EDITOR’S NOTE: A previous version of this story included quotes from Hannah Barnes that were out of date as of NHS England’s March 12 policy decision and did not note that Global News spoke with Barnes prior to that announcement. It also incorrectly quoted Barnes as saying that previous research on puberty blockers for transgender youth in the U.K. yielded ‘exceptionally high’ results. In actuality, Barnes had indicated that an ‘exceptionally high’ number of U.K. patients who were prescribed puberty blockers went on to cross sex hormone therapy. We regret the error.
Alberta Premier Danielle Smith is doubling down on her government’s proposal to ban puberty blockers for youth aged 15 and under, referencing a recent decision made by England’s National Health Service.
In a policy document published on Tuesday, the NHS said it has 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.”
This comes after the NHS announced last June that it would be limiting the use of puberty blockers to youth enrolled in clinical research trials. Youth who are already on puberty blockers will be able to continue treatment, the NHS said.
At an unrelated news conference on Wednesday morning, Smith said that there is “increasing international evidence” indicating that there is no consensus amongst the medical community about puberty blockers.
Smith referenced the NHS’ policy paper in her response to a reporter’s question about her parental rights policy, saying Alberta is looking at the “broader international picture” and the “evolving evidence.”
“The U.K. and many of the Nordic countries are taking a different approach. We want to be cautious. We want to make sure that children are making decisions when they’re old enough to understand the consequences because we’re talking about sterility,” she told reporters Wednesday.
“Let’s be frank about it. If you stop the process of puberty and then you do cross-sex hormones and don’t develop, become sexually mature, you can’t have children. So we have to decide at what age a child should make that decision. From the feedback that we’ve gotten from those who are in the field, from looking at the international evidence, we just don’t feel comfortable that would be the age 15 and under.
“We have agreed that we believe that children who have good medical care, psychological support and support family can start that when they’re 16. I think that increasingly is going to be supported by the international evidence.”
This isn’t the first time Smith referenced the U.K. or Scandinavian countries while talking about her government’s new policy on gender-affirming care. Previously, Smith said on an episode of Your Province, Your Premier that the medical community is “divided” on providing puberty blockers to youth.
However, medical associations across Canada are concerned about any government proposal that would restrict access to evidence-based medical care, including for trans people.
The Canadian Medical Association published a letter on Wednesday saying Canadians have the right to make personal choices about their health with the support of their families, physicians and other regulated health professionals.
Thirteen medical associations signed the letter – 10 provincial associations, the Canadian Medical Association and two territorial associations.
“There is no one-size-fits-all approach for patients experiencing gender dysphoria. Restricting choices and appropriate care for patients can lead to permanent harm,” the CMA’s news release said. “We urge all levels of government to consult with physician experts in their field when considering any major changes in policy related to health care impacting the 2SLGBTQ+ community.”
Kristopher Wells, MacEwan University associate professor and Canada research chair for the Public Understanding of Sexual and Gender Minority Youth, said puberty blockers have been used to safely treat heterosexual youth for over 30 years and banning them for use with transgender youth is discrimination.
Dr. Tehseen Ladha, pediatrician and assistant professor at the University of Alberta, previously told Global News there is no connection between puberty and gender transition.
The Alberta Medical Association’s pediatrics section also says the effects of puberty blockers are not irreversible. Puberty goes forward after treatment is stopped, the AMA said.
“Health-care decisions should be left up to medical professionals, not politicians,” Wells said in a statement to Global News on Wednesday.
“Make no mistake, these decisions are about bodily autonomy and who has the right to decide what decisions are appropriate … Everyone should be very concerned when governments start dictating personal health-care decisions.”
Smith’s representation of U.K. discussions around puberty blockers ‘accurate’: author
Hannah Barnes, associate editor of British political and cultural magazine New Statesman and author of the book Time to Think, said Smith’s representation of the medical discussions, and the lack of agreement, is accurate.
“I think it’s only really in the U.S. and Canada where there’s total agreement,” Barnes said. “I just don’t see it in any European country (where) that argument is made, that there is consensus across the medical community.”
Barnes spoke with Global News before the NHS England policy decision was released this week.
She also said the conversations around gender-affirming care in the U.K. are a lot more nuanced than what Smith is saying.
There is currently only one clinic providing gender-affirming care to trans and non-binary youth in the U.K., called the Tavistock Clinic. Barnes said thousands of youth are referred to the clinic each year, and puberty blockers are now available at much younger ages. Staff at the clinic said many of the youth referred to the clinic are often living “very complicated lives” and there wasn’t enough time to explore every aspect of the youth’s lives before deciding on gender-affirming care.
Concerns began to arise as to whether puberty blockers are the right medical pathway for everyone.
Barnes added the National Institute for Care and Health Excellence reviewed the research behind puberty blockers and found the certainty of any evidence for benefits and harms is very low.
“We can’t just keep rolling out of treatment for which the evidence base is not strong,” the editor said.
“Across Europe, there is a move towards greater caution when it comes to the care we provide for gender-questioning or gender-distressed children and young people … And they’ve all come to the same conclusion that the evidence base is weak and it doesn’t matter where children live or where they’re born. The evidence base is the evidence base. And that is the same for children that live in Canada as it is for children who live in Europe.”