The Facts on Puberty Blockers: Gender-Affirming Care in Youth

In Canada, health care professionals are guided by the mature minor doctrine (Government of Canada) when attending to those under 18. This doctrine also serves Alberta as common law. Alberta Health Services (AHS) has a mandatory policy guided by the mature minor doctrine (AHS Summary Sheet). 

A mature minor is someone under the age of 18 who is deemed to have the capacity to give informed consent (Calgary Legal Guidance (CLG)). This determination is made by the most responsible health practitioner involved in the young person’s care. In alignment with their typical role as the most responsible health practitioner, the College of Physicians & Surgeons of Alberta’s (CPSA) standards of practice also adhere to the mature minor doctrine (CPSA Informed Consent).

The flexibility this allows is necessary for an individualised approach to a person’s health care needs. This tailored approach is especially necessary for youth as their needs can often change as they develop.

Political mandates cannot infringe upon this evidence-based approach to health care! 

For transparency’s sake, the two main health issues associated with GnRH agonists use are loss or stunted bone growth and mental health challenges related to atypical development in a cisnormative culture (TES). What little evidence there is on bone development in youth taking GnRH agonists suggests that only after prolonged use can this relationship be seen and is buffered by the use of HRT (TES). The mental health challenges are only speculation and a proper support system, which includes gender-affirming care, typically renders this point obsolete. 

The proper use of GnRH agonists, as outlined by TES and the World Professional Association for Transgender Health’s (WPATH) Standards of Care v8, greatly diminishes any risks associated with prolonged use. It is standard practice to only use GnRH agonists within a short range of development, averaging only a year or two (WPATH).

Another lie perpetuated by the UCP Government of Alberta, as evidenced by their endorsement of Bill 26 (Alberta), is the current standard practice of care for trans youth. As anyone who has ever had to deal with the medical system in this province knows, it moves incomprehensibly slow. Absolutely no one is meeting with a trans youth and for a 10-minute evaluation session and prescribing surgeries. 

In line with this, there is an ordered standard of care for transgender youth. Social transition is typically the first step, where the youth expresses their gender and is affirmed by their family and friends. Puberty blockers and hormones are used as necessary as the child moves through puberty and into being a teenager. Most surgeries are only recommended once the youth reaches the age of majority (usually 18) (TES; WPATH).

The UCP have said their position is derived from the Cass Review (CR). Not even in the actual body of text, in the forward Dr Cass pats herself on the back for talking to a variety of people with lived experience – not of which are trans youth. The constant appeal to cis authority is a consistent theme in trans discourse at the expense of actual trans voices. She drones on about the charged political environment in which these conversations are happening instead of concentrating on the real issues at stake. 

This review pushes for an abundance of caution to treating trans youth and highlights the lack of evidence to support any standards of care. This is a lie. Both the TES and WPATH have clear guidelines on medical interventions in trans youth. Pausing treatments is not a benign action as many trans youth will develop through an unwanted natal puberty waiting for enough studies to say what we already know is true.

At a time when Albertans are facing severe anxiety around basic needs, the UCP is using transgender youth as a distraction and scapegoat. Premier Smith has spouted family values and bringing Albertans together while at the same time targeting some of the most vulnerable of our family members.

By Gary Rosastik (he/him)
BSc Biology & Psychology
Grant MacEwan University