CACAP Statement on Proposed Legislation in Alberta to Restrict Treatment for Transgender Youth

Authored by the CACAP Advocacy Committee (M. Morrissette, R. Rasasingham, L. Anang, S. Abidi, N. Signhal, A. Gajaria, I. Mian, J. Guzder, J. Wittenberg, J. Gibson)

On January 31, 2024, the Premier of Alberta announced plans to put forth legislation that would support restricting access to puberty-blocking and gender-affirming treatments for individuals under the age of 18 years, and would require parental consent for schools to respect name or pronoun changes for those under the age of 15 years.  The Canadian Academy of Child and Adolescent Psychiatry (CACAP) is unequivocally opposed to this proposed legislation that would infringe upon the rights of transgender youth to receive timely evidence-based medical treatment.

Numerous scientific studies have concluded that transgender youth are disproportionately affected by psychiatric conditions including depressive and anxiety disorders, as well as elevated rates of suicidal ideation and suicide attempts.Encouragingly, treatment with puberty-suppressing medications among youth who want this treatment has been associated with lower odds of suicidal ideation over one’s lifetime compared to those individuals who were unable to receive this treatment.2  Moreover, the effects of some treatments that would be banned with this proposed legislation, such as puberty-suppressing medications, are completely reversible, pausing irreversible pubertal changes to allow youth and their families to more fully explore and plan for medical, psychological, and social issues that they may encounter.  For some younger individuals, these treatments are indeed medically necessary.3

Access to gender-affirming hormone therapy (GAHT) has also been identified as medically necessary for some transgender individuals.  GAHT is reserved for individuals who have experienced sustained incongruence between their assigned and identified gender over time, and have demonstrated the ability to understand the potential risks and benefits associated with this treatment.3 Crucially, access to GAHT has been associated with lower rates of depression and suicide attempts for transgender youth as young as 13 years old.4

Acceptance and affirmation of chosen names and pronouns across different settings has been associated with improved mental health for transgender youth.  Previous research has demonstrated that for each additional setting (e.g., home, work, school) in which chosen names were used for transgender youth, there was a corresponding decrease in depressive symptoms, suicidal ideation, and suicidal behaviours.5 For some transgender individuals, they may experience acceptance of their chosen names and pronouns in some settings and not in others.  To promote the health of transgender individuals, it is therefore imperative to respect chosen names and pronouns in as many settings as possible, and the affirmation of chosen names and pronouns in the school environment should not be dependent upon parental consent.

The CACAP affirms that parents and caregivers play an essential role in supporting children and youth to understand and make medical treatment decisions.  The CACAP also agrees with the World Professional Association for Transgender Health (WPATH) in asserting that “proper medical care for any condition is a matter best negotiated between patients and their trained and qualified medical providers who are relying on clinical evidence and experience”6 and respectfully believes that these decisions should occur without encroachment from government.

The CACAP therefore urges the rejection of this proposed legislation that would result in irreparable harm to transgender youth and their families.

References

  1. Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Netw Open. 2022;5(2):e220978.
  2. Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics. 2020;145(2):e20191725.
  3. Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(Suppl 1):S1-S259.
  4. Green AE, DeChants JP, Price MN, Davis CK. Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. J Adolesc Health. 2022;70(4):643-649.
  5. Russell ST, Pollitt AM, Li G, Grossman AH. Chosen name use is linked to reduced depressive symptoms, suicidal ideation and behavior among transgender youth. J Adolesc Health. 2018;63(4):503-505.
  6. World Professional Association for Transgender Health. Statement in response to proposed legislation denying evidence-based care for transgender people under 18 years of age and to penalize professionals who provide that medical care. 2020 January [cited 2024 February 21]. Available from: https://www.wpath.org/media/cms/Documents/Public%20Policies/2020/FINAL%20Joint%20Statement%20Opposing%20Anti%20Trans%20Legislation%20Jan%2028%202020.pdf