints of both long waiting lists and medical treatments being too readily available to youth.

Last month, the Cass Review findings led to a ban on the prescription of puberty-suppressing hormones except for youth enrolled in clinical research.

That's a move away from the standard of care supported by many international medical bodies, including the Canadian Pediatric Society (CPS), the American Academy of Pediatrics and World Professional Association for Transgender Health. Though several European countries including Sweden have also restricted access to puberty blockers and other medical treatments for youth.

The report cites a systematic review of evidence, commissioned as part of the Cass Review, which found "a lack of high-quality research" that puberty blockers can help young people with gender dysphoria.

While experts in the field say more studies should be done, Canadian doctors who spoke to CBC News disagree with the finding that there isn't enough evidence puberty blockers can help.

"There actually is a lot of evidence, just not in the form of randomized clinical trials," said Dr. Jake Donaldson, a family physician in Calgary who treats transgender patients, including prescribing puberty blockers and hormone therapy in some cases.

"That would be kind of like saying for a pregnant woman, since we lacked randomized clinical trials for the care of people in pregnancy, we're not going to provide care for you.… It's completely unethical."

What are puberty blockers?

When evaluating a drug or treatment, the question is always: how safe and effective is it? 

"Puberty blockers have been used for decades for precocious puberty," or very early onset of puberty, said Dr. Sam Wong, president of the pediatrics section with the Alberta Medical Association.

"There are side effects with every medication, and I would talk [with patients and their families] about the side effects, but for the most part it's a safe medication."

Puberty blockers slow or pause the effects of hormones a young person's body produces — for example, delaying the onset of a menstrual period or physical changes like breast growth, a lowered voice, or growth of the Adam's apple. 

Their effects are considered reversible. When the medication stops, puberty resumes. 

The drugs are associated with lower bone density accumulation while someone is on them, and doctors can advise steps to counteract that, like weight-bearing exercise and using calcium or vitamin D as needed, according to the CPS position statement.

Their effectiveness in pausing puberty is not in dispute.

What is now banned by NHS England is the use of the medications specifically to treat "children and young people who have gender incongruence/gender dysphoria." (Alberta's plan to ban puberty blockers and hormone therapy in youth under 16 is also specific to gender affirmation.)

Wong says when he speaks with a patient and their family, he discusses the bigger picture of gender-affirming care, including "the necessity of having some counselling and a thorough assessment before going forward with anything like medications." He refers those who want to explore medication use to a specialist. 

"Sometimes those blockers allow the patient and their parents to have a couple more years without having to deal with the ramifications of puberty to decide if they want to move on with more gender-affirming care" such as hormone therapy.

Donaldson says, in the patients he treats, he's seen dramatic improvement in the quality of life for transgender youth on puberty blockers.

"If a transgender youth is refused medication and is forced to go through a puberty that does not match their gender identity, that will put them in a body that will make them stand out as a transgender individual for the rest of their lives."

WATCH | Medical experts and patients discuss Alberta's proposed changes:

Scoring the evidence

The World Professional Association of Transgender Health (WPATH), in its influential guidelines, notes "the number of studies is still low" on gender-affirming care for young people, but there is a "slowly growing body of evidence supporting the effectiveness of early medical intervention."

Numerous studies cited by WPATH, CPS and other medical groups suggest that access to puberty blockers helps transgender youth, and is associated with improved mental health and lower risk of suicidal thoughts and ideas. 

The difference between that characterization and the review published last week in the U.K. comes down to how the research done so far is viewed. 

The systematic review, published in the peer-reviewed journal Archives of Disease in Childhood, looked at 50 peer-reviewed papers published between 2006 and April 2022, and scored the strength of their evidence as low, moderate or high quality based on things like study design, outcomes and how many patients were involved. 

One was scored as high quality; 25 were moderate. Twenty-four of the papers, including the 2020 study on puberty blockers and suicidal ideation, which was based on a survey of 20,000 transgender adults, were excluded from the synthesis as "low quality."

"No conclusions can be drawn about the impact on gender dysphoria, mental and psychosocial health or cognitive development," the authors wrote.

WATCH | Teens fight for gender-affirming health care:

Dr. Tehseen Ladha, a pediatrician in Edmonton and assistant professor at the University of Alberta, says the review may be misleading and ignores the context of pediatric medicine — where there is often imperfect evidence. 

"That is the case in almost every sphere of medicine because the cost, time, feasibility and ethical ability to conduct what is considered a high-quality scientific trial, it is just not there," she said.

Getting that research done can be even harder when it comes to marginalized populations like trans youth, she said. "They haven't been thought of as priorities or important."

Wong agrees there is often a lack of high-quality studies in pediatrics, saying 75 per cent of medications prescribed to children are used "off-label" because they were never tested on children. 

What does 'low-quality evidence' mean?

The gold-standard in determining effectiveness of a treatment is a randomized controlled trial where neither patient nor doctor know if they are receiving the treatment or the placebo.

But Wong says that's not always feasible.

Beyond ethical concerns of doing such a trial on the mental health of young people with gender dysphoria, there would be no way to keep participants in the dark. 

"Within a few months, it's obvious to the person that they're on puberty blockers or they're not on puberty blockers. So … they have feelings and they have impressions of what they should be going through," Wong said. "So that's going to influence the study itself."

Surveys and interviews are considered low-quality evidence in medicine, said Ladha, but that might be misleading to the general public. 

"Many people would see low-quality evidence and think well, that means this could harm our children. But that's not what it means."

Even something as routine as treating a kid's ear infection with antibiotics or painkillers may not have robust evidence, notes Donaldson.

"That doesn't mean we just every time we see an ear infection we turn around and walk the other way. Sometimes, an ear infection needs to be treated, sometimes it doesn't."

Ladha wondered if the review was "coming from a place of bias."

"I think the framing of it really made it feel as though it was trying to create fear around gender-affirming care," she said.

Donaldson called the systematic review paper and the broader Cass Review "politically motivated." 

The Cass Review, while aiming to be an independent assessment, has been criticized as flawed and anti-trans by trans activists in the U.K., and was described as a product of the U.K.'s hostile environment for trans people in the International Journal of Transgender Health.

The review authors, based at York University in England, declined to comment on their research, though it was promoted in a media release by the British Medical Journal. The Cass Review also did not respond to a request from CBC News.

Canadian groups support access 

Though the review's findings are being used to restrict access to puberty blockers in the U.K., no Canadian medical organization that responded to CBC News said it would change advice here.

"As with all areas of medicine, new and emerging evidence is evaluated as it becomes available," said the Canadian Pediatric Society in a statement. 

"Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient's mental and psychosocial health."

Children's Healthcare Canada, which represents children's hospitals, referred to its previous statement in support of evidence-based gender-affirming care for youth, saying: "Our position remains unchanged on the topic."

Doctors say they're used to advising patients about what is and isn't known when it comes to a treatment, and helping them make an informed choice.

"None of this is being done in a vacuum," said Donaldson.

"We have institutions that are set in place that are evidence based that are providing this care for individuals in a way that is following the guidelines to the best available evidence."

If you or someone you know is struggling, here's where to get help:

• Suicide Crisis Helpline: Call or text 988.

• Kids Help Phone: 1-800-668-6868 (phone), live chat counselling on the website.

• Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.

• This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you're worried about.