How Alberta's proposed trans youth rules fit into a polarized international landscape

It's been a little more than a month since the Alberta government announced a planned fall rollout of legislation focused around top and bottom surgeries, puberty blockers, hormone therapies and other elements of what's referred to as gender-affirming care. 

Canadian doctors, nurses and medical groups have pushed back against the move, while an open letter was released by 36 Alberta academics, predominantly from law schools, asking the province to reconsider the changes. 

The measures in question — the strictest transgender youth rules in the country — are part of a fraught, polarized debate that has only recently entered Alberta's political landscape but have already been subjects of great controversy in Saskatchewan and New Brunswick. 

They have long been the subject of battles fought by lawmakers and courts in the United States, where gender-affirming care for minors is endorsed by a number of major U.S. medical associations, including the American Medical Association and the American Academy of Pediatrics.

But though they have long held support from those U.S.-based medical organizations, in recent years, traditionally right-leaning states have taken a different view of the issue. More than 20 states have moved to ban gender-affirming care, according to tracking by the Kaiser Family Foundation, a non-partisan organization focused on health policy. Many of those bans are currently subject to lawsuits. 

Lawmakers in those states have argued the U.S. should adopt some of Europe's more cautious and restrictive approach when it comes to gender-affirming care. In response to rapid growth in the number of youth seeking treatment, several countries in Europe have revised their approaches to gender-affirming care in recent years, most notably in the United Kingdom.

In response to the growing number of bans in the United States, the American Academy of Pediatrics commissioned a systematic review of evidence behind gender-affirming care in August 2023. The professional association of pediatricians, the largest of its kind in the U.S., acknowledged similar reviews in Europe had recommended a more cautious approach to treatment but said it had confidence its current policy was appropriate.

"At the same time, the board recognized that additional detail would be helpful here," Mark Del Monte, the chief executive of the AAP, was quoted by the New York Times as saying last August. 

Closer to home, the Canadian Paediatric Society, Canadian Medical Association, Alberta Medical Association and Alberta Psychiatric Association all have stated their support of gender-affirming care. However, in discussing the possible upcoming changes in this province, Alberta Premier Danielle Smith has cast her eye past North America's shores and toward Europe's ongoing policy debate. 

The day after the measures were rolled out, the premier said the province had been tracking what was taking place internationally, including in Great Britain.

Much of the debate in the U.K. has revolved around the Tavistock clinic, the country's only centre dedicated to treat children with gender dysphoria, a formal diagnosis that refers to the distress that comes to a person when their experienced gender doesn't align with the sex they were assigned at birth.

In February 2022, an interim review of the clinic was published by Dr. Hilary Cass, the past president of the Royal College of Paediatrics and Child Health, the professional body for pediatricians in the U.K.

In her review of the clinic, Cass stated that Tavistock was overloaded by demand and had not seen data properly collected. 

"We need to know more about the population being referred and outcomes. There has not been routine and consistent data collection, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service," the report states.