A physician out of Lethbridge is speaking out against the province's legislation governing transgender children in Alberta, saying that taking health care away can only lead to more harm. Teens rally in support of trans youth during a protest event in Medicine Hat in 2024.--NEWS FILE PHOTO
zmason@medicinehatnews.com
Almost a year ago, Premier Danielle Smith told listeners on her call-in radio show that she was prepared to use the notwithstanding clause to override charter challenges to a suite of three bills affecting transgender youth.
“Because I feel so strongly about protecting kids’ right to preserve their fertility until they’re adults, we would, as a last resort, have to use the notwithstanding clause,” said Smith. “I hope it doesn’t come to that, but for sure, we would.”
This week, the UCP government invoked that last resort, shielding the bills against ongoing lawsuits challenging two of them that are currently before Alberta courts.
Lethbridge-based Dr. Jillian Demontigny was one of the physicians that joined the Canadian Medical Association’s constitutional challenge to Bill 26, which would obstruct the delivery of gender-affirming care to transgender people under 18 in the province.
“It’s heavy-handed, and it just to me indicates that the government knows that these laws will not stand up to a constitutional challenge,” Demontigny said of the use of the notwithstanding clause. “It’s just cowardice and garbage and harmful.
“The thing that we have to keep front and centre in this whole discussion is that these are real people whose access to health care and whose safety moving through their lives as young Albertans is under threat.”
The Canadian Medical Association released a statement Tuesday condemning the decision to invoke the notwithstanding clause to interfere in the clinical care of patients, calling it an infringement on physicians’ freedom of conscience and a political intrusion into evidence-based care.
“I think it’s important for people to know that any threat to patient autonomy means their own autonomy in their health care is under threat,” said Demontigny.
She says the legislation unfairly targets a specific group of people by obligating doctors to withhold care that will still be provided to other patients.
“It interferes with our ability to practice ethical, best quality health care, just specifically for trans teens.”
Demontigny says the Canadian Medical Protective Association requires physicians to honour a patient’s chosen name and pronouns. Under this legislation, only transgender patients will lose that right.
Bill 26, one of the three affected bills, prohibits the use of medications to pause puberty and the use of hormone therapy to cause permanent physical changes in the body, like the development of breasts or growth of facial hair.
The premier has long defended it on the grounds that a child’s fertility should be preserved into adulthood, allowing them the time and maturity to choose what’s best for them after the age of 18.
However, the very purpose of the puberty blockers withheld under Bill 26 is to preclude the need for immediate, irreversible intervention.
“If a child has gender dysmorphia that’s aggravated by puberty, the thing that can really take some pressure off is medication that can pause their body’s changes and give them some time to think about and discuss options, maybe access mental health support or make a plan for what might come next. And that’s done with puberty blockers.”
Puberty blockers do not have a permanent effect on fertility – puberty can be safely resumed at any time by stopping the treatment.
Demontigny says the safety of puberty blockers is well-established, as they are prescribed to children even much younger than pubescent-age to treat precocious puberty, which occurs when puberty begins much earlier than usual in children.
“That use of the same medication isn’t under threat. This is really just targeting its use is trans kids,” she said.
While hormone therapy can have permanent effects on long-term fertility, it’s not a guarantee. For people with ovaries, a general fertility rate of around 85 per cent after puberty drops to 60 to 70 per cent after hormone therapy.
“The way its being talked about by the people writing these bills is as if all gender-affirming hormone therapy is somehow a guarantee that you’ll never become a parent,” said Demontigny. “The first thing that’s needed is for someone to be healthy and grow up. And this bill really significantly impacts a person’s ability to grow up and be healthy if they’re trans in Alberta.”
Demontigny says there is no evidence to suggest that any harm has been caused by the treatment of transgender youth in Alberta younger than 16.
Long before any medical interventions, Demontigny says gender-affirming care starts with socialization with friends and in schools, and conversations with parents and physicians.
“There’s no medicalizing happening. You’re just honouring the kid’s experience, which is what you do for all other kids in their health-care visits anyway.”
But the legislation also targets these kinds of gender-affirming care, preventing transgender children from competing on girls sports teams and adding regulations governing their ability to use preferred names or pronouns.
Demontigny is one of only a handful of Alberta physicians who practice the kinds of gender-affirming care targeted by this legislation for children under 16. She’s exhausted by the battle and disheartened by the loss, particularly amid all the other strains already put on physicians in the province’s health-care system.
“Adolescence is hard enough. And practising medicine in Alberta in 2025 is also hard enough.”
She says increasing the burden that physicians have to bear and decreasing their trust in government could have the effect of driving more physicians away.
“It’s harmful to the individuals affected, its a moral injury, and it’s also going to be harmful to our communities, because we’re either going to lose physicians or we’re going to see physicians that are changing their practices in ways that aren’t best for the patients they’re serving.”
