Alberta Gender Policies Cause a Stir

On Jan 31st 2024, Alberta’s United Conservative Party (UCP) Premier Danielle Smith posted a 7 minute long video on X announcing changes to gender policies in healthcare, school, and sports. This was followed up later in the week with a 33 minute press conference with a largely hostile press.

The policy changes

Set to soft music and lighting, Premier Smith’s X video started with reassurances to trans and gender diverse Albertans that she cares and supports them. She then went on to announce an array of changes for the upcoming school year, including that minors under the age of 16 would no longer be able to change their name or pronouns without parental consent. Minors above the age of 16 could change names/pronouns without parental consent but parents would need to be notified.

Smith then announced that puberty blockers and cross sex hormones will not be permitted for youth 15 and younger, essentially banning the use of puberty blockers. Cross sex hormones would be allowed for 16 and 17 year olds, with parental consent. Surgeries (top and bottom) would no longer be permitted for any minors.

In a surprise move that was not given much attention in the media, Smith also announced that her government was seeking to recruit a specialist in trans surgeries to provide care in-province to transgender adults rather than trans people having to journey to Quebec, as they currently still do.

Smith went on to announce changes to sex education in schools, requiring parents to opt-in to sex education lessons, and requiring government approval for lesson plans.

Regarding sports, Premier Smith indicated that transwomen would no longer be permitted to participate in women’s sports categories but that the government would work with sporting authorities to create co-ed sports opportunities so that everyone could participate.

Photo by Igor Kyryliuk & Tetiana Kravchenko on Unsplash

The uproar

Unsurprisingly to anyone who is involved in trans discourse, the furor that erupted as a result of Smith’s announcement was swift and loud. Federal Employment Minister Randy Boissonault, an openly gay Liberal, protested that “this is our NATO moment. An attack on one of our communities is an attack on us all”.

Those who opposed the policies accused Premier Smith of opportunism, and of using this issue to distract the public from other more pressing concerns in the province. Premier Smith was accused of not engaging in public consultation prior to the announcement, and her detractors claimed she was ignoring the recommendations of medical experts and organizations such as the Alberta Medical Association (AMA) who came out with a statement against her policy. The most ardent accusations were that Premier Smith’s policies would lead to increased self-harm and suicide rates among transgender youth.

In a popular political podcast, Dr Joe Raiche, a psychiatrist in Calgary who works almost exclusively with gender diverse minors, argued that Premier Smith was developing a policy solution for a “problem that does not exist”. I find this claim particularly interesting, considering the uproar that followed Premier Smith’s announcement. Surely, if surgeries for minors are not actually occurring in Alberta, then banning them should not be a big deal? And what to make of another piece of research, that found that 62% of minors were receiving puberty blocker prescriptions at their first visit with a physician at a Canadian gender clinic?

The context

In Canada, many who support Gender Affirming Care (GAC) as currently practiced point to organizations like the World Professional Association of Transgender Health (WPATH) to argue that scientific consensus backs up GAC as best practice for trans and gender-distressed individuals.

And that is the rub. If I had not myself had to navigate the gender medicalization system and if I was simply looking in from the outside, I would have also said that this is a perfectly reasonable stance to take: Listen to the experts. Listen to the healthcare organizations tasked with protecting the best interests of the public. Listen to doctors like Dr Joe Raiche, a seemingly well-spoken clinician who clearly cares about his patients.

But what do we do when respected clinicians like Dr Raiche make indefensible claims such as that “puberty blockers are 100% reversible”, or when esteemed organizations like the American Academy of Pediatrics (AAP) actively seek to suppress research looking into the evidence for pediatric medicalization.

Neither WPATH nor the AMA nor the APA have made any effort to acknowledge the experiences of a growing cohort of detransitioners, desisters, and disenchanted trans people. WPATH, in its most recent Standards of Care 8, barely mentions regret or detransition at all, and as of yet offers no medical guidelines for how to support someone who comes to realize that transitioning was not the right path for them. This, despite their decision to include an entire chapter on the healthcare needs of an even smaller cohort than detransitioners, eunuchs.

For years now, clinicians in the US and Canada have witnessed GAC spread virtually unchallenged as a best practice for gender distress. Many have held onto the hope that medical and healthcare institutions would eventually acknowledge the harms and change course. But that hasn’t happened yet. At least, not in Canada. We have seen other countries in Europe change course, after reviewing the evidence via systematic reviews.

The harms

In the meantime I have heard directly from people about their experiences of regret, I have met detransitioners, I have spoken with clinicians who had worked with them, and, most difficult of all, I have had to face my own feelings of betrayal at the professionals who persuaded me that medicalization was the only path forward for me.

When Premier Smith made her policy announcement — the most comprehensive of any province in Canada, though others have moved in a similar directions (e.g. Saskatchewan and New Brunswick) — I felt a sense of relief. I am a life-long liberal (in the classical sense) and have no great love for the conservative party Premier Smith represents. But this is not a left-right issue. This is a healthcare issue. And when the healthcare institutions themselves refuse to review best practices that are not based on evidence, what other choice is there than to turn to government for leadership and direction?

In speaking with friends and loved ones about my feelings about this issue, many have expressed fears that Premier Smith is simply using this issue — an issue that impacts a relatively small minority of people — to distract voters from other, more serious problems the province faces. Others have claimed that her pronouncements are a step closer toward restricting abortion rights. After all, if the government can interfere with the healthcare that a gender-distressed minor receives, what’s to prevent the government from dictating laws around abortion care too?

The view ahead

I am no politician and time will have to tell if the cynics are right. Politics aside, however, our medical institutions have failed a cohort of people who deserve a voice. Detransitioners, desisters, disenchanted trans people, and their loved ones, whistleblowers and concerned clinicians, have all had to endure the vitriol of illiberal activists who bully anyone who might offer a different narrative to their own.

With Premier Smith’s announcement, and more recent articles in the mainstream media emerging about the very real harms of current GAC practices, the hopeful part of me is starting to think maybe, just maybe, the bullies’ time is coming to an end.