Smith insists her gender policies follow the science
THAT IS NOT GOOD MEDICAL PRACTICE. — DANIELLE SMITH
Alberta Premier Danielle Smith says the United Kingdom’s recently published Cass report will inform the development of her government’s transgender policies. The document, which was produced by esteemed British pediatrician Hillary Cass after four years of investigatory work, convincingly shows medical sex transitions for minors are risky and often unnecessary.
In an exclusive interview with the National Post, Smith said the Cass report confirmed that her government’s concerns about pediatric gender identity services are evidence-based. She said she recently spoke with Cass to better understand her findings, and said, “If we want to take a science-based approach, we’ve got to use the best information available.”
According to the bombshell report, which spans 400 pages and includes several systematic evidence reviews, the research in support of transitioning youth is “incredibly weak” and globally influential treatment guidelines are “not evidence-based.”
Cass determined that the long-term effects of puberty blockers, which transgender activists have claimed are “fully reversible,” are actually unknown. As such, she recommended the pediatric use of puberty blockers and cross-sex hormones be limited to small-scale clinical trials.
Cass noted that, starting in the 2010s, the number of minors seeking pediatric gender services exploded and, concurrently, the nature of this patient population changed dramatically. Youth wishing to transition increasingly came from troubled backgrounds, struggled with internalized homophobia or had mental health comorbidities or developmental conditions such as autism.
Given these trends, Cass cautioned against automatically “affirming” youth and rushing them into medicalized transitions. The better solution, according to her, would be to provide patients with holistic mental health supports, such as psychotherapy, instead.
In response to Cass’s findings, Smith said it’s clear that there is currently no good evidence supporting medicalized transitioning in minors.
“I would say that these kinds of intense psychotherapy sessions should already be the standard in how we’re approaching these issues of children who are facing gender dysphoria,” she said, concurring with Cass’s proposed treatment model.
Smith said that clear standards need to guide the provisioning of these services. As it stands, decisions over whether youth receive access to psychosocial support seem to be “quite arbitrary” in Canada today, she said.
The premier said that, since the federal government made it a potential Criminal Code offence to question a child’s gender identity, many psychologists have privately told her office that they’re “afraid that they can’t do anything other than affirmation,” which has created a “chill in the discussion.”
Her comments appeared to reference Bill C-4, a 2021 act that amended the Criminal Code to ban vaguely defined “conversion therapy” practices, including attempts to change a person’s gender expressions.
To solve this problem, Smith proposed creating a provincial pilot program that will allow psychologists to freely explore all the reasons why a child may be presenting as transgender before moving forward with treatment. However, she did not specify when this pilot project would be implemented and was unable to explain how the province could protect professionals from prosecution, given that criminal law falls under federal jurisdiction.
The premier argued that the current “affirmative” approach to treating gender-distressed youth constitutes a “new form of conversion therapy,” as “a lot of these young people might just be same-sex attracted.” She argued that, rather than transitioning these patients, the province should help them “come to terms with their sexuality and be able to openly express that they’re gay or lesbian.”
Her statements echoed the views of many former gender clinicians, particularly in the U.K., who have said that internalized homophobia seemingly drove many of their patients into medicalized transitioning.
Smith stood firmly behind the blanket ban on blockers and hormones for youth aged 15 and under that she announced in January, even though the Cass report recommends that these interventions be permitted via limited clinical trials.
She argued that, given the irresponsibility of recent policy-making in this domain, it would be good to have a “bit of a reset.” However, she expressed openness to revisiting her stance, depending on what emerging evidence from other jurisdictions ends up showing.
“I’m always open to looking at science and looking at the best available evidence. I think the problem has been that there has been a rush down a certain pathway in our province and in the country that isn’t science-based,” she said.
Smith confirmed she would support launching an investigation similar to the Cass report in Canada, to explore domestic standards of care. She was “deeply troubled,” for example, by a recent CBC French report that featured a 14-year-old actress who was able to receive a testosterone prescription within 10 minutes of visiting a gender clinic.
“I have to say that is not good medical practice,” said Smith. “I want to know if there are doctors who are prescribing puberty blockers or cross-sex hormones on a first visit. I want to know if children are being referred by social workers and teachers and skirting around parents. I want to know if there is a multidisciplinary team that is making sure that a child is living for a time through being transgender before they start down a medicalized path.”
While the premier supports more restrictions on pediatric gender services, she emphasized her ongoing support for transgender adults. Her government is working to expand access to sex-reassignment surgeries and long-term followup health care for this population.