Canada one of the world's last holdouts on medically transing children
U.S., Australia, New Zealand and much of Europe are now pulling back on puberty blockers and surgeries for minors
As democracies around the world pull back on the tenets of youth gender medicine, Canada is emerging as one of the last countries still hewing to the idea that minors should be prescribed hormones and even surgery to affirm a self-described gender identity.
Just last month, two leading U.S. medical associations recommended a halt to elective mastectomies, orchiectomies (surgery to remove the testicles) and other “gender affirmation” surgeries for children.
In a Feb. 3 statement, the American Society of Plastic Surgeons warned its members that they risked performing irreversible procedures on children whose gender dysphoria was likely to alleviate in adulthood.
“Available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention,” it read.
The American Medical Association soon issued a statement in support, stating “in the absence of clear evidence, the AMA agrees … that surgical interventions in minors should be generally deferred to adulthood.”
This follows on a November decision by New Zealand to slap strict new controls on hormones prescribed for the “purpose of puberty suppression for children or adolescents.” The country’s Ministry of Health has previously stated that there was a “lack of good quality evidence to back the effectiveness and safety of puberty blockers.”
The Australian state of Queensland similarly banned puberty blockers in January, with the state’s premier framing it as a reaction to “troubling allegations” that a sexual health clinic had been caught distributing unauthorized hormone therapies to 42 children.
When an Australian court ordered a freeze on the puberty blocker directive, Queensland Health Minister Tim Nicholls simply ordered it again.
All the while, countries across Europe have been systematically pulling back on policies that prioritized immediate hormone treatment for children expressing gender dysphoria.
Denmark, Finland, Norway and Sweden, among others, have all tightened the requirements under which a child can be prescribed puberty blockers.
In Italy, for instance, the country’s national bioethics committee recommended in 2024 that puberty blockers only be prescribed after “psychotherapy” or “psychiatric interventions” had failed to alleviate feelings of gender dysphoria.
The Canadian Paediatric Society, most notably, explicitly dismissed all of the conclusions of the Cass Review, and continues to recommend an “affirming approach” to gender dysphoric youth.
That same year, the U.K. released the Cass Review, a comprehensive government inquiry into the country’s system of “gender services” care for minors. One of the report’s most influential findings was that the routine prescription of puberty blockers had been pursued based solely on the conclusions of a “single Dutch study.”
There was “very limited evidence” the hormones improved mental health, despite plenty of risk that they were imposing “longer-term neuropsychological consequences,” the report found.
Puberty blockers for children have been subject to a blanket British ban ever since, with the country’s Department of Health and Social Care declaring that they are an “unacceptable safety risk for children and young people.”
Even in France, which maintains relatively liberal access to puberty blockers, the official position of the Académie nationale de médecine is that they should only be a last resort.
A 2022 communique by the academy stated that “psychological supports,” not drug treatments, should be the first treatment offered to any child “expressing a desire to transition.”
The statement also urged parents to be wary of trans identities being the product of social contagion. The academy warned that “excessive consultation of social networks” was “responsible, for a very important part, of the growing sense of gender incongruence.”
In Canada, by contrast, virtually every health body and government agency continues to defend a policy of permitting children of any age to obtain hormone therapies with minimal oversight. Often, these therapies are framed as being completely safe and even reversible.
Under the most recent version of their guidelines, published in June 2023, symptoms such as “a strong dislike of one’s sexual anatomy” and “a strong preference for playmates of the other gender” are among a list of markers that may warrant a diagnosis of gender dysphoria requiring a course of “gender-affirming hormone therapy.”
Health Canada’s official guidelines similarly break with conclusions in both Europe and the U.S. that puberty blockers carry both side-effects and long-term consequences.
“Puberty suppression is reversible, as puberty restarts when a person stops taking puberty-blocking medications,” reads a Government of Canada website entitled “how to access gender-affirming care.”
The only jurisdiction in Canada that has broken with the “affirmation” approach is Alberta, which in 2024 banned “hormone therapies to minors for the treatment of gender dysphoria or gender incongruence,” as well as “sex reassignment surgery on minors.”
The Canadian Medical Association has not only opposed the action, but has funded litigation to block it.
In a statement last May, the association complained that the Alberta law “directs physicians on how to deliver gender-affirming care to people under 18, down to which medications they can use, when and how.”
“When a government bans specific treatments, it interferes with a doctor’s ability to empower patients to choose the best care possible,” said association president Joss Reimer.
