Protecting the vulnerable from dangerous and unproven gender-affirming treatments is well within a government’s proper sphere of authority

John SikkemaAlberta Premier Smith recently announced that “gender-affirming” surgeries will not be permitted in Alberta before age 18, while puberty blockers and cross-sex hormones will not be permitted before age 16. The leading objection to the Premier’s policy pronouncement is that politicians should not interfere in personal health care decisions.

But it is very much in doubt whether “gender-affirming” pharmaceutical and surgical interventions for minors do more good than harm, and thus whether they should be considered health care at all. Is Premier Smith interfering with access to health care or protecting young people from a dangerous experiment?

Gender medicine has been a cutting-edge and rapidly expanding area of practice in recent years. Gender clinics have multiplied rapidly in recent years, alongside the exponential rise in young patients, disproportionately female, being referred to them. There is a lot of money to be made here. But the damage that gender medicine can do ranges from the inevitable and severe to the remote and comparatively minor.

gender-affirming treatments alberta
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Puberty blockers can cause infertility, early menopause, sexual dysfunction, headaches, anxiety, depression, insomnia, mood swings, suicidal ideation, and loss of bone density, sometimes severe, among other side effects. Some research suggests they may also impair cognitive development.

And for what?

Puberty isn’t a disease. It’s a natural and essential part of human development. But it is also an increasingly common cause of psychological distress for youth – for which medicalization is now considered an appropriate response.

There’s more. Males taking cross-sex hormones significantly increase their risk of sexual dysfunction, infertility, stroke, blood clots, coronary disease, cerebrovascular disease, and breast cancer. Females on testosterone risk infertility, high blood pressure, higher cholesterol, type 2 diabetes, erythrocytosis, cerebrovascular disease, hypertension, pelvic pain, and uterine cancer.

Mastectomies, which have been performed on several hundred Canadian minors in recent years, make breastfeeding impossible, inflict major wounds and scars, and have implications for sexual intimacy. “Bottom surgeries” – which, for example, may remove the uterus, ovaries, and vagina and may also include creating an imitation penis via skin grafts – come with additional risks, severe side effects, and ongoing care needs. Some cause infertility. While genital surgeries are not currently being performed on minors, the path that begins with puberty blockers at a young age often leads to such surgeries later on, as young adults.

Here is how MyHealth Alberta, a government agency, explains gender-affirming surgeries: “Gender-affirming surgeries are procedures that change the look and function of your body. There are many kinds of gender-affirming surgery. They make your body more closely align with your gender identity. Some people choose one or more surgeries. Some don’t. It’s up to you to decide if it will be part of your gender affirmation.” It’s hard to imagine talking about heart surgery, or any other medically necessary surgery, this way.

These treatments create serious and enduring physical health problems these patients wouldn’t otherwise have. And there’s scant evidence that “gender-affirming care” makes up for all this physical damage by improving mental health, especially in the long term. Some research suggests it may worsen mental health in the long run.

Medical specialists can be gung-ho about the latest advancements in their field and ambitious in pursuing them. In 1949, for example, Portuguese neurologist Antonio Egas Moniz won the Nobel Prize for discovering the “therapeutic value” of lobotomy in treating certain psychoses. Tens of thousands were performed in North America – disproportionately on women and gay men – between the 1940s and 50s. It’s now considered a dark chapter in medical history.

Premier Smith will continue to be derided for thinking she knows better than doctors. But protecting vulnerable young people from dangerous and unproven treatments by self-selected specialists in a highly politicized field of medicine is well within the government’s proper sphere of authority. These young patients with troubled minds cannot possibly comprehend the lifelong implications and physical damage such treatments may do.

John Sikkema is the Director of Law and Policy for ARPA Canada.

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