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Can desired gender-affirming care wait until adulthood?

By Leonie O’Sullivan, March 11 2024—

Premier of Alberta, Danielle Smith, revealed her proposal for alterations to gender-affirming care on Jan. 31. Smith informally posted the announcement on social media and began her speech with a promise to safeguard transgender rights. Her promise was followed by an explanation of a contradictory plan to strip access to gender-affirming care for transgender and nonbinary (TNB) youths in Alberta. 

The proposed changes entail the prohibition of top and bottom gender surgeries for individuals aged 17 and under. From 2022 to 2023, eight top surgeries were conducted on minors in Alberta for gender affirmation, while bottom surgeries for minors are already restricted nationally. Dr. Kate Greenaway, who has been delivering comprehensive care to TNB youths for the past two decades, has questioned and labelled this change as “showmanship.”

In addition to the restriction on top surgeries, individuals aged 15 and under will not be permitted to take puberty blockers or undergo hormone therapy for gender reassignment or affirmation, unless they have already commenced treatment. Minors aged 16 and 17 will be allowed to initiate hormone therapies if they are deemed mature enough and have approval from their parents, physicians and psychologists. In Canada, puberty typically occurs between the ages of nine and 13. This change would prevent youths from reversibly delaying or stopping the biological effects of puberty. Often, this delay is necessary to give children the time to decide what is the right choice for them.

This restriction could result in severe ramifications for TNB youths in Alberta. It is already widely recognized that TNB individuals face challenges when navigating healthcare systems, leading to puberty blockers and hormone therapies being illicitly sourced. A study in 2007, which conducted interviews with 101 male-to-female transgender persons in 2007, found that 29 per cent to 63 per cent of trans-Americans were sourcing hormones from disreputable sources. 

Removing safe access to puberty blockers and hormone therapy could endanger Alberta’s youth, pushing them to seek these treatments from untrustworthy avenues. Risks related to self-administration of hormones without medical oversight include poor-quality or toxic hormones and inappropriate dosages.

Gender-affirming care, including puberty blockers and hormone therapy, is recommended by the American Academy of Pediatricians and the Endocrine Society for TNB youths and is viewed as evidence-based patient care by the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA). Before embarking on a medical gender transition, many TNB youths undergo a social gender transition, encompassing reversible changes to external presentation such as clothing, hairstyle, and a change in name or gender pronouns. 

Generally, research indicates that supporting transgender youth in living according to their internal sense of gender is associated with better mental health and feelings of safety at school. However, Smith’s proposed plan will hurt social gender transitions across Alberta for children with unsupportive parents. Minors aged 15 years and younger will not be allowed to use their preferred name or pronouns at school without parental notification and consent. At 16 and 17 years old they will not need consent, but their parents will be notified — ironic, given that Smith herself prefers to use her middle name, Danielle, instead of her first name, Marlaina.

The Premier also plans to block transgender women’s access to sports competitions. She incorrectly states that transgender athletes have a “massive competitive advantage.” The proposed plan will include new “Women’s Only Divisions” in athletic competitions. The noun woman is associated with gender, not sex, and a women’s only competition should include transgender women by definition. Also, present evidence indicates that trans women who have undergone testosterone suppression have no clear biological advantages over cis women in elite sports.

Some may argue their ethical concerns for gender-affirming care in youth, including but not limited to fertility preservation. But the risks of denying access to this care include a great risk of harm, including violence, homelessness, poverty, sexually transmitted infections, depression, anxiety and suicide. 

Numerous studies in the literature support the need for gender-affirming care. A recent study in Australia demonstrated that a quarter of trans adolescents seeking gender-affirming care had evidence of disordered eating.

Gender-affirming care improves mental health and overall well-being. A study in the US showed that among 104 TNB youths, gender-affirming care results in 60 percent lower odds of depression and 73 percent lower odds of suicidality. Another study found that puberty blockers are associated with lower odds of lifetime suicidal ideation in transgender adults. The rate of suicidal ideation in TNB youth is reported to be three times higher than in cisgender youth.

The choice for desired gender-affirming care cannot wait until adulthood. The current scientific literature does not substantiate Smith’s rash plan to revoke access to gender-affirming care for TNB youths in Alberta. The existing research strongly advocates for such care in TNB youths. Smith’s commitment to safeguarding transgender rights is falsehearted and untrustworthy.

This article is a part of our Opinions section and does not necessarily reflect the views of the Gauntlet editorial board.

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