Edmonton pediatrician says Smith 'drumming up fear' with new policies on trans health care

Luce Evans (right) said gender-affirming surgery has changed his life for the better, and he's worried about how trans youth will be negatively affected by the UCP's proposed limitations on gender-affirming care. (CamWiebe /CTV News Edmonton)

Luce Evans says gender-affirming surgery changed his life.

"I hated myself, I hated the body that I lived in," the teenaged Evans said. "There was something wrong, and I couldn't figure it out for the longest time."

Evans is one of many voices speaking out against new proposed rules limiting gender-affirming care for trans youth in Alberta.

Alberta Premier Danielle Smith said the rules aim to keep kids from "making permanent and irreversible decisions regarding one's biological sex" while they're still young.

Smith said the Alberta government wants to stop trans people under 18 years old from getting top or bottom surgery. It also wants to prevent trans youth under 16 years old from accessing puberty-blocking medication.

"That was drumming up fear, to be honest. That was drumming up some controversy where there is no controversy," said Simone Lebeuf, an adolescent medicine pediatrician specializing in gender-affirming care.

Lebeuf said young people are not being offered irreversible medical procedures.

In Alberta, a person already has to be 18 years old or older to get onto the roughly three-year-long waiting list for a provincially funded gender-affirming surgery.

It's why Evans and his family chose to go the private route in 2022.

It cost the family $12,500 to have a surgeon remove Evan's breast tissue and give him a masculine chest.

He was 17 at the time, and his family and doctor agreed it was the best option to improve his mental and physical health.

He said the surgery made him a happier, healthier person. He doesn't have to bind his chest, a painful and sometimes dangerous practice, and he's more comfortable in his own skin.

"I had never felt better. The moment I woke up, I was like, 'Yay,'' Evans said.

"I have the ability to be myself," he said. "I have the ability to be confident in myself in public and just exist as a person."

'This is medical care'

Gender-affirming care includes medical and non-medical interventions that range from fully reversible to permanent.

While Smith asserted the new rules are to protect kids from making permanent changes before they reach adulthood, the Alberta government is seeking to limit access to fully reversible puberty-blocking medication.

Lebeuf said puberty-blockers are often misunderstood. It's a medication that has been used safely in children with different medical conditions for decades.

The blockers slow down or pause the processes that cause secondary-sex characteristics, like breast tissue or an Adam's apple, to develop.

For trans men and women, preventing those developments makes long-term transition easier. Delaying puberty also gives trans youth more time to consider the bigger, more permanent changes.

"Maybe they needed a little bit of space and time for their brain to mature for them to figure out their goals, for them to figure out their gender identity," Lebeuf said. "Then they might continue on to different interventions as their brain is more mature, or maybe they would stop and that would be it."

According to the Government of Alberta, puberty in Canada usually begins between the ages of 9 and 13.

Under the new laws, trans youth would not be able to access puberty-blocking medications until 16 years old, by which time many youth will have gone through puberty.

The 16-year-old benchmark doesn't make sense, Lebuef said.

"It's not a light switch, there's no magic prefrontal cortex fairy that arrives on your 16th or 18th birthday and says, 'Yep, this young person is ready to make decisions for themselves,'" she said.

"This is medical care that should be decided between a physician, a young person and their parents, not the government," Lebeuf said. .

Lebuef said the two-year wait to see a specialist or get gender-affirming care as a trans youth is already too long, and Evans said making it even longer will only hurt young people.

"That's a really high-risk time for young people," Lebeuf said. "There have been some studies to show that's a time of increased suicidality, of increased risk around mental health, especially if a young person doesn't have family or social supports."

"Do I think the suicide rates will go up? Yeah, probably," Evans said.

The Alberta Medical Association (AMA) responded to the new policies Friday, saying trans youth have higher rates of mental health and suicidality, and will suffer more under the new policies.

"These new medical restrictions single them out and reinforce stigma. This will add to the current and future burden of mental health issues on a system that is already inadequate to meet the needs of the population," the AMA section of pediatrics said in a statement.

"Children and youth have the right to the appropriate medical care, at the appropriate time, and this should not be denied to them," the AMA continued. "We urge the Premier, in the strongest terms, to reconsider these proposed changes for care of transgender youth."

With files from CTV News Edmonton's Nicole Lampa and Jeremy Thompson