evolveDigital | Let Kids Be

Seven hundred and seven days after Alberta Premier Danielle Smith announced that Alberta intended to protect minors from medical transitioning, the province has fully implemented that commitment. Alberta now fully bans sex-denying surgeries for minors. Albertans under 16 may not be given puberty blockers or cross-sex hormones, unless they already started taking them. Sixteen- and seventeen-year-olds can access puberty blockers and cross-sex hormones with parental, physician and psychologist approval.

This is a huge triumph! Alberta is the first province in Canada to legally restrict these harmful interventions.

But it wasn’t an easy path to get here. After many legislative hurdles and judicial interventions, let’s chronicle how this came to be.

January 31, 2024 – Danielle Smith announces on social media her government’s plan to restrict medical transitioning for minors, require parental notification or permission for a child to socially transition at school, and preserve women’s-only sports. This announcement came as a surprise as it was not part of the United Conservative Party’s election platform.

October 31, 2024 – The main piece of legislation to ban medical transitioning for minors, Bill 26: Health Statutes Amendment Act, 2024 (No.2), was introduced in the Alberta legislature. The bill contained three important clauses. Section 1.91 prohibits sex-denying surgeries for all minors. Section 1.92 prohibits puberty blockers or cross-sex hormones for all minors under 18, though Section 1.93 allows the Minister of Health to create exceptions.

December 5, 2024 – Bill 26 receives royal assent. The prohibition on sex-denying surgeries for minors goes into effect immediately, but the sections dealing with puberty blockers and cross-sex hormones do not. The government claims that the ban on puberty blockers and cross-sex hormones will come into effect once the Minister of Health crafts and signs a ministerial order allowing mature minors and those already on these drugs to access them.

July 27, 2025 – Justice Allison G. Kuntz issues an injunction preventing the ban on puberty blockers and cross-sex hormones from going into effect. Various pro-LGBTQ organizations, parents, and children challenged the legislation in court. Justice Kuntz opined that this ban on puberty blockers and cross-sex hormones might infringe on the Charter right to equality and to life, liberty, and security of the person. Until these rights can be considered in full in a future case, she temporarily blocked the ban on hormonal transitioning from going into effect. The ban on sex-denying surgeries was left unchallenged and remained in force.

September 8, 2025 – Health Minister Adriana LaGrange creates exceptions for the blanket ban on puberty blockers and cross-sex hormones for minors in Ministerial Order 31/2025. These exceptions allow minors who had already started these hormonal interventions or started these interventions in another province to continue to receive these drugs. The order also allows mature minors aged 16 and 17 to access puberty blockers and cross-sex hormones with parental, physician, and psychologist approval. It also exempts children with an intersex condition who also experience gender dysphoria.

November 18, 2025 – The Alberta government invokes the notwithstanding clause in Bill 9: Protecting Alberta’s Children Statutes Amendment Act, 2025. The notwithstanding clause is a constitutional provision that allows laws passed by the elected legislature to remain constitutional notwithstanding the decisions of appointed courts. However, the constitution stipulates that the notwithstanding clause expires every five years unless renewed by another act of the legislature.

December 11, 2025 – Bill 9 receives royal assent. This law nullifies Justice Kuntz’ injunction preventing the ban on hormonal transition from coming into effect and paves the way for the full set of restrictions on medical transitioning for minors to come into force. It also prevents any future court decisions from striking down the restrictions.

January 7, 2026 – Alberta brings the ban on puberty blockers and cross-sex hormones into effect. It is now illegal to prescribe puberty blockers or cross sex hormones to minors to treat gender dysphoria, with exceptions for mature minors, those who were already on these hormones, and those with an intersex condition.

This brings us up to the present. But that is by no means the end of the story.

The government is still appealing the temporary injunction against the ban on hormonal transitioning by Justice Kuntz. Furthermore, Egale and company are still waiting for the court to officially opine on whether the ban violates the Charter of Rights and Freedoms. In some ways, the outcomes of these two cases don’t matter. Even if the judges find the ban violates certain sections of the Charter, the ban is saved by the notwithstanding clause of the Charter. However, a ruling by the courts that the ban on medical transitioning for minors does violate the Charter rights of gender dysphoric children will likely sap public support for the ban.

Also, the notwithstanding clause protecting this ban expires on December 11, 2030, unless it is renewed by the government. If the clause is allowed to expire and if the courts rule that the ban on medical transitioning is unconstitutional, then gender dysphoric children will again be at risk of the harmful and potentially irreversible consequences of gender medicine.

But until then, Alberta is leading the way in Canada in letting kids be.

Each of Canada’s ten provinces regulates gender medicine differently. This gives each province the ability to adapt to new evidence more quickly and respond to the demands of local citizens better than if health care were centralized with the federal government. But this also means that it is harder to understand all the nuances of each system and to collect data from across the country. Over the coming months, we will do our best to profile the data and policies on medical transitioning for minors in each province.

Newfoundland and Labrador is unique. It was the last province to join Canada (in 1949), has its own special time zone (30 minutes ahead of the rest of Atlantic Canada), and boasts the most distinctive accent in the country. The population of the entire province is smaller than the city of Hamilton, Surrey, or Quebec City. It is the least densely populated province in Canada, and just under half of the population resides in or around St. John’s.

Unfortunately, Newfoundland and Labrador is not unique when it comes to sex-denying medicine. While it does not perform sex-denying surgeries due to its size and lack of facilities, the province has not tapped the brakes on medical transitioning for minors.

Policy

Newfoundland and Labrador’s Medical Care Plan (MCP) generally covers the cost of puberty blockers and cross-sex hormones. The public health system also covers the cost of most sex-denying surgeries, but not all (e.g. facial feminization or voice pitch surgery).

Notably, all of the province’s policies and procedures relating to medical transitioning are based on the seventh version of WPATH’s Standards of Care (released in 2012) rather than the eighth version (released in 2022). The older edition notes that only 6-23% of cases of gender dysphoria in prepubertal children persisted into adulthood. Thus, “in most children, gender dysphoria will disappear before or early in puberty.”

Given this reality, the Standards of Care 7 are a bit more cautious about “gender-affirming care.” They recommend that clinicians working with gender dysphoric children and adolescents provide “supportive psychotherapy to assist children and adolescents with exploring their gender identity, alleviating distress related to their gender dysphoria.” But the Standards still support sex-denying procedures.

The seventh edition of the Standards of Care requires four criteria to be satisfied for clinicians to provide puberty blockers:

The adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria;

Gender dysphoria emerged or worsened with the onset of puberty;

Any co-existing psychological, medical, or social problems that could interfere with treatment have been addressed;

The adolescent has given informed consent and, particularly when the adolescent has not reached the age of medical consent, the parents or other caretakers or guardians have consented to the treatment.

The Standards give no requirements for cross-sex hormones for minors specifically, though the following criteria are for hormone therapy in general:

Persistent, well-documented gender dysphoria;

Capacity to make a fully informed decision and to consent for treatment;

Age of majority in a given country (if younger, follow the Standards of Care outlined in section VI [on children and youth]);

If significant medical or mental health concerns are present, they must be reasonably well-controlled.

Curiously, although the third criterion refers to the section on children and youth, the section provides no further guidance on the prescription of cross-sex hormones to minors.

The Standards of Care 7 recommend that genital surgery not be performed prior to the age of majority, but suggests doing mastectomies earlier, “preferably after ample time of living in the desired gender role and after one year of testosterone treatment.” The requirements for surgery are the same as for cross-sex hormones, with the additional requirements of “12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones)” for all genital surgeries and a further requirement of “12 continuous months of living in a gender role that is congruent with their gender identity” for genital reconstruction surgeries.

Thus, these requirements mandate no hard age limits on medical transitioning for minors, with the exception that bottom surgery is not recommended before the age of majority.

Providers

Trans Support NL, a non-profit organization that receives government funding, states that most gender-affirming care in the province is provided by a small group of providers that are mostly based in the St. John’s area. In response, the province is working to train primary care providers to provide gender-affirming care themselves. On its medical transitioning page, Trans Support NL encourages anyone seeking hormone replacement therapy to contact their family doctor.

However, there is one pediatric Gender Wellness Clinic at the Janeway Children’s Health and Rehabilitation Centre in St. John’s. The clinic serves children and youth under the age of 18 and is staffed by pediatric endocrinologists who prescribe puberty blockers and cross-sex hormones.

According to WPATH’s Standards of Care 7, only health care providers who meet “WPATH credentials” may provide surgical readiness assessments. Trans Support NL’s website lists four doctors who provide such assessments, though they note that the list is not exhaustive. Previously, the province had required a referral from the Centre for Addiction and Mental Health in Toronto for surgery.

The province does not perform most gender surgeries within the province. Most “top” surgeries are performed in New Brunswick, while most genital surgeries are performed at GRS Montreal.

Prevalence

In response to an access to information request, the government of Newfoundland and Labrador did not have any records detailing the number of minors who had received sex-denying interventions. The province was able to release data on the number of patients of all ages receiving puberty blockers or cross-sex hormones, but only for all underlying conditions (e.g. precocious puberty, breast or prostate cancer, menopause, or naturally low hormone levels in addition to a medical transition).

Given this level of aggregation, it is impossible to deduce the number of children, adolescents, or even adults who are hormonally transitioning. However, the use of these drugs has nearly tripled in two decades. More minors who are medically transitioning may be one factor driving that growth, but we cannot know for certain.

The only surgical data that Newfoundland & Labrador released was that it approved 169 sex-denying mastectomies between November 2019 and May 2022. Only 22 of these mastectomies were actually performed, however. One reason for this discrepancy could be that some women and girls reconsidered having their breasts permanently removed. The more likely reason is that, since no facility regularly performs these surgeries, most gender dysphoric women and girls have not (yet) travelled to have a mastectomy. The province provided no information regarding the age of the patients for whom mastectomies were approved or performed.

Conclusion

Although there are no legal restrictions on medical transitioning for minors in Newfoundland & Labrador, the province does rely on the older – and slightly more stringent – WPATH Standards of Care 7. These standards permit puberty blockers, cross-sex hormones, and top surgeries for minors, though they recommend bottom surgeries only after the age of majority. All of these procedures are eligible for public funding. No data on the number of minors who are medically transitioning is available.

And so, while Newfoundland & Labrador might be unique, they are not unique in their liberal provision of medical transitioning.

Prince Edward Island is the setting for a renowned children’s story: Anne of Green Gables. In the classic tale, an imaginative, talkative, and red-haired orphan is adopted by the Cuthberts. Anne initially struggles to fit in and bucks traditional norms. Accidentally dying her hair green doesn’t help. But through growth, love, and self-sacrifice, Anne eventually settles down and gives up her educational dreams to care for her adoptive mother. These themes reflect the values and times of 1908, the date Anne of Green Gables was published.

Many girls have similar struggles about fitting into today’s society. One of those growing struggles is over what it means to be a female or whether it is even possible to define what a woman or a girl is. A girl pushing back against gendered expectations (e.g. perhaps purposely dying her hair green) today might be drawn in by trans influencers, contract gender dysphoria, and pursue a medical transition to find belonging and identity.

Sadly, rather than encouraging a modern Anne to allow time and biology to take their course, Prince Edward Island would be all too willing to help Anne medically transition.

Policy

According to PEI’s Primary Care Toolkit, the Consent to Treatment and Health Care Directives Act allows minors over the age of 16 to consent to sex-denying hormones without parental consent. No minimum ages are required or recommended for puberty suppression or hormone therapy, though states of puberty are mentioned. Puberty suppression is recommended in “the early stages of puberty” and hormone therapy for those “past puberty or well-advanced in puberty.” As with all other provinces, PEI covers the cost of puberty blockers and cross-sex hormones.

Prince Edward Island publicly funds more forms of sex-denying surgeries than any other province. In addition to paying for all forms of genital surgeries as well as both mastectomies and breast augmentations, the province will also pay for procedures that other provinces deem cosmetic or non-medically necessary. This includes facial surgery, hair removal or replacement therapy, voice therapy, and gamete harvesting and preservation.

For the province to cover the cost of these surgeries, physicians or mental health professionals who are trained in “gender-affirming care” (as defined by WPATH’s SOC 8) must assess the patient, recommend surgery, and complete a Gender Confirming Surgery Prior Approval Request Form. This form requires applicants for surgery to affirm that they are at least 18 years old. A physician must also attest to this age requirement for genital surgery further on. This seems to rule out sex-denying surgeries for minors. However, the Primary Care Toolkit notes that “there may be rare exceptions for those who began their transitions at a young age.”

Providers

The government’s Gender-Affirming Health Services page offers two different routes for a medical transition for minors. Minors under the age of 16 are directed to a pediatrician to discuss any medical transition. Those over the age of 16 are encouraged to contact their primary health provider. These pediatricians and family doctors can prescribe sex-denying hormone therapy. Alternatively, these mature minors can visit the Gender Affirming Clinic in Charlottetown, a clinic that is open on the first and third Wednesdays of each month.

Due to the province’s small population, most sex-denying surgeries are not performed on the island. Most are performed at GrS Montreal except for hysterectomies (removal of the uterus) and oophorectomies (removal of the ovaries), which are performed locally.

Prevalence

In response to our access to information request, Prince Edward Island did not have any data on the number of people who visited a primary care provider for gender dysphoria or the number of patients currently prescribed puberty blockers or cross-sex hormones. The province was only able to release the number of patient visits and the number of unique patients to the province’s one Gender-Affirming Clinic. This data covered only the last three years and does not capture all of 2023 nor all of 2025.

In each of these (partial) years, the majority of patients were adults. Despite the steady growth in the number of adults visiting the clinic, the number of minors has remained relatively stable over the past three years. At least eighteen minors visited the Gender-Affirming Clinic in the last 10 months of 2023, although a couple more may have dropped in January and February that year. Sixteen visited in 2024. Fifteen visited through the first nine months of 2025, but by the end of the year, that total will likely be a few visitors higher.

These numbers may be small, but that is because Prince Edward Island has a small population of around 182,000. (For comparison, the entire population of the island is comparable to the mid-sized cities of Sherbrook, Oshawa, or Abbotsford.) Thus far in this series, we have data on the number of unique pediatric visitors to the Gender-Affirming Clinic in Prince Edward Island, the hospital-based gender clinics in Ontario, and the hospital-based gender clinics in Alberta. If we compare the number of children and adolescents who visited these with the number of children and adolescents in each of these provinces, the rates of minors seeking help with their gender dysphoria are comparable. In Prince Edward Island, there are 1.0 pediatric gender clinic visits per 1,000 children aged 10-17. In Ontario, that rate was 1.1. In Alberta, it was 1.8. While this data is incomplete (e.g. it does not take into account community gender clinics in Ontario or Alberta), this gives us some idea of the rate at which children and adolescents are seeking help with gender dysphoria.

The province reports that fewer than five sex-denying procedures have been performed in the province in the last 25 years. Given that all other surgeries are performed out of province, these surgeries were likely hysterectomies and oophorectomies. All of these surgeries were performed on adults. No sex-denying surgeries have been performed in minors in PEI.

Conclusion

Despite its small size and population, Prince Edward Island is not immune to the promotion of medical transitioning. It fully funds more types of sex-denying procedures than any province in the country. Although gender surgeries are limited to adults, there are no age restrictions on hormonal interventions. Most children suffering from gender dysphoria are referred to pediatricians or family doctors, though there is one dedicated gender clinic in Charlottetown. Forty-nine minors have visited this clinic in the last three years, but the number of minors who have been treated for gender dysphoria by family doctors is unknown. The number of children and adolescents who are on puberty blockers and cross-sex hormones is also unknown. Thankfully, there is no record of any underage Prince Edward Islander ever receiving a sex-denying surgery.

With nearly 40% of Canada’s population, Ontario likely provides the greatest number of medical transitions to minors in the country. While the Ontario policy and providers of sex-rejecting interventions are publicly available, any specific statistics on the number of children and adolescents who are transitioning are lacking.

Until now.

After describing Ontario’s gender medicine policies and where these interventions are provided, this article gives some insight into the extent of medical transitioning for minors in Canada’s largest province.

Policy

As with most other Canadian provinces, Ontario doesn’t regulate medical transitioning. Sherbourne Health, an organization that provides services “to people who may experience barriers to accessing health care” such as “2SLGBTQ people” runs Rainbow Health Ontario. Rainbow Health Ontario is the province’s leading promoter of medical gender transitioning. As part of their efforts, Rainbow Health Ontario publishes its own 136-page Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patientsto help clinicians in their day-to-day practice. However, the document focuses on those who have completed puberty “and does not address considerations for trans and non-binary children or youth who have not completed puberty.”

The Guidelines promote an “informed consent model” for hormonal transitions rather than a traditional “gatekeeper model.” This informed consent model dispenses with any in-depth mental health assessment or referral process, though the Guidelines claim that this does not equal “hormones on demand.” Sherbourne Health claims that “new patients are usually seen for a number of visits prior to the initiation of hormone therapy,” though urgent cases are fast-tracked. A diagnosis of gender dysphoria or gender congruence is recommended prior to hormonal transition.

To be eligible for public funding under OHIP, a physician or nurse practitioner must fill out a Request for Prior Approval for Funding of Sex-Reassignment Surgery to be approved by the Ministry of Health. This form requires that a patient be assessed “by a provider trained in the assessment, diagnosis, and treatment of gender dysphoria in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care.” This assessment for “chest surgery” requires the diagnosis of persistent gender dysphoria for a mastectomy and a gender dysphoria diagnosis plus 12 months of continuous hormone therapy with no resulting breast enlargement (unless hormones are not recommended) for breast augmentation. For “genital surgery,” the assessment requires a diagnosis of persistent gender dysphoria, 12 continuous months of hormone therapy (unless hormones are not recommended), and 12 continuous months of living in their new gender role.

These are not legal requirements, however. They are funding requirements. It is perfectly legal to perform a sex-denying surgery on a minor who doesn’t have a diagnosis of gender dysphoria, who has never been on cross-sex hormones, or lived in their “new gender role.” Those requirements must only be met if the surgeon or patient wants the government to pay for their surgical transition.

There are no age restrictions for surgery on the form. Most surgery providers do not publicly list any minimum age requirements for gender surgeries, either.

Ontario covers the cost of puberty blockers, cross-sex hormones, and most “top” and “bottom” gender surgeries for minors if the proper forms are submitted. Some chest contouring and breast augmentation procedures are not publicly funded.

Providers

Puberty blockers and cross-sex hormones are relatively easy to access in Ontario. Many primary care providers (i.e. family doctors) now prescribe them to children and adolescents. One study with data collected in 2009-10 found that 67% of trans-identifying people in Ontario who were hormonally transitioning were prescribed these hormones by their family doctor. Rainbow Health Ontario believes that percentage “is almost certainly greater now.”

But if a family doesn’t have a family doctor who is willing to prescribe hormones, many community health clinics offer them. For example, Northern Ontario’s Gender Diversity Clinic, York’s Gender Affirming Health Clinic, Kingston’s Transgender Health Program, Durham’s Gender Care Team, Chatham-Kent’s Youth Gender Diversity Clinic, and Thrive Kids’ Clinic’s Gender-Affirming Pediatric Care program in Toronto all explicitly say on their websites that they prescribe puberty blockers and cross-sex hormones to children and adolescents.

There are also four hospital-based gender clinics in Ontario. SickKids Hospital Gender Clinic in Toronto, “one of the largest transgender youth clinics in Canada,” and CHEO’s Gender Diversity Clinic in Ottawa garner the most attention. But the London Children’s Hospital’s Gender Pathways Service and McMaster Children’s Hospital Adolescent Medicine Clinic provide hormonal transitioning to children as well.

Gender surgeries are primarily performed at the Women’s College Hospital in Toronto and the Ottawa Hospital. The Women’s College Hospital began offering gender surgeries in 2018, claiming to be the “first public hospital-based surgical program in Canada focused on providing safe and timely access to gender affirming surgical care.” It offers most “top” and “bottom” surgeries. The Ottawa Hospital’s gender-affirming surgery clinic opened in 2023, offering not only “top” and “bottom” surgeries but also facial feminization and masculinization surgeries. That hospital claims that “it is the only clinic in Ontario and the second in Canada to offer all three” types of procedures.

Specialty clinics such as Catalyst Surgical and GraceMed are dedicated to exclusively providing gender surgeries, with GraceMed alone claiming to have performed over 2,500 gender surgeries since 1988. Other plastic surgeons and clinics across the province also list “gender-affirming surgeries” among their wider cosmetic offerings.

Prevalence

It is challenging to find data on the number of minors who are medically transitioning in Ontario. The ideal dataset would reveal the full number of minors currently prescribed puberty blockers or cross-sex hormones for the purpose of a gender transition, plus the number of “gender-affirming” top and bottom surgeries performed on minors each year. But there are a couple of factors that make such data difficult to collect.

First, so many players are involved in gender medicine – children’s hospitals, specialized gender clinics, and family doctors. Not everyone involved in providing gender medicine is reporting all the needed data. And so, the little data available is often only a few puzzle pieces of the entire picture. Second, because all the medications or surgeries prescribed for a gender transition are also used to treat other conditions (e.g. precocious puberty, breast or prostate cancer, menopause, or naturally low hormone levels), it is difficult to isolate prescriptions for “gender-affirming care.” For example, it is relatively straightforward to find the number of prescriptions of testosterone through a public drug plan. But that data isn’t very helpful when the reason for prescribing testosterone isn’t listed in the data.

Because of all of this, the government doesn’t publish comprehensive data on medical transitioning anywhere. In most cases, that’s because the government doesn’t have the information. They simply let the system of medical transitioning carry on.

A couple of FOI requests to the government of Ontario confirm this. The government confirmed that they do not comprehensively track the number of minors receiving puberty blockers or cross-sex hormones at community health clinics from family doctors. However, the Ministry of Health began receiving data on the number of children and adolescents served at the four hospital-based gender programs. Due to a lack of reporting, the only total that we can report with certainty is that these hospital-based pediatric gender clinics saw 1,430 children in 2023-24. The Children’s Hospital of Eastern Ontario (CHEO) in Ottawa saw more than half of those patients. And in three of the four comparative years, the number of minors visiting these clinics increased from the previous year.

These numbers, however, are just the tip of the iceberg. They do not include the number of children and adolescents seen at community gender clinics or by family doctors. Remember that as far back as 2009-2010, two-thirds of hormonal transitions were prescribed by family doctors, and that figure is likely much higher today. If family doctors still see two-thirds of all children with gender dysphoria and community gender clinics see as many children as the hospital-based clinics, the number of children seeking medical help for gender dysphoria would be approximately 8500 a couple of years ago.

Furthermore, Ontario stated that it does “not track SRS [sex reassignment surgeries] performed in-province.” Ironically, they do track such surgeries performed out-of-province and even out-of-country.

From 2018-2024, Ontario sent almost 3,000 individuals out of the province and even out of the country for gender surgeries. That averages out to about 420 per year. For the sake of context, Ontario sent more residents out of the province for gender surgeries than the province of Alberta performed last year. Now, Ontario doesn’t send patients out of the province for these surgeries because no institution provides them in Ontario. As mentioned above, hospitals and gender surgery clinics provide the full gamut of gender surgeries in the province. Patients were likely sent out of the province and out of the country because there was too much demand for these surgeries for these Ontario hospitals and clinics to handle. Sending patients outside Ontario allowed them to get surgery faster.

The government did not release the locations of where these surgeries occurred, but most out-of-province surgeries likely occurred at GrS Montreal, which is well known for handling gender surgeries for people around Canada.

Relatively few gender surgeries (roughly 40) were performed on minors out-of-province or out-of-country over the last few years. In 2018, fewer than five minors were sent out of the country for a phalloplasty. (Ontario lists numbers between one and four as <5, which makes data less precise but protects individuals’ privacy.) Nineteen minors received mastectomies out of province in 2021, sixteen more in 2022, and fewer than five in both 2023 and 2024.

Many gender ideologues claim that gender surgeries are not performed on minors in Ontario. But the above data demonstrates that minors from Ontario have been operated on out of province, paid for by OHIP. And while there is ironically no data on gender surgeries performed within Ontario (even though we have data on out-of-province surgeries for Ontarians), with no legal or clinical rules against it in Ontario, such surgeries have likely happened here too.

Conclusion

There are no legal restrictions on medical transitioning for minors in Ontario. The non-governmental organization Rainbow Health Ontario provides guidelines for clinicians, but its guidelines don’t address age restrictions. Puberty blockers, cross-sex hormones, and most “top” and “bottom” surgeries are eligible for public funding through OHIP, provided that a person is diagnosed with persistent gender dysphoria. In some cases, a twelve-month waiting period is required as well.

Unfortunately, only some of the data on children who are medically transitioning is available. Over 1,400 children visited hospital-based gender clinics in 2023-24. Many more visited community gender clinics or their family doctor. Approximately 40 minors received mastectomies out-of-province in the last few years, and up to four minors received bottom surgeries out-of-country in 2018. No data is available on the number of gender surgeries performed in the province.

Under the Microscope: Nova Scotia

Policy

Nova Scotia is the only province other than Alberta to have clearly stated age restrictions for medical transitioning in its Gender Affirming Care Policy. Unfortunately, it only applies to surgery. The general rule is that a person must be 18+ to receive gender transition surgery, but 16- and 17-year-olds may request an exemption if they “demonstrate the emotional and cognitive maturity required to provide informed consent.” In other words, there are exceptions to this rule for mature minors.

However, Nova Scotia’s policy sets no hard age limits on hormonal therapies (puberty blockers and cross-sex hormones). Instead, following the World Professional Association for Transgender Health (WPATH) Standards of Care (SoC) 8, Nova Scotia requires that a gender dysphoric adolescent must have begun puberty (i.e. Tanner 2). The policy states that adolescents normally reach this stage of development between the ages of 8-14 years.

Most forms of medical transitioning are publicly funded. Hormonal therapies are covered under the Nova Scotia Pharmacare Programs. “Top” and “bottom” surgeries are also publicly funded through the province’s Medical Services Insurance, though other surgeries (e.g. facial feminization, liposuction, tracheal shave and voice pitch surgery) are not covered.

Providers

The primary provider of pediatric gender medicine is IWK Health, formerly the Izaak Walton Killam Hospital for Children. According to their website, “IWK Health is a proud leader in gender-affirming care. We ensure youth in Nova Scotia access support and treatment based on evidence. Gender-affirming services at IWK Health include assessment for gender incongruence and assisting non-binary and transgender adolescents in understanding and meeting their embodiment and health goals.”

Nova Scotia Health advises that adolescents 17 and younger living within the Halifax Regional Municipality will be served by IWK Health’s Trans Health Team, while those outside the area will be connected with a “trans health clinician” in a local Community Health Centre. Specialized gender youth clinics recently opened in Kentville and Bridgewater, with more such clinics in the works. Eighteen-year-olds (who are still minors in Nova Scotia) can simply go to their family doctor or nurse practitioner or to a “WPATH SoC-trained clinician.”

As for surgeries, while some are performed in Nova Scotia, the province sends most people seeking surgeries to the Centre Métropolitain de Chirurgie-GrS Montréal in Quebec.

Prevalence

As we’ve mentioned before, it is challenging to find data on the number of minors who are medically transitioning. The ideal dataset would reveal the full number of minors currently prescribed puberty blockers or cross-sex hormones for the purpose of a gender transition, plus the number of “gender-affirming” surgeries performed on minors each year. But there are a couple of factors that make such data difficult to collect.

First, so many players are involved in gender medicine – children’s hospitals, gender clinics, and family doctors – that it is hard to collect all the relevant data. Not everyone involved in providing gender medicine reports all of the needed data. And so, the little data available makes up only a few pieces of the puzzle. Second, because all the medications or surgeries prescribed for gender transition are also used to treat other conditions (e.g. precocious puberty, breast or prostate cancer, menopause, or naturally low hormone levels), it is difficult to isolate prescriptions for “gender-affirming care.” For example, it is relatively straightforward to find the number of prescriptions of testosterone through a public drug plan. But that data isn’t very helpful when the reason for prescribing testosterone isn’t listed in the data.

In sum, the government doesn’t publish comprehensive data on medical transitioning anywhere. In most cases, that’s because the government doesn’t have the information. They simply let the system of medical transitioning carry on.

Some data on the number of minors who are medically transitioning in Nova Scotia have been uncovered by various Freedom of Information Requests, mostly filed by Melanie Bennet from Juno News. The FOIs revealed that 21 “top” surgeries (mastectomies) and 9 “bottom” surgeries were approved for minors in the fiscal year 2023-2024 in Nova Scotia and out of province. (In an attempt to maintain privacy, every number that is below 5 is redacted under the code 20(1). Hence, each cell obscured by 20(1) could be read as below 5 but at least 1.)

However, only a few of these surgeries were actually performed. No “bottom” surgeries and fewer than five “top” surgeries were performed on Nova Scotians younger than 19 from 2023-2024.

The reason for the difference between the number of surgeries approved and performed is not clear. It is possible that there was enough of a time delay between the approval of a gender surgery and the performance of a gender surgery that the person aged out of the data. For example, an 18-year-old could be approved for a mastectomy, but that mastectomy isn’t performed until she is 19. Alternatively, a young person may initially want surgery and receive approval but then decide they don’t want it.

Unlike most other provinces, Nova Scotia has released some data on the number of minors receiving puberty blockers and cross-sex hormones in recent years. Prescriptions for these hormonal interventions were relatively low from 2019-2023, with no more than 9 minors receiving puberty blockers and 37 receiving cross-sex hormones in a given year. But these numbers exploded in 2024 when 90 received puberty blockers and 195 received cross-sex hormones the following year. That is a 1000% and 696% increase, respectively, in a single year.

The reason for this spike is unclear. It may be the result of the opening of a new youth gender clinic in Kentville in February of 2024, allowing many minors who wanted hormones but previously couldn’t get them to access them. Or the number of minors actually seeking gender hormones went up drastically. Neither of these seems plausible to account for such a dramatic spike, however. It might simply be due to differences in data reporting, with the majority of minors receiving hormone therapy not being reported in previous years.

Conclusion

As in most other provinces, Nova Scotia liberally permits medical transitioning for minors. There are no hard and fast age restrictions to receive puberty blockers or cross-sex hormones. The province generally restricts “top” and “bottom” surgeries to those eighteen and older, but allows exceptions to this policy for 16- and 17-year-olds. Unlike most other provinces, Nova Scotia has some specific data on the number of minors who are medically transitioning. Ninety kids were prescribed puberty blockers and 285 were prescribed cross-sex hormones in 2024. Twenty-two were approved for “top” surgery and nine for “bottom” surgery in 2023-2024, though fewer than five actually received a mastectomy, and none received genital surgery.

Sadly, many children today experience distress about their bodies – about being male or female and about sexually maturing into a man or woman. They may say they feel stuck in the “wrong” body. A technical term for this is “gender dysphoria.” It has risen exponentially in children in the past decade, especially among teen and pre-teen girls. Plenty of evidence suggests this rise is largely a social phenomenon or “social contagion.”

People who support medical transition for minors believe they are supporting kids’ freedom to “be themselves.” But it’s not so simple. A person’s self-conception can change. His or her DNA and biological sex cannot change (though pharmaceutical and surgical interventions can make somebody appear more masculine or feminine). In a fundamental sense, you are your body. You didn’t choose it. You wouldn’t exist without it.

Male and female bodies are good and beautiful just the way they are. Boys should be free to take joy in picking flowers or playing with babies without questioning if they’re in the wrong body. Likewise, girls should be free to love sports, find bugs or be uninterested in dresses or dolls while still accepting and celebrating their natural bodies.

But our culture presents a mess of conflicting messages: airbrushed, impossible standards of beauty and people as sexual objects on the one hand; messages of body positivity and self-acceptance (“love the skin you’re in,” “amazing just the way you are”) on the other, and so on.

When did “being yourself” begin to require major medical alterations to healthy bodies?

We should not teach children to question basic bodily realities, as our schools currently do, by teaching them that their body might not match their “true” identity. Not only does this reinforce tired gender stereotypes, but it also causes mental and physical anguish.

Using puberty blockers, cross-sex hormones and even so-called gender reassignment surgeries on minors is quite new. While most children overcome gender dysphoria by adulthood without pharmaceutical or surgical interventions, once a child is given puberty blockers, that decision usually proves fateful, as most who start puberty blockers go on to also receive cross-sex hormones.

This helps explain parents’ desire to know what is going on with their children at school since school is where a child might start to identify as trans and be affirmed in that identity. By the time a child is convinced he or she is trapped in the wrong body and needs medical treatment, a concerned parent will be in a very difficult position.

The risks from cross-sex hormones alone include infertility, blood clots, hypertension, heart disease, cardiovascular disease, cerebrovascular disease, weight gain, sleep apnea, central nervous system tumours, urinary problems, erectile dysfunction, type 2 diabetes, low bone mass, osteoporosis and more. The risks of surgeries are significant as well.

Thus, it is no surprise that even progressive, trans-affirming nations have recently reversed or revised their approach to treating gender dysphoria in children. In Sweden, pediatric gender clinics stopped prescribing puberty blockers after a documentary by Mission Investigate, Sweden’s premier investigative news program, revealed that clinics neither fully informed parents of the harmful side effects of puberty blockers and cross-sex hormones nor monitored for such effects. Sweden’s famous Karolinska Institute, which pioneered medical interventions for gender dysphoria, now permits puberty blockers only as part of controlled clinical trials.

In Australia and New Zealand, the medical regulators of psychiatry have advised pediatric gender clinicians to first support children’s mental health needs and move cautiously and slowly toward medicalization.

Canada has become perhaps the most “affirming” and “progressive” nation on Earth when it comes to gender ideology, especially in education and healthcare. But this has largely occurred without meaningful public debate. That debate is long past due.