As Europe bans puberty blockers, Canada’s medical leaders double down

Article content

Doctors’ groups across Canada are urging the provinces not to interfere with “evidence-based” medical treatment of children with gender dysphoria.

But others say what little evidence exists points to using caution and restricting treatments for minors, and that Canada’s medical leaders are ignoring shifting trends in gender-affirming care.

Article content

England last week announced children with gender dysphoria would no longer be routinely prescribed puberty suppressing hormones at publicly funded gender clinics, after the country’s National Health Service concluded insufficient evidence exists to support the safety of puberty blockers. The ban is in response to public consultations held on an interim policy announced last June.

Article content

Blockers will be available only to children enrolled in study trials, and those already receiving treatment. Doctors can apply for approval on a case-by-case basis, but must explain why the child’s circumstances are exceptional.

England’s decision, condemned by LGBT groups, was based on an independent review that found evidence relating to pediatric gender care scant and inclusive, and that some authors are interpreting their data “from a particular ideological and/or theoretical standpoint.”

One day after the NHS decision was announced, the leaders of 11 medical organizations across Canada posted a statement on X, formerly Twitter, warning that “restricting choices and appropriate care for patients can lead to permanent harm.”

“Medical associations from coast to coast are deeply concerned abut any government proposal that would restrict access to evidence-based medical care for patients, including the transgender population,” leaders of the Canadian Medical Association, Ontario Medical Association and nine other provincial/territorial medical associations wrote.

Article content

Article content

“Canadians have the right to make personal choices about their health with the support of their families, the guidance of physicians working with other regulated health professionals and free from ideological intrusion,” they said.

Several people commented that Canada appears at loggerheads with European counterparts. Norway, Sweden and Finland are also taking more conservative approaches to puberty blockers after conducting their own literature reviews. “So, the NHS in the U.K. is wrong and doesn’t make decisions based on science. Got it,” one commentator commented.

When contacted for comment, the Canadian Medical Association said no one was available for an interview. A spokesperson said the statement’s timing — one day after England’s announcement — was coincidental.

It’s the latest skirmish in the highly polarized and politicized debate around gender-affirming care, with extremes on both sides — either “pro-everything transition or shamelessly anti-trans,” National Post contributor Julia Malott said recently. “Neither are very helpful.”

Article content

Pamela Buffone, founder of the Canadian Gender Report, said the NHS policy decision is “prudent” and effectively “makes clear to parents and children that taking puberty blockers is experimental.

“We do not know whether the risks will outweigh the benefits,” she said.

Canada diverges from the U.K.’s path by approaching gender-affirming care from a human rights perspective rather than through a medical lens, Buffone said in an email.

“As soon as a child declares a trans identity the health-care approach shifts to affirming and supporting the child’s gender goals, and the normal protocols one would expect from our medical practitioners are absent.”

In an undercover investigation, Radio-Canada recently sent a 14-year-old actress, posing as transgender, into a private gender clinic. It took nine minutes of consultation for “Sascha” to get a prescription for testosterone.

“That’s what prescribing based on identity rights looks like,” Buffone said.

Testosterone and estrogen are cross-sex hormones given to older youth on the medical transition path.

Puberty blockers like Lupron are given to younger children with gender dysphoria — the distress experienced when a child’s gender identity conflicts with his or her birth sex.

Article content

The drugs arrest the process of puberty. The objective is to give children identifying as transgender more time to explore their gender identity and free them from the anxiety and distress of their bodies developing in unwanted ways.

The monthly injections act on the brain to block the release of estrogen and testosterone and stop the changes that come with puberty.

Most children who start puberty blockers progress to gender-affirming hormones, raising concerns the drugs are “locking in” a gender identity by stopping normal hormonal surges that drive sexuality and gender identity through the early teen years.

In addition to effects on fertility, concerns have been raised about the potential impact of puberty blockers on adolescent brain development.

One Canadian study found that 62 per cent of 174 children with gender dysphoria under 16 referred to one of 10 gender clinics were prescribed puberty blockers at their first visit, though the average wait time after referral was 269 days. Some clinics accept referrals from school guidance counsellors or teachers.

Article content

“It may be possible to avert adverse adult outcomes if trans people accessed gender-affirming medical care, if needed, at younger ages,” the authors wrote.

In an open letter to Alberta Premier Danielle Smith in February, the Canadian Paediatric Society and Alberta Medical Association said Alberta’s proposed policies to ban hormone treatments for children 15 and under “will lead to significant negative health outcomes, including increased risk of suicide and self-harm.”

Buffone’s group said it was “highly irresponsible” to suggest Smith’s policies will lead to increased suicide risk. Some studies have found lower odds of depression and suicidal thoughts in youth receiving  puberty blockers or gender-affirming hormones over 12 months of follow-up. But a recent systematic review couldn’t draw any conclusions about death by suicide.

“Every patient has unique needs and circumstances that need to be taken into consideration when developing their health-care plan,” the Canadian Paediatric Society said in an email to National Post. “As in other area of medicine, decisions regarding gender-affirming care should be between patients, parents and health-care providers.”

Article content

Children identifying as transgender experience more bullying, stigma and harassment, and poorer mental health than cisgender children. Their suffering is real, said Dr. Sam Wong, president of the Alberta Medical Association’s section of pediatrics, and the Canadian Paediatric Society’s medical affairs director.

“Transgender patients are not going away,” Wong said. “Whether you stop using puberty blockers, whether you ban their use…. These patients are still there. They’re still suffering from dysphoria. They’re still suffering from (poor) mental health.”

Puberty blockers have been used for years in children with precocious puberty. “Decades of clinical patients have shown that puberty blockers seem to be safe and efficacious for stopping puberty,” Wong said.

However, with precocious puberty, puberty blockers are stopped once the child reaches a more appropriate age. Their use in children with precocious puberty shouldn’t  be extrapolated to their use in gender-affirming care, Buffone said.

National Post

Our website is the place for the latest breaking news, exclusive scoops, longreads and provocative commentary. Please bookmark nationalpost.com and sign up for our daily newsletter, Posted, here.

Article content