Doctors call out contradictions in UCP gender policies, say policies create 'culture of fear'

An Alberta doctor says Premier Danielle Smith will struggle to attract trans specialists to the province if her other policies restricting health-care options for trans youth are made law.

Dr. Kate Greenaway, a trans health-care specialist and medical director of the Foria Clinic, is part of a growing number of medical professionals calling on the UCP to scrap the proposed legislation.

Greenaway said restricting health care for trans and non-binary youth will create a "culture of fear and discrimination" that will act as a barrier to attracting specialists or even keeping the few that already practise here.

"It's hard to imagine a surgeon that specializes in this area and has close relationships with trans, non-binary communities wanting to come to Alberta and set up a practice here. I just don't see how those align," Greenaway said.

Another contradiction lies in Smith's alleged motivation to prevent children from "making permanent and irreversible decisions" about their bodies before adulthood.

"I think there's some misinformation being propagated within these policies and the conversations around them," said pediatrician Dr. Tehseen Ladha. "There's this notion that these policies are preventing things that are irreversible, when actually hormone-blockers or pubertal-blockers are reversible."

According to the Canadian Paediatric Society (CPS), natural puberty resumes when the medication is stopped and fertility is not affected long-term.

The medications have been used to treat numerous medical conditions for decades, and Ladha said the side effects are mild and minor.

Greenaway said puberty-blockers give trans youth time to consider "complicated decisions about their future" without the distress and emotional harm that puberty brings for many trans and non-binary youth.

Limiting them to 16-year-old patients – who have likely already entered or finished puberty – effectively removes them entirely as a treatment option, Greenaway said.

"So, Premier Smith's declaration that preserving youths' choice in the future could be rescued by limiting our ability to act with puberty blockers is actually opposite to how we understand this situation," she added.

"It removes such an important intervention that we know supports mental health, wellness, as well as decreases suicidality and self harm in these youth … that is not at all understanding medically what we need to do to support the youth that we're seeing," she added.

'Parental rights are actually being taken away'

The Alberta Medical Association (AMA), the CPS and the Social Workers Association of Alberta have all come out against Smith's proposed policies.

The AMA's section of pediatrics said medical decisions for minors should only involve the patient, their parents and their doctor or health-care team.

Ladha said the framing of the policies has included protecting parent's rights, but the consequences of the legislation will be to restrict them.

"These policies are taking away the rights of parents and caregivers to endorse or give permission to their children for puberty blockers," Ladha said. "Parental rights are actually being taken away and taken out of the hands of the medical professionals who have the expertise in using these therapies."

Smith has asked Albertans not to politicize the conversation about trans youth.

Greenaway said that's exactly what Smith has done herself, adding it's inappropriate for the government to open a public debate around trans people's bodies.

"Especially when we're talking about youth. That is a very painful and harmful discussion that you're creating if people feel like it is totally appropriate to talk to a 14-year-old about their body in [that] way in the media," Greenaway said.

Smith's office said some of the policies will be implemented through regulation and ministerial orders, while others may require legislation.

Smith has not yet said what the penalties would be for doctors who choose to provide care outside of what is allowed under the new policies.

If it does pass, Ladha and Greenaway both expect that some doctors will continue to provide gender-affirming care beyond what the rules allow.

"I think unless there is a strict legislation in opposition to this, they will continue to do what's best for transgender youth and their families alongside and in alignment with the scientific evidence and literature, rather than being directed by policies that have no scientific evidence and also have not had stakeholder engagement," Ladha said.

A spokesperson from the minister of health's office said Thursday the province is consulting with medical professionals on how the policies will be implemented and "to ensure minors that require puberty blockers or hormone therapy for medical reasons, other than gender reassignment, will still get access to the medical care they require."

The AMA and CPS said they have not been consulted. Ladha or Greenaway both said they were unaware of any consultations taking place with the medical community.

The minister's office said the UCP is also looking at "evidence-based guidelines" and treatment recommendations around youth gender transition from public health authorities in other countries including Finland, Sweden, Denmark, Norway and the UK.

 With files from CTV News Edmonton's Chelan Skulski