Alberta transgender policies: Edmonton pediatrician breaks down current gender dysphoria practices

Some pediatricians in Alberta are speaking out against the province’s new proposals regarding the health care of transgender youth.

The Alberta Medical Association is urging Premier Danielle Smith to reconsider legislation limiting puberty blockers and hormone therapies.

The medical professionals say that the decision belongs to the patient, their medical team and – when dealing with a minor – their parents.

“This is a huge intrusion into someone’s privacy, into someone’s medical care. It’s putting government in your chart, in your space,” said Dr. Simone Lebeuf, an adolescent medicine pediatrician in Edmonton who specializes in treating transgender and gender-diverse youth.

Smith announced earlier this week her plans to change rules for transgender children in Alberta.

She said the fall sitting of the legislature would bring a ban on gender reassignment surgery for those 17 and under. There would be no puberty blockers or hormone therapies for the purposes of such surgery for anyone 15 and under unless they’ve already begun such procedures.

Parental consent would be required for students 15 and under who want to change their names or pronouns at school. Students 16 and 17 would not need consent, but their parents would have to be notified.

And the province would clamp down on transgender female athletes competing in women’s and girls’ sports.

“We’re all surprised, not just from the gender-affirming care perspective, but physicians who want to practise evidence-based medicine and don’t want non-experts guiding those decisions,” Lebeuf said.

Smith said the changes are to protect children from the consequences of choices they may later regret and to preserve the role of parents in their lives.

The proposed legislation is causing a whirlwind of debate. Lost in the storm are the current practices for pediatricians treating gender dysphoria.

“When we talk about medical care for trans youth, there’s three kinds of levels I would say of interventions that are available,” Lebeuf told CityNews. “The more serious the intervention, the more planning, the more preparation, the more thought process goes into that decision.”

Lebeuf says the biggest impact of the proposed changes comes with limiting puberty blockers.

Right now, they can be prescribed around the first signs of puberty – typically 10-12 years old – and parents or legal guardians have to be involved and understand the side effects.

Lebeuf is pushing back on the premier’s claim this is irreversible, saying the medical community sees it as a reversible choice.

“By not allowing for puberty blockers until age 16, puberty would be over for the vast majority of kids,” she said. “It’s done. The window has passed. And we really look at puberty blockers as an option for kids to have some space and time to make decisions about their future selves and who they might want to be as adults. Their puberty is not benign, it is not a nothing process to go through. The physical changes with puberty are permanent.

“So for example, for a young trans person who is assigned male at birth and maybe identifies as female, the voice change that happens is permanent. Any Adam’s apple growth that would happen would be permanent. Any major hair development would be permanent.

“So there are permanent changes that happen with puberty. And so when we’re weighing these decisions, we’re really looking at, yes, there are potential side effects to something like a puberty blocker. But there are also side effects to puberty.”

WATCH: Premier Smith defends against criticism of Alberta’s new gender identity policies

Lebeuf explains that in the mid to late teens, discussion around hormone therapies can begin, as these have more permanent impacts.

“Typically, the first step we’re looking at is a youth who’s consistent with their identity over many years. These are not flippant decisions; ‘someone came out last week, and they’re being placed on hormones.’ This is years of consistency.

“They also have to have relatively stable mental health, relatively stable physical health. And we have lots of conversations about fertility preservation options. Unfortunately, fertility preservation or egg banking or sperm banking is not covered in Alberta. And so this is a big financial decision for a lot of families.”

The Edmonton pediatrician says unless a teenager has a legal reason, parents and guardians are involved.

On the topic of banning gender reassignment surgery for those 17 and under, Dr. Lebeuf says “That’s not happening” in Alberta anyway.

“For something like an affirming chest surgery or top surgery, that could occur after the age of 18, with a diagnosis of gender dysphoria from a psychiatrist or expert in the care of gender diverse youth. And then that youth has to be 18, and they have to find a surgeon. Right now, that process, most of the wait times would be two to three years after that decision to refer for surgery.”

As her patients’ health care becomes a political discussion, Lebeuf is asking trans youth in the province not to lose hope.

“We’re still working together, use your voice,” she said. “I really want to centre your voice in all this. The stories of all my patients I’ve been so privileged to hear and to share in their journey. And I think it’s really important that they continue to fight to continue to work to safeguard their care and safeguard the care for future generations.”

She’s also asking Albertans to be mindful.

“Lead with kindness,” she said. “So I think a lot of people want to develop opinions and want to make a decision. But try and centre the person who had impacts in your thoughts, trying to imagine how that person might feel and listen to the stories of your fellow Albertans and how it impacts them, how it impacts trans young people.”

–With files from The Canadian Press