Sweeping changes to gender-affirming care, announced by the Alberta government this week, are sparking widespread backlash and condemnation from doctors, nurses and medical organizations, and calls are mounting for the province to reverse its decision.
Touting it as a move to protect children, Premier Danielle Smith positioned Alberta as the most restrictive in Canada and introduced a suite of policies impacting transgender youth this week, including a ban on the use of puberty blocking medication and hormone therapy in children under 16, for the purposes of gender affirmation.
While Smith also announced a prohibition on gender-affirming surgeries in children under 18, lower surgeries are already restricted to people over 18, and doctors say top surgeries are very rarely performed on older teens.
"This is a direct attack on trans youth," said Dr. Ted Jablonski, a Calgary family physician who specializes in transgender care. "This is an assault on their medical care."
Jablonski has been treating transgender Calgarians for more than two decades.
"I feel like we've stepped back in time," he said.
"There's no medical evidence to make any kind of restrictions. We have very good guidelines to manage trans youth."
These guidelines include a detailed position statement published by the Canadian Paediatric Society and standards of care published by the World Professional Association for Transgender Health.
The pediatrics section of the Alberta Medical Association issued a statement late Thursday, calling on the provincial government to back off of its plan.
"Children and youth have the right to the appropriate medical care, at the appropriate time, and this should not be denied to them," the statement said.
"We urge the Premier, in the strongest terms, to reconsider the proposed changes for care of transgender youth."
The Canadian Paediatric Society also condemned the plan and called on the premier to walk it back.
"We are deeply concerned that implementation of these policies will not only undermine the fundamental rights of transgender children and youth in Alberta, but will lead to significant negative health outcomes, including increased risk of suicide and self-harm," the group said in a letter to Smith.
Facing a barrage of criticism, Smith defended her government's plan at a news conference on Thursday.
"We want to make sure that children do not prematurely make decisions that are going to be irreversible and affect their ability to have sex and affect their ability to have children, until they're of an age where they're fully responsible for those decisions. That's age 18," she said.
Dr. Joe Raiche, a psychiatrist who works in the youth gender clinic at the Alberta Children's Hospital, called the policies "shocking" and "devastating."
"This does tremendous harm. It has the potential to cause an irreparable impact on lives of trans youth and families," he said, adding no clinicians at the youth gender clinics in either Calgary or Edmonton were consulted on the policy.
Puberty blocking medication
One of Raiche's biggest concern is the ban on puberty-suppressing medication in kids under 16.
Dr. Joe Raiche is a psychiatrist working with transgender youth at the Alberta Children's Hospital in Calgary. (David Aleman/f-stop Photography)
"This would make Alberta having the most restrictive gender-affirming care across all of Canada," he said in an interview with CBC News.
"The magnitude of the harm of having somebody go through puberty that's not aligned with their gender identity … is just downright cruel," he said.
The Canadian Paediatric Society notes hormone suppression is reversible and puberty continues once the treatment is stopped.
"It gives youth and their families a chance to pause, reflect [and] explore, without their body going through devastating changes that can be irreversibly and irredeemably harmful for them," said Raiche.
According to the society, gender-affirming hormones, which the province also seeks to ban for kids under 16, are considered partially reversible. These medications are prescribed to "promote the development of physical features that are better aligned with an individual's experienced gender."
Mental health concerns
Doctors are warning the mental health implications of these changes will be significant and long-lasting.
According to the Canadian Paediatric Society, transgender youth have a higher risk of mental health concerns, including depression, anxiety, self-harm and suicide.
"Now we're asking youth to endure more mental distress, more mental anguish," said Raiche.
The AMA section of pediatrics said the move will increase the mental health needs, and burden, on the health system.
"The mental health of these children and youth will be markedly worse when denied care," the statement said.
"These new medical restrictions single them out and reinforce stigma."
Dr. Jake Donaldson, a Calgary-based family physician who treats gender diverse youth and adults, is worried about his patients
"Most studies, including here in Canada and here in Alberta, have shown that about 40 per cent of gender diverse individuals will try to kill themselves at some point if they are not in a supportive environment," he said in an interview on CBC Radio's Alberta at Noon.
"So it really can be a life-or-death situation for some of these kids."
Calling it an assault on human rights, the United Nurses of Alberta also lambasted the policy, warning it amounts to political interference.
"To use medical treatment of young people as an excuse to mount a politically motivated attack on gender-affirming health care will put the lives of young people at risk, ultimately increase the costs of providing health care, and set a dangerous precedent that should concern us all," the statement said.
"Political decisions to block one kind of medical treatment can easily lead to political decisions to block other kinds."
"I don't think there's any role for our premier to tell us what we should be doing medically," he said.
According to Donaldson, the policy puts doctors in a position where they face violating the Hippocratic oath.
"I took an oath when I went through medical training that I'm not going to do any harm to individuals," he said.
"If I sit back and do nothing … and force them to go through a transition that does not match their gender identity and live a life in a body that's going to leave them as a target of hateful violence … that just breaks my heart. I don't know if I can accept that."