Opinion by Julia Malott •
In the wake of Alberta Premier Danielle Smith’s announcement of comprehensive reforms to the province’s transgender care protocols, a flurry of commentary has erupted, spanning a broad spectrum of opinions on the social and medical treatment of transgender youth.
The polarizing opinions largely align with partisan biases, offering either staunch support for, or vehement opposition to, the proposed policies. Astonishingly, there’s been scant exploration of the complexities inherent in such policies, which is a disservice to gender dysphoric children.
A nuanced understanding seems necessary, given that the irreversible nature of transitioning in childhood is matched by an equally consequential decision to forego such medical interventions until adulthood. Once sexual development has taken hold — whether through natural puberty or cross-sex hormones — irreversible changes happen to the body. The stakes are high with either outcome.
Unfortunately, a lack of nuance is starkly evident in our political discourse. Earlier this month, Conservative Leader Pierre Poilievre broke his silence on Alberta’s policy shift and weighed in on the use of hormone therapies and puberty blockers for minors. Yet his response was marked by contradiction and divisiveness.
He stated that, “We should protect children” and their ability to “make adult decisions when they become adults,” but also that, “We should protect the rights of parents to make their own decision with regards to their children.” Pressed further, he clarified that he is against puberty blockers for children. He then blamed the status quo on Prime Minister Justin Trudeau (who has been equally divisive in his own statements)
Poilievre’s contradictory statements ignore that a decision for a child not to undergo puberty blockers is itself a decision that cannot be undone in adulthood, because it results in profound changes to the body that cannot be completely reversed. It is those changes that lead a transgender adult to stick out in public and receive much of the negative attention they are often subjected to.
He also appeared to stumble on the contradictions inherent in Smith’s recent policy changes, which respect parental rights over social transitioning and sex education, but impose restrictions on hormonal treatments, even when consensus might exist between the child, its parents and medical professionals that such a treatment might be best.
(More recently, Poilievre stated his opposition to transwomen participating in women’s sports and using female-only spaces, such as change rooms and washrooms.)
The Conservative leader’s comments underscore the broader issue of transgender health care moving away from scholarly discussion and being dragged into the arena of partisan politics. As noted by York social work professor Kinnon MacKinnon and Pablo Expósito-Campos, writing in the Conversation , the resulting polarization and spread of misinformation may pose greater risks to gender-diverse individuals than the medical treatments in question.
The direction of our discourse mirrors past debates over abortion, which quickly became mired in political ideology. The abortion discussion became framed in terms that implied stark opposition between the “pro-choice” and “pro-life” camps, as if most Canadians are not broadly in support of both choice and life as guiding principles. In social politics, solutions lie in carefully balancing virtues, not pitting them against one another as though they’re diametrically opposed.
With minds already made up on whether a transition is to be celebrated or condemned, partisan players are all too comfortable making any case that will advance their position, with little consideration for the real-life consequences.
Statements from Conservative politicians continue to overlook Canada’s troubling history of LGBTQ+ abuses, which persist to this day, and are reluctant to recognize that one of the primary benefits of medical transitions in childhood — achieving more seamless post-transition integration as one’s affirmed gender — can significantly mitigate the challenges faced by transgender individuals who are marginalized in a society that’s deeply divided by these political debates.
On the other end of the political spectrum, progressive voices have yet to acknowledge the medical risks and regrets involved in transitioning, acting as though every desire professed by a child is unquestionably flawless. These narratives from progressive quarters have painted medical transitioning as a straightforward, low-risk endeavour with negligible regret rates, framing it moreso as a journey of self-discovery.
Progressive resources have been leaned upon heavily under current policy. Juno Dawson, in her influential work, “This Book Is Gay,” which is considered a top resource for LGBTQ+ youth, addresses this topic directly. Dawson states that, “There is no such thing as ‘sex changes for kids.’ It doesn’t happen. If a young trans or non-binary person wants medical intervention (many do not) … they will have extensive counselling before possibly being prescribed a course of hormone blockers that delay the onset of puberty.
“All this means is that if that individual chooses to make permanent physical changes as a young adult, they won’t then have to counteract the bodily consequences of puberty, ie., breasts, a deeper voice, etc. It basically saves them a lot of time on a surgeons table at a later date.”
While Dawson highlights the benefits of puberty blockers for those who continue their transition into adulthood, her vacuous portrayal simplifies the medical process involved in prescribing these treatments. Contrary to the rigorous medical review one might expect, Canadian health-care providers, operating under an affirmation-first model, often face pressure to prescribe puberty blockers without extensive vetting.
This approach, aimed at avoiding crossing into conversion-therapy practices, relies on the principle that one’s professed gender identity must always be affirmed, even by medical professionals. Dawson’s reassurance that permanent changes are deferred until adulthood also overlooks the significant issue of infertility resulting from the use of puberty blockers, as they prevent the attainment of reproductive maturity.
Our conversation around transgender youth care needs to be more thoughtful and medically grounded, and politicization does not lend well to that endeavour. Several European countries have recognized potential shortcomings in the current standards of gender-affirming care and have embarked on systematic reviews of the medical literature to ensure evidence-based approaches that prioritize the well-being of gender dysphoric youth.
This is a discussion that would be better to have within the medical community, rather than the political sphere. We should follow the evidence of where gender-affirming care yields powerfully positive life-changing outcomes for gender dysphoric youth, while also taking a cautious approach in deference to the profound nature of these interventions.
Wouldn’t that service gender dysphoric youth better than the politicization of their health care?
National Post
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