Kudos to Alberta's Premier For Her New Gender Legislation — But It Doesn't Go Far Enough

Poison is poison.

Image by OpenIcons from Pixabay

I was in Edmonton yesterday to witness the introduction of the provincial government’s new legislation erecting guardrails around the provision of “gender transition” care to youth. (Two other bills were also introduced — one that looks to enhance parental rights to be notified if their kids change their names/pronouns at school and to give parents the right to “opt in” to what sort of gender and sex education (indoctrination?) their kids are given; and another designed to protect females in sports).

Bill 26, the Health Statutes Amendment Act, 2024, proposes to prohibit the prescription of puberty-blockers and cross-gender hormones for the treatment of gender dysphoria to youth aged fifteen and under; it would allow for minors aged 16 and 17 to begin puberty blockers and hormone therapies for gender “reassignment” and “affirmation” purposes only with parental, physician and psychologist approval. The Bill also prohibits health professionals from performing sex reassignment surgeries on minors (anyone under the age of 18).

Despite all the pearl-clutching by the left since Premier Danielle Smith first announced last January her plans to introduce these measures, they are entirely reasonable. And they’re wholly in line with safeguards being introduced in a number of European countries as it becomes ever more clear that the previous free-for-all “gender affirming” approach was based on scant evidence and was causing significant harm to youth.

I took part in a media roundtable yesterday prior to watching Premier Danielle Smith deliver a press conference on the new legislation; and then I joined the gallery of onlookers in the Alberta Legislature Building as the bills were officially tabled for first reading. Naheed Nenshi — elected in June as head of the opposition NDP — joined us plebs in peering down at the MLAs at work; without a seat in the legislature, Nenshi was on the outside looking in with the rest of us, even as his MLAs howled in protest as the three bills were introduced.

During the initial media roundtable, I fielded a question from a journalist questioning whether legislation prohibiting the prescription of puberty-blockers and cross-gender hormones to youth is even necessary. I’m paraphrasing, but in essence his query was, “Like, is this even happening?”

I wanted to respond with some version of: “Are you living under a rock?” But I bit my tongue and responded a tad more civilly.

Danielle Smith encountered the same skepticism in the subsequent press conference. She handled it far more ably and succinctly than I had (whatever you might think of the Premier, she’s an impressive politician):

“If it’s not happening at all, then there shouldn’t be any controversy around putting the guardrails around it.”

Boom.

It is happening of course, in Alberta and across the country, as any not living under a rock knows perfectly well. We don’t have exact numbers — transparency around these practices isn’t exactly stellar — but those of us working the pediatric front lines see kids on these drugs with regularity.

We do have a rough handle on how commonly these medications are being prescribed in Alberta. As Rahim Mohamed reported in the National Post last month, drawing on data from the province’s Pharmaceutical Information Network, in 2023 there were a total of 107 “first pharmacy dispenses” of estrogen, testosterone and the puberty blocking drug leuprolide; with 139 new prescriptions in 2022 and 124 in 2021. Some leuprolide prescriptions were undoubtedly written — appropriately — to treat the rare condition of precocious puberty; but that doesn’t come close accounting for all of them.

Asked by another reporter whether decisions on these matters shouldn’t best be left to discussions between doctors and their patients, the Premier replied dryly:

"I would say doctors aren't always right."

Which is rather an understatement, as anyone familiar with the opioid drug crisis can attest, or as anyone acquainted with the darker corners of medical history knows: the frontal lobotomy saga, the thalidomide catastrophe, and the “recovered memories of sexual abuse” scandal are just a few examples of where doctors didn’t “get it right”.

As physicians we advocate strongly for self-regulation and for the principle that medical decisions are private matters between physicians and patients. But self-regulation isn’t infallible; and when it fails it can be very much in the interests of the public —and especially of patients — for others to intervene, whether they be journalists, lawyers, or political leaders.

The pediatric trans discussion shouldn’t be a partisan issue, although it certainly has become one. Last winter, for instance, Nenshi went full hyperbole on the premier by telling her that “votes aren’t worth a few dead kids”. Not only was that grossly irresponsible (suicidal “contagion” is a real phenomenon, and planting that notion into the minds of our youth is plainly dangerous), it was also flagrantly false.

Around the time of Nenshi’s comments, for instance, Finnish psychiatrist Riittakerttu Kaltiala, one of the architects of that country’s gender program (and who has done an about-face on “gender-affirming care”), published an excellent study in which she and colleagues followed 2,000 gender dysphoric kids for twenty-four years and found zero increased risk of suicide, after controlling for confounding psychiatric comorbidities like depression, anxiety, and autism spectrum disorder.

And yet parents with gender dysphoric kids continue to be subjected to the nonsense of: ”Would you rather have a live boy or a dead girl?” It’s despicable, and it needs to stop. 

The narrative frequently spun by trans activists is that those of us who have concerns about the “gender affirming care” model, and who have raised those concerns, are somehow “transphobic” — that we’re opposed to what’s best for kids. Nothing could be further from the truth. 

What we want — what I hope we all want — is for our kids to grow up happy, healthy, and whole, and with all the life choices available to them that the rest of us have enjoyed. Medicalizing kids for life and foisting permanent infertility upon them doesn’t square with those goals, to put it mildly.

As a profession we should be fostering open debate on this, just as we do with any other issue. After all, debate, discussion, and yes, dissent, are the basis of proper scientific inquiry. And if that inquiry leads us to conclude that we got something wrong, then we should change our practice; that’s what finally happened in Britain following the Cass Review, and in other European jurisdictions like Finland, Sweden and elsewhere; that's what’s beginning to happen in multiple U.S. states, and that’s what should happen here in Canada.

I do have a major quibble with the government’s new legislation, which will allow those youth who have already begun taking puberty blockers and cross-gender hormones to continue taking them. That strikes me as analogous to banning the prescription of thalidomide after realizing it was causing birth defects but allowing pregnant women already on the drug to keep ingesting it.

If we truly believe that puberty blockers and cross-gender hormones are dangerous to kids (and by now we should believe that, given the mounting evidence), then we should ban them immediately for all kids, including those currently taking those medications poisonous to their health and well-being. To do less, in my view, makes no sense whatsoever.

Nor does it make sense, for that matter, to allow gender dysphoric youth older than 16 to access these medications — and ultimately, after 18, surgical modifications. Poison is poison, period.

One can certainly argue that those older than 18 are free to make their own decisions. But what to make of doctors who prescribe treatments and perform surgeries that are ultimately harmful to their patients? I know the recitation of the Hippocratic oath has become passé in most of our medical schools — but good grief.

All that said, I’m profoundly grateful for the action that this government has taken. The proposed legislation will do much to protect our kids from the trans ideology which has sunk its tentacles so deeply into our culture and into the profession of medicine; and it’s by far the most muscular yet introduced in Canada.

For that the Premier and her team deserve robust applause and our profound gratitude.