How Alberta’s Child Gender Transition Restrictions Compare to Those in US, Europe

by EditorL

Pro-transgender protesters in Montreal, Canada, on March 17, 2023. (Andrej Ivanov/AFP via Getty Images)

Pro-transgender protesters in Montreal, Canada, on March 17, 2023. (Andrej Ivanov/AFP via Getty Images)

Alberta’s sweeping changes to restrict medical transitioning for children are a first in Canada in the face of ever-increasing numbers of children surgically altering their bodies.

Before the province’s latest announced policies, a number of U.S. states had implemented bans on altering the bodies of minors—those under 18 years of age. As well, some European countries have introduced restrictions on the procedure for children.
In May 2023, Florida passed legislation that bans gender-reassignment prescriptions and procedures for those under 18. The legislation also allows the state to step in and take custody of a child under 18 if there is concern that these gender-reassignment treatments are being used or will be used on the child.
The following month, Texas passed a law that restricts health-care providers from performing gender-reassignment surgery on those under 18. They are also prohibited from providing or prescribing drugs that induce transient or permanent infertility, including puberty blockers meant to stop or delay normal puberty and hormone therapies meant to change a child’s body to that of a different sex.
Utah had also earlier, in February 2023, passed a bill that prohibited transgender surgeries on those under 18 and prohibited hormone treatments to those minors not diagnosed with gender dysphoria before the bill was put into effect.
About 20 other U.S. states have bans or restrictions on transgender medical care for minors, according to a review by Reuters published in August 2023. Among them Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, South Dakota, Oklahoma, Tennessee, and West Virginia.

Some states are considering laws to allow individuals who were provided transgender medical care to launch civil lawsuits for medical malpractice.

In Hawaii, Oklahoma, and New Jersey, legislation has been introduced to require jail time for medical professionals who offer gender-altering treatment or procedures to those under 18.

Under Alberta’s new policies introduced on Jan. 31, “top and bottom” gender reassignment surgeries are banned for those under the age of 18, while those under 16 will not be permitted to take puberty blockers or hormone therapies as part of gender reassignment treatment.

Those aged 16 and 17 will be permitted to take medications for gender reassignment “so long as they are deemed mature enough to make these decisions and have parental, physician, and psychologists’ approval,” Alberta Premier Danielle Smith said on Jan. 31.


In the United Kingdom, gender-transition surgery is not permitted for children under 18, and medications like puberty blockers are only permitted if the patient has met “strict criteria.” Cross-sex hormones are permitted for individuals who are 17 and have been on puberty blockers for at least 12 months.

The National Health Service (NHS) changed its policy over the past several years, first to ban access to gender-change surgery for teens and in 2023 to restrict access to transgender-care medications.

“Most treatments offered at this stage are psychological rather than medical,” the NHS website says. “This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.”

In 2022, Sweden also began to pull back on medical interventions for children looking to change genders, following a similar move by Finland two years earlier.

Finland opted to focus on mental health interventions for those identifying as different genders.

Sweden’s National Board of Health and Welfare aimed to update its policy, and advise against puberty blockers, surgery, and hormonal treatments before adulthood.

Rise of Transgender Treatments

According to an industry analysis by India- and U.S.-based Grand View Research, the U.S. sex-reassignment surgery market was estimated at US$2.1 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 11.25 percent from 2023 to 2030.

“The rising prevalence of gender dysphoria and the increasing number of individuals in the U.S. opting for gender affirmation surgeries are expected to boost market growth over the forecast period,” the analysis found.

Numbers compiled by Komodo Health for Reuters show that the number of minors across the United States who received a diagnosis of gender dysphoria nearly tripled between 2017 and 2021.

In 2017, 15,172 children and teens between the ages of 6 and 17 in the United States were diagnosed with gender dysphoria. By 2021, that number had grown to 42,167.

The data show that “top surgery” to remove breasts is more common among teens than other types of transgender surgery.

From 2019 to 2021, at least 776 mastectomies, the surgical removal of breasts, were performed in the United States on patients ages 13 to 17 with a gender dysphoria diagnosis. The information is based on insurance claims and does not include treatments that were privately paid for.

Naveen Athrappully, Lily Zhou, and Reuters contributed to this report. 

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