Read the Statement from Child and Adolescent Psychiatry of the Alberta Medical Association here.
I have been privileged to care for hundreds of transgender and gender-diverse children and youth throughout my career. Each one has their own personal story to tell. But they all have one thing in common: Hope is lifesaving.
Alberta’s proposed changes to medical, educational and sport policies, however, undermine that hope. They would interfere with medical decision-making between health-care provider, patient and parent. They would place already marginalized youth in the position of choosing between being forcibly outed or misgendered. They would limit the ability of gender-diverse children to play sports.
And this is all entirely unnecessary.
Gender-affirming care includes a broad range of options – at its core it is quite simply validation of a transgender or nonbinary person’s experience of themselves. That doesn’t always mean medical intervention. For some folks, just acknowledging their identity is valid enough. If medical affirmation can potentially be useful, it is done after thorough consultation with experienced health-care providers. The more serious the intervention, the more planning, preparation and support for decision-making.
Wait times to even begin to engage with a specialist in these discussions are lengthy – gender-affirming clinics across the country have extensive wait times; those in Alberta reach well over two years. With very rare exceptions, parents and guardians are almost always included in the decision-making. These are not flippant decisions made on the whim of a teen “going through a phase.” There are clear clinical practice guidelines from well-respected organizations, such as the Canadian Paediatric Society, the Endocrine Society and American Academy of Pediatrics.
Each option is weighed against the risk of no intervention. “Nothing” is not always benign. Puberty brings about permanent irreversible changes such a voice deepening and Adam’s apple growth for someone assigned male at birth; chest and hip development for someone assigned female at birth. To put it simply, nothing is not nothing. The onset of physical pubertal changes typically occurs between 9-13 years of age and takes between two to five years to complete. The political suggestion of waiting until age 16 for a fully reversible intervention like pubertal suppression (even with parental support) is far too late for many transgender youths to prevent irreversible changes.
In sports, proponents of the changes have made transgender women targets. But the irony of limiting access to the very intervention – puberty suppression – that would prevent any potential advantage in sport for a transgender woman is incredibly frustrating. Take a look at any basketball team – most likely there are some teens who are taller than your population average. “Biologic advantage” is not a novel concept in athletics. One of the critiques of pubertal suppression is the risk to bone health, and one of the most protective things for bone density is physical activity. It is also an incredible intrusion into the privacy of a young person. Birth certificates can be amended, so are we going to be seeking genital inspection for any tall girl who plays a sport?
Birth certificates can be amended, so are we going to be seeking genital inspection for any tall girl who plays a sport?
From a brain development perspective, it is a very normal and expected part of the teen years to want privacy from parents. This is a well-known developmental task of adolescence. We know teens are more likely to disclose important and sensitive medical information when they have the guarantee of doctor-patient confidentiality. If teens are not allowed to express themselves safely in settings such as schools, they will take it to places like anonymous public forums like Discord or other social media platforms to find their information and figure out their identity. Even with the most supportive, accepting parents, a teenager might need a little time to explore it for themselves.
The patients in my practice who thrive are typically well supported by the adults in their lives. Unfortunately, unwavering love and acceptance of young transgender persons by their parents is not always a given. While parental support is strongly associated with positive outcomes for transgender youth, the flipside is that 2SLGBTQ+ youth are overrepresented in the unhoused population. In the absence of the safety net of parents, we need other supportive adults in a young person’s life to enable them to become their true, authentic selves. We trust teachers, doctors, psychologists, social workers and other professionals with young people’s health, education and mental well-being. When it comes to topics surrounding gender and sexuality, this should be no different. The more adults we have supporting young people, the better.
Transgender youth already deal with enough from society at large. I think of my patients who have been assaulted or verbally harassed.
Transgender young women who quit sports because they didn’t want to make anyone else uncomfortable.
Youth who can’t change their clothes or shower without turning off the lights.
Those who are bullied or victimized by peers.
Turned away from a doctor’s office or asked intrusive and irrelevant questions about their gender.
Prescriptions refused to be filled.
Injections declined from being given.
Transgender men who wear hoodies even when it is 35 C out.
Young people who won’t speak out loud because of fear of being misgendered.
I’m not even in danger of breaching doctor-patient confidentiality since these stories are so common. Legislating how transgender and nonbinary youth can exist actively worsens the situation.
Government insertion into medical care is a dangerous step for all Canadians. While it may seem limited to a small minority of people in this case, it sets an unfortunate precedent. This means your health care is subject to the whims of the current political party. Medical decision-making should be left to the patient and the provider.
Leave the politicians out of the exam room.