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Thank you to Our Duty Canada for composing this letter.

An Open Letter to the Alberta Medical Association (AMA)
Regarding the February 1st Statement from the AMA
Section of Pediatrics on gender-affirming treatments March 2024

On February 1, 2024 your association released a statement in response to
Alberta Premiere Danielle Smith’s proposed changes to the treatment of
trans-identified children and adolescents, those struggling with gender
ideation. We ask that you consider and respond to our questions and
concerns regarding your statement and explain how the official position
described therein is consistent with your profession’s fundamental
principle to first “do no harm.”

We are a group of concerned parents, most of whom have children
struggling with gender ideation and grappling with the largely unrestricted
social and medical options being presented to them in Canada. We believe
that no child has the necessary cognitive and psychosocial maturity to
provide informed consent to the use of off-label synthetic hormones and
surgical procedures, often referred to as “gender-affirming healthcare,”
that have irreversible and damaging effects on their health and fertility.
We also carefully follow the results of peer-reviewed research in this area,
which, to date, has NOT yielded strong evidence of the safety or efficacy
of gender-affirming medical treatments. Therefore, we work to increase
public awareness and pressure our social, medical and political
organizations to conduct themselves from an evidence-based perspective.

We have identified several areas of concern in your recent statement and
we address them herein. In summary, your statement contains
generalizations that are not supported by sound evidence; false statements
about the safety and efficacy of the off-label drugs you recommend for
children and adolescents; reference to your steadfast opposition to
safeguarding children and adolescents through proper regulatory
processes and networks; and finally, a strong disregard for age-appropriate
decision-making and consent to medical treatments and surgical
procedures that have irreversible and damaging effects, and which
increasing numbers of youth are living to regret.

Your statement first asserts that “transgender youth have higher rates of
mental health issues and suicidality because of the stigma attached to
their status. The mental health of these children and youth will be markedly
worse when denied care.” The fact is, however, that recent peer-reviewed
research, such as this 20-year Finnish study, does NOT show that gender
affirming healthcare improves the mental health outcomes of children and
adolescents. For example, and perhaps most importantly, this research
does NOT find decreased suicide rates in youth who have accessed
gender-affirming medical treatment.

Your statement further asserts that “the effects of puberty-blocking agents
are not irreversible; and once treatment stops, puberty goes forward.
Treatment allows the patient time to determine their options without
permanent effects.” This assertion is particularly disturbing for two
reasons: (1) it blatantly misleads readers about how puberty blockers are
actually used in trans-identified children and adolescents, and (2)
consequently, it evades the full truth about the actual impacts of these
off-label drugs. In regard to (1), your assertion is premised on cases where
puberty blockers are used for brief periods of time and then stopped so
that natural puberty can progress.

However, this is not how puberty
blockers are actually being used in the majority of trans-identified children
and adolescents. In reality, puberty blockers are most often followed by
cross-sex hormone treatment (up to 98% of the time) and these minors
never go through natural puberty. Further, the long-term effects of puberty
blockers when they are followed by cross-sex hormones are
well-documented and dire, as even the president of WPATH confirms in
this linked video and with this statement, “Every single child or adolescent
who was truly blocked at Tanner Stage 2 has never experienced orgasm, I
mean it’s really about zero.” The pituitary gland is actually rendered
indefinitely dormant with GnRH Analogues (Puberty Blockers), which is why
several countries, most recently England, have corrected their course and
banned their use for gender affirming healthcare. Medical associations owe
it to the public to provide COMPLETE and TRUTHFUL information, which
your statement does NOT do.

Your statement goes on to point out that “Bottom surgery in Canada is
already limited to patients over 18 years.” Once again, you assert a
half-truth that is misleading to readers when you state that “bottom surgery”
is limited, but you remain silent about bilateral mastectomies (“top
surgery”). The fact is that bilateral mastectomies ARE being performed
on patients UNDER 18 YEARS old in Canada. We know this first-hand
because it has happened to our own children, and we know that this
procedure is completely irreversible. Asserting half-truths and omitting
information is not conducive to maintaining the trust of the public.
In light of the recent release of the WPATH Files, we find the following part
of your statement to be an effort to escape the duty to be transparent that,
as a regulatory body for the entire province of Alberta, is crucial to the
AMA’s role and responsibility: “Requiring a private registry of physicians to
provide gender-affirming care has the feel of surveillance, to which we
object. It is an unnecessary bureaucratic process given the current
existence of effective referral processes and networks.” First, what you
refer to as “surveillance” is understood by the Albertans to whom you are
accountable as the transparency you are charged to uphold. Second, you
fail to explain that your referral process is based on the WPATH guidelines,
which have been largely discredited. The fact is that these guidelines, for
“gender-affirming healthcare,” are not evidence-based, but experimental.

A 2023 article in the prestigious British Medical Journal confirms this. As
parents, we are paying close attention to this, and we are asking that our
medical professionals do the same. Statements like the one you have just
made show us that you are NOT paying attention and that you are NOT
following the overwhelming and growing body of evidence.
When professional medical associations cease to be guided by
evidence-based research and principles, and cease to be open and honest
with the public, then the public– rightly and understandably– becomes
alarmed and will, in turn, support the intervention of governments and
ultimately the courts. While we do respect the doctor/patient relationship,
your lack of adherence to the evidence is a symptom of a problem to which
you, as a medical association, have contributed. Your statement is shining
evidence of this.

There is, however, one part of your statement with which we could not
agree more: “Children and youth have the right to the appropriate medical
care.” Children and adolescents DO have the right to safe, evidence-based,
non-experimental medical care that protects them from long-term harm
such as loss of sexual function and infertility. This right is enshrined in the
United Nations Convention on the Rights of the Child. Moreover, children,
adolescents and their families ALSO have the right to provide informed
consent to drugs and surgical procedures that are recommended to them.
This requires doctors and medical associations to be informed and
evidence-based, transparent and accountable. Your statement shows a
shocking disregard for these responsibilities, which the AMA SHOULD hold
sacred. Full stop.

We strongly recommend that your organization cease to follow the
guidelines put forth by the heavily discredited WPATH, stop promoting
medical negligence and harm while operating from a non-evidence-based
perspective, and change course now as progressive European countries
including Sweden, Finland, England, Norway and France have already
done.

We ask that you explain your comments from an evidence-based
perspective. If you cannot, we must assume that they, along with your
official position, are ideologically driven, in which case we call for complete
retraction or substantial correction to the AMA’s original statement. Should
you fail to respond, we will understand that as further dismissal of the
parents, children and adolescents, and citizens to whom you are
responsible, and we will proceed accordingly.
In Support of Children and Families,
Our Duty Canad