Opinion

Prescribing compassion: Standing up against transphobic policies in Alberta  

The sacred oath to “do no harm” underscores the responsibility of health-care professionals to protect the well-being of all patients. In light of the policies proposed by Alberta Premier Danielle Smith targeting trans (two-spirit, transgender, non-binary, gender non-conforming) youth, we, as medical students, feel an overwhelming duty to challenge the misguided ideology underlying these policies.

Gender-affirming care encompasses a continuum of social, psychological and medical interventions that support trans people in expressing their gender identity, and is endorsed by the Canadian Pediatric Society and Canadian Psychological Association. This continuum of care is often misconstrued as a rigid “pathway” that all trans people progress, beginning with a social transition (e.g., using gender identity-congruent pronouns, etc.) and progressing to medical and surgical interventions, as suggested by Smith. In reality, trans people choose to transition in a variety of ways that meet their needs, and every individual’s path is unique.

Smith would mandate that parents be notified before a school could change their child’s (under 17) name or pronouns at school. This follows a troubling trend of legislative transphobia in Canada, including Saskatchewan’s Parents’ Bill of Rights and New Brunswick’s move to allow teachers to ignore preferred names/pronouns of students under 16. These measures are unconscionable in light of recent evidence showing that trans youth who are “outed” to their families experience more depressive symptoms and less family support.

It is well documented that trans youth already face disparities in their health and well-being, often related to the stress of marginalization, including anti-trans social norms, social stigma and transphobic policies. Trans youth experience higher rates of substance use and social isolation; are more likely to be unhoused; and have poorer access to psychological support. These factors contribute to the higher rates of suicidality among trans youth, with nearly half of transmasculine and non-binary youth having experienced a suicide attempt (versus the general youth rate of 14 per cent).

Smith’s policy to restrict access to puberty-blockers to those under 16 directly contradicts medical best practices. While Smith’s stated intention is to prevent youth from “feeling rushed into surgery,” puberty-blockers provide trans youth with valuable time to explore their gender identity before the irreversible changes of puberty. Given that guidelines recommend starting puberty-blockers when one exhibits the first signs of puberty, delaying access until age 16 will be too late for most youth. Puberty-blockers are, in fact, reversible, and potentially could negate the need for some gender-affirming surgeries. Medical professionals approach the prescription of these medications with great care, and are recommended to delay hormonal suppression until youth exhibit the first signs of puberty. This is recognized as a critical juncture in gender identity development.

Puberty-blockers provide trans youth with valuable time to explore their gender identity before the irreversible changes of puberty.

Canadian gender-affirming care providers follow the World Professional Association for Transgender Health (WPATH) standards, which refrain from prescribing age criteria for medical intervention, deferring instead to the discretion of the clinician. The WPATH standards recognize the irreversible and enduring nature of hormonal therapy and gender-affirming surgeries and emphasize the importance of careful discussion and consideration between physicians and patients.

By her own admission, Smith’s policies are not evidence-based but rather a “concern of what will happen.” Furthermore, some of her policies regarding gender-affirming surgeries and hormone therapy are futile, displaying her lack of understanding. Across Canada, bottom surgeries are not performed on minors, and of the few minors that seek top surgery in Alberta, the vast majority do so for medical reasons unrelated to gender affirmation.

Smith omits mention of the well-established benefits associated with gender-affirming care for youth, including improved school functioning, increased social inclusion, and decreased body dysmorphia, anxiety, depression and suicidality.

We are taught to “do no harm” – yet, Smith’s policies, rooted in anecdotes and a disregard for medical evidence, will force health-care providers to be complicit in perpetuating barriers to gender-affirming care. Anti-trans social norms, transphobic policies and social stigma harm trans youth and need to be dismantled.

As medical students, we are instilled with the importance of delivering inclusive and equitable health care. This prioritizes creating safe spaces where people from all backgrounds can confidently access evidence-based and patient-centered care. Policy must involve in-depth consultation with health-care professionals and people with a diversity of lived experience – all of which Smith has failed to deliver. If these uninformed policies are implemented, there is no doubt that trans youth will suffer dire physical and emotional health consequences. These are decisions that cannot and should not be made under the constraints of governmental intrusion.

Countless voices have come out against Smith’s proposed policies, including Dr. Sam Wong (Alberta Medical Association’s head of Pediatrics), Rachel Notley (Leader of Alberta’s NDP), the Social Workers Association of Alberta and the Canadian Pediatric Society.

As medical students, we add to the chorus of voices calling for the Alberta government to reconsider its policies. If the goal is really to “support with kindness and inclusion,” Smith must rescind her attack on trans youth.

The comments section is closed.

48 Comments
  • Michelle Zacchigna says:

    I am a Canadian woman who was treated with “gender-affirming care” and have been irreversibly harmed as a result. (Google my name for details on my personal story.)

    After I stopped identifying as transgender, I did a deep dive into the evidence behind this treatment. What I found was shocking. Every systematic review of the evidence comes to the same conclusion: the health risks do not appear to outweigh the benefits, especially not when it comes to people under the age of 18.

    The existing studies are highly biased (often conducted by people who profit from gender-affirming care or are otherwise invested in its success, i.e., people who accessed it themselves). Most of the studies have low sample sizes, no control groups, and its “success” relies on self-reports. I know from experience that the personal, financial, and social investments that go into “transitioning” mean that people are very motivated to report positively on gender-affirming care, even when their lives are falling apart. Self-reports are not reliable.

    Gender-affirming care rests on the premise that a person is “innately” the opposite sex, while there remains absolutely no scientific evidence that someone can be born in the wrong body. There is no way to empirically test whether someone is transgender or not. Quite frankly, the concept qualifies as pseudoscience. We have no way of knowing the truth of their “identity.” This is an incredibly big risk that doctors are choosing to take… again, especially when it comes to children.

    This is not an evidence-based intervention.

    This short article is full of inaccuracies and falsehoods. Puberty blockers are not a pause button. In the past, most children with dysphoria grew out of it during puberty. By blocking a child’s natural development, you prevent the very thing that could help them come to terms with their bodies. (e.g., Sometimes the child grows up to be gay, and if their puberty is being blocked, they are prevented from coming to this realization.)

    The effects of GnRH agonists are also not reversible. Even when prescribed for precocious puberty or used as endometriosis treatment, there are lasting side effects, including loss of bone density and infertility. One woman reported being sent into menopause overnight after a single injection. There have been multiple lawsuits launched.

    WPATH is not, despite their claims, scientific or evidence-based. Their membership is made up of activists who can simply pay a fee to be involved; they don’t have to have medical experience. The WPATH guidelines do not qualify as true “standards of care.” (e.g., They do not qualify for an ECRI Guidelines Trust scorecard because they did not base their guidelines on a systematic review.) Recent leaks from within WPATH prove that many of their members have no idea what they are doing and admit that they are not receiving informed consent from their patients.

    Other countries have started to wake up to these facts. I continue to be horrified by the Canadian medical industry turning a blind eye to them, particularly as someone who has directly suffered as a result of their failures.

    “Do no harm,” indeed.

  • Anonymous Woman says:

    Dr. Kaltiala who just won Finland’s most prestigious medical award for her work in adolescent psychiatry disagrees.
    In her acceptance speech, Dr. Kaltiala discussed how current cultural trends undermine healthy adolescent development. “The slow development towards the authentic self turns into a lightning-fast self-presentation on social-media forums that are always under observation.”

    Dr. Kaltiala observed that “a stable, developed identity enables an individual to have a permanent self-experience from one situation and life stage to another, as well as to maintain a sense of permanence and psychological ability to function even in the face of adversity.” She noted that “too much focus on the individual and individuality disconnects from stabilizing communities and shared realities.”
    Dr. Kaltiala pointed out that general identity development and gender identity development challenges are intertwined and that a rush to permanent medicalization is not consistent with the principles of adolescent identity development
    https://youtu.be/vCRLcFHivmo?si=aRwgYtHQ1_9THFIR

  • Rhonda gallant says:

    Therapy first in every situation.
    Put back all the gatekeepers!! If children, youth and adults were fully and properly assessed before any medical intervention, good chance we wouldn’t be seeing all of these detransitioners now suffering and struggling with deep regret, and irreversible damages.
    This rush to affirm and medicalization must stop! Especially in under 25-29 before brain is fully developed.
    Informed consent is only really legal if it is fully understood.

  • Cathy says:

    Why do you think permanent and irreversible medical interventions on healthy bodies are ‘kind’? Why are unhappy people not helped to accept their bodies without the need for lifelong treatments that do more harm than good?

  • Roy Eappen says:

    You seem completely unaware of the multiple systematic reviews on the subject all of them show poor evidence. The latest country to do a systematic review is Germany. Do no harm.

  • Jea says:

    Please read the WPATH Files here: https://environmentalprogress.org/big-news/wpath-files Watch and read the private conversations of those at the core of gender medicine.

  • Jeanette Dietrich says:

    As medical students you should probably actually read the evidence and do a critical appraisal before writing an article. There are several systematic reviews that show the evidence for GAC for minors is very weak. Numerous European medical agencies are putting the brakes on GAC by saying it has to be done in the context of research, or focusing on psychological treatments first or limiting by age. Canadian physicians should follow their lead and put some appropriate guardrails up.

  • Tracey Berube says:

    Children who experience harmful trans ideation reflect the same rate of suicidality as other children with mental illnesses.

    We know from European and UK reviews that most children with harmful trans ideation will grow up to be gay adults.

    There’s ample evidence amongst this cohort of serious comorbidities, such as autism, trauma and Cluster B disorders, that are being ignored in the “compassionate” rush to affirm this harmful ideation.

    Every medical system that has conducted a systemic review of the evidence upon which affirmative care is based, has stopped pediatric transition outside of clinical studies.

    Canada is negligent in not conducting a systemic review of the evidence.

  • Malcolm Berry says:

    1 WPATH has been discredited in Finland, Sweden, Holland, France and the U.K.
    2 How can children, some of whom have never had a biology lesson give informed consent? They have no understanding that PB’s lead to cross sex hormones and surgery and possibly not able to have a family.
    3 Transphobia is a condition that requires psychological intervention.
    4 I am not anti trans, but like any mental condition requires professional examination.
    5 Why should females ( not self ID males) have to share their facilities with men? Why should male genitalia be displayed? Many females have been abused or stalked by men. Yet transwomen expect to be welcomed?
    6 Men are physically larger than females, so the pose a physical danger when playing against females in all sports.
    7 What gives a TF the right to serve time in a female jail?
    8 Transgendered people can live their lifestyle, but do not do so at the expense of women. Along with your expectation of rights comes responsibilities – do not assume that men are welcome in female spaces.

  • Douglas Campbell says:

    “We are taught to “do no harm” – yet, Smith’s policies, rooted in anecdotes and a disregard for medical evidence …”

    This is nonsense. It is pretty clear you haven’t kept up with any of the developments in Sweden, Finland, Norway, France and most recently the U.K., where the use of puberty blockers has been suspended. As they state:

    “We have concluded that there is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make the treatment routinely available at this time.”

    You should also read “Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children” by Hannah Barnes, about the lack of rigour and safeguarding in the practice of gender medicine.

    If you had any concern about the health and well-being of children and adolescents you’d give a good hearing to contrary points of view, because you just might be wrong. Instead, you seem to care more about having fashionable opinions and being invited to the right parties.

    • Malcolm Berry says:

      Well stated. Once the conditions that led to the use of PB’s et al on children were examined, the closure of Tavistock and restrictions placed on their use were imposed. WPATH have not followed medical double blind experiments and their guidelines are a green light for clinicians to hack away, provided there is a credit card with spending capacity and a signed indemnity form.

  • John Sherber says:

    Thank you for all the comments. Most of which let the article authors know that this trend is not a good thing. For instance: Please read the story of John Money. One of the researchers promoted this to two young Canadian twins. His research was debunked numerous times but the ball had started rolling. If a child knows they would like to be a different sex maybe we should let them smoke, and drink: all the things that adults hold. Children cannot understand the ramifications of this experimental piece of health care. Thank you Danielle Smith in Alberta. In BC we are a wash with a lack of evidence-based care.

  • shannon Boschy says:

    It would help if these student activists began their examination of this issue with an open mind instead of forgone conclusions.

    The foundational research on puberty-blockers (Dutch Protocols) are easily accessible. 73 participants, All boys with GD screened for MH issues, carefully selected. almost 1/4 loss to follow-up. 1 death.

    Any basic training on research ethics would lead to the conclusions that this study was insufficient to justify the zero gatekeeping for self-ID’d GD kids in the medical environment of today.

    No long-term studies on outcomes. Massive spikes in girls presenting for transition, & the medical system using suspect studies on boys to justify transition, AND doing it today without proper medical & psychological assessments as a human rights issue, NOT a medical issue.

    I’m deeply discouraged if this article reflects the mental capacity and ethical standards of med students today.

    • Malcolm Berry says:

      Very recently, the Dutch have banned PB’s being given the children . It says something when the country whose ‘research’ led to the transgender ideology, has realised their mistake.

  • Krissy says:

    The first question that should be asked of someone visiting the clinic is…. “have you ever been abused”?

    The numbers are staggering. Victims of abuse as children now becoming victims of deranged activists and money hungry doctors.

    Shame on all involved.

  • Pp says:

    This isn’t medicine, it’s mental illness.

  • Karen G says:

    Gender affirming care misses out basic ethical principles. The ‘depathologizing’ of gender dysphoria/trans identity means that diagnostic principles are no longer fully employed. This eliminates differential diagnosis and the possibility of the physician investigation whether there are deeper factors and co-morbidities underlying this condition. A recent article analyses the ethical problems in detail: https://t.co/5w1BgacaLE

  • J Waldman says:

    Please familiarize yourself with how western societies became infected with this Lysenkoist ideology. You’re practicing Lysenkoism, not medicine.

    https://www.spectator.co.uk/article/the-document-that-reveals-the-remarkable-tactics-of-trans-lobbyists/

  • @justdad7 says:

    You cite article by Tordoff et al. in support of your claim that gender affirming care leads to improvements in depression and suicidality. Take a look at this analysis of the study which shows that it does nothing of the sort.
    https://jessesingal.substack.com/p/researchers-found-puberty-blockers

  • Caroline Morgan says:

    Just the fact that studies in mammals show that puberty blockers impairs brain development should make you pause.
    Just the fact that one study, albeit small, on children treated with Lupron for precocious puberty showed IQ drop should make you wonder.
    Just the fact that the Amsterdam team that first transitioned kids knew the risk and were supposed to study the effect of puberty blockers on the brain, but didn’t because funds were lacking (as reported by Zembla on Dutch public TV) should restrain you from prescribing them for gender dysphoria.
    If you don’t record those facts, I don’t trust your capacity to become competent physicians.
    https://pubmed.ncbi.nlm.nih.gov/38334046/

  • Julie Power says:

    What is your opinion on the systematic reviews of evidence carried out by the UK, Sweden, Finland, and Germany that all fou d the evidence base for youth gender medicine to be of very poor quality? Were they all motivated by transphobia?

  • Leslie MacMillan says:

    When I was in med school it took all my time just learning endocrinology (as a small component of the million other things I had to learn in order just to be safe, not even expert), not telling doctors how to practise it or telling politicians how to legislate about it. These kids must be exceedingly brilliant to be so sure of themselves and their “overwhelming” duty.

    The profession of medicine has to earn its privilege of self-regulation, which means having a visible, credible commitment to enforcing professional standards based on ever-accumulating scientific evidence, not a quasi-religious ideology. When the doctors fail to regulate themselves in the public interest and get caught up in a censorious groupthink that may harm patients or the public, the government has every right and responsibility to step in and impose regulation on them. This is what Alberta and a couple of dozen U.S. states have wisely decided to do. Bravo to them.

    We repudiate the claims made by these misguided virtue-signaling UBC medical students at a very early stage in their medical education and training. I hope they come to understand just how much they don’t know about medicine before they enter internships and residencies. They are altogether too sure of themselves now.

  • Michael Hoffmann says:

    Terrifying that our medical schools are producing such ideologically captured doctors to be like yourselves. Your judgement is clearly flawed. I sincerely suggest you become familiar with the harm you are advocating for. Start with the WPATH files. Really it should be self evident that blocking puberty and surgery are horrific solutions to a psychological problem. The people harmed by these procedures are angry. The lawsuits are coming. The loss of medical license and prison is a definite possibility. Please, for your own benefit, your future patients and society as a whole reconsider your position. You are not as righteous as you think you are.

  • Sherlock says:

    Leave underage kids out of this trans-nonsense. Nobody ever had a successful sex change and nobody is owed validation for their made-up gender identities, least of all impressionable kids.

  • Par says:

    Do no harm? Wonder how all the ‘allies’ will square when next gen writes of the destruction caused to vunerable by these ‘affirming’ practices

  • Dmitri says:

    As important as it is to not lose trans kids to suicide, drugs or trafficking, it’s equally important to not transition kids who are confused, caught up in a fad, or looking for an off-the-shelf identity to fix their mental state.

    We should be extremely hesitant to make permanent life altering changes in children because they say they want it. This is clearly a social contagion.

  • Kathryn Holding says:

    Put simply, you are lying to today’s youth.
    Mammals cannot change sex.
    Puberty blockers are not reversible, they are an unlicensed under researched medication.
    Puberty is a vital process for the full maturation of the human body.
    Shame on you

  • Nancy Fraser says:

    This crop of medical students are spouting dangerous ideological nonsense, disguised as ‘compassion’, thereby endangering children. Take a look at the newly released, whistle blown WPATH Files. ‘Gender’ affirming care is a made-up, un-evidenced nonsense — a monumental medical scandal is closing in on us. Billions of dollars in court case settlements coming up. Doctors’ licenses will be revoked. Wake up Canada.

  • @justdad7 says:

    https://www.bmj.com/content/380/bmj.p382
    The claims in the article that gender affirming care is beneficial to children and youth is supported only low or very low quality evidence. The authors ignore the decisions in countries such as Finland, Sweden, England, Norway and Denmark to curtail the use of hormone therapy for children and youth with gender dysphoria on the basis of systematic reviews of evidence. The article relies very heavily on the WPATH standards of care which are not evidence based. The authors should consider the implications of the WPATH files which call into question WPATH’s reliability as a scientific and clinical organization.
    https://environmentalprogress.org/big-news/wpath-files

  • Concerned Parent says:

    One of your references states that puberty blockers are reversible, then in the very next sentence lists the adverse effects of using them. Did you know that males on puberty blockers who go off it years later will never have more than a micro-penises? I’m not sure you have read all the medical references before putting this together. Your opinion piece which seeks to challenge an ideology is ideological in itself. You are still students. You need to take the next few years to read follow the science on this and become independent thinkers and medical professionals who really seek to do no harm. This is a complex issue. You are not doctors (yet) and you are not parents (yet). There is still time for you to learn. Your generation needs clear thinkers, not ideological sheep.

  • Eve says:

    https://mentalhealth.bmj.com/content/27/1/e300940

    This is a study conducted in Finland. Parents of children affected with trans ideology would find reading this helpful. Thus study will hopefully squash the fear mongering generalization about suicide. Responsible med students might want to widen their perspective.

    • Dave says:

      R. Kaltiala discloses her competing interests, which is ethical to do, but includes the Society for Evidence-Based Gender Medicine. Please take a look at their initiatives with an “open mind”. As others have noted, poor science involves determining what outcome you want before initiating the study.

  • Eve says:

    How about considering studies from other countries where there is longitudinal research and is superior to Canada? Sounds narrow minded .

  • Angie Maniam says:

    Have any of you read the WPATH Files?

    https://environmentalprogress.org/big-news/wpath-files

    • Kyle Reese says:

      This article reads like science fiction, filled with false claims. These unevidenced claims harm vulnerable people who maybe struggling with normal issues, but are vulnerable to the harmful claims in this article. Most kids grow out of their wish to ID as another gender with puberty, if they dont take gender meds. Every study ever done on earth shows this. No studys show anything different. But even if kids dont grow out of gender dysphoria, theres no evidence gender meds help. Every gov systematic review ever done on earth found gender meds dont help anything. They dont help gender dysphoria, mental health, social function or anything else. Every stat and claim suggesting gender meds help is a lie. Check the methods section of these studys. You will find all of them are based on meaningless online polls, low quality studys that measure 9 months of placebo after which ppl do terrible and 2nd hand nurse notes describing plastic surgery wounds. Every gov review that look at these “studys” have found theyre garbage. Yet your article acepts them as fact. Youre being lied to. Gender ideology is a religous mens rights movement that harms vulnerable groups to benefit men who claim to by marginalized but arent. 98% of kids who take puberty blockers for gender dysphoria go onto hormones that cause permenent loss of sexual function and tons of other life long severe health problems. Amasterdam says those on gender meds die early 2x more than ave and commit suicide 20x ave. But if kids dont start these meds, 85% grow out of their issues, as most people with normal similar issues do.

Authors

Sanya Grover

Contributor

Sanya Grover is a third-year medical student at the University of British Columbia’s Vancouver-Fraser Medical Program and is passionate about addressing health-care gaps for children and youth through political advocacy and community engagement.

Vivek Gill

Contributor

Vivek Gill is a second-year medical student at the University of British Columbia’s Vancouver-Fraser Medical Program and a youth advocate on CIHR-IHDCYH’s Youth Advisory Council, with interests in child and adolescent health, health equity and social medicine.

Lindy Moxham

Contributor

Lindy Moxham is a third-year medical student at the University of British Columbia’s Vancouver-Fraser Medical Program and an aspiring future pediatrician.

Kira Stoochnoff

Contributor

Kira Stoochnoff is a third-year medical student at the University of British Columbia’s Vancouver-Fraser Medical Program, born and raised in the West Kootenays.

Kiera Lee-Pii

Contributor

Kiera Lee-Pii is a third-year medical student at the University of British Columbia’s Southern Medical Program with interests in child and adolescent health, health advocacy and education.

Sophia Sidi

Contributor

Sophia Sidi is a first-year medical student at the University of British Columbia’s Vancouver Fraser Medical Program and previously completed her Master of Public Health at UBC.

Elaine Hu

Contributor

Elaine Hu is a second-year medical student at the University of British Columbia’s Vancouver- Fraser Medical Program based on stolen Coast Salish lands, and is passionate about Indigenous health, equity and wellness, and addressing the health and social disparities for people who use drugs.

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