The evidence is weak, the risks are high, yet Canadian minors still have easy access to medical transition procedures
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Canada is falling behind its Anglophone peers in developing a science-based policy on medical transitioning for minors. The United States, the United Kingdom, Australia and New Zealand have all made significant policy changes in recent months.
Of these four countries, the U.K. has grappled with the issue the longest. Over the past decade, whistleblowers at the Gender Identity Development Service (GIDS) have raised concerns about treatments for gender dysphoria. In 2023, the independent Cass Review concluded there was “a lack of high-quality evidence” supporting medical transitioning for minors. In response, the Conservative government imposed a temporary emergency ban on puberty blockers for minors. In December, the Labour government extended the ban indefinitely for those under 18. Concerns over medical transitions clearly cross party lines in the U.K.
In November, New Zealand commissioned a study on puberty blockers. The study “found significant limitations in the quality of evidence for either the benefits or risks (or lack thereof) of the use of puberty blockers. This means there is insufficient basis to say that puberty blockers are safe or reversible (or not) for use as an intervention for gender dysphoria in adolescents.” Following the study, the New Zealand government announced it was considering new regulations on prescribing puberty blockers and updating clinical guidelines.
 Hundreds of Canadian girls—some as young as 14—are undergoing double mastectomies. |
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In January, Queensland, Australia’s third-largest state, stopped providing puberty blockers and cross-sex hormones for minors. The decision followed a government review of the evidence and coincided with the launch of an independent review of medical transitioning practices.
In the U.S., newly inaugurated President Donald Trump took immediate action by signing an executive order declaring that “the policy of the United States [is] that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” The order also directed federal agencies to conduct a literature review on best practices for treating gender dysphoria, following the example of other countries.
These federal actions align with policies in the majority of U.S. states. Twenty-six states have banned medical transitioning for minors, and six have made providing such treatments a felony. While the federal withdrawal of funding for these procedures will not affect states that already ban them, it will impact the 17 states with “shield laws” that guarantee access to medical transitioning for minors, despite the lack of supporting evidence.
While these nations have taken steps to review and reform their policies, Canada remains largely silent. The country lags behind its Anglophone peers in addressing the potential harms of medical transitioning for minors.
In most provinces, there are no minimum age requirements for accessing puberty blockers or cross-sex hormones. Despite claims that surgical transitions are not performed on minors, the Canadian Institute for Health Information (CIHI) reports that hundreds of Canadians under the age of 18—some as young as 14—have undergone double mastectomies. While consistent data on puberty blockers or cross-sex hormone use in minors is lacking, it is likely that thousands of children seek these interventions annually.
Amid Canada’s inaction, Alberta stands as an exception. The province recently passed legislation banning hormonal interventions for children under 16 and prohibiting gender transition surgeries for those under 18. But Alberta stands alone.
The upcoming Ontario election presents a critical moment to bring this issue to the forefront. Elections should foster robust policy debates on critical issues. Ontario should establish 18 as the minimum age for accessing puberty blockers, cross-sex hormones or surgical interventions for medical transitioning. At the very least, the province should launch an independent commission to review evidence on medical transitioning for minors and assess current practices.
Voters must demand this change, and all parties should commit to it in their platforms. The health and well-being of thousands of children and adolescents depend on it.
Levi Minderhoud is a policy analyst for the Association for Reformed Political Action (ARPA) Canada.
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