By J. Edward Les, November 5, 2025
Alberta’s new law restricting puberty blockers and “gender-affirming” surgeries for minors under 18 has sparked a firestorm of controversy. Officially called the Health Statutes Amendment Act 2024 (No. 2), it has drawn sharp criticism from politicians, advocacy groups, and some medical professionals.
At a February 2024 rally outside of Calgary City Hall, former mayor and future Alberta NDP leader Naheed Nenshi declared: “Premier, I want you to understand that votes aren’t worth a few dead kids.”
Mark Holland, then federal Health Minister, decried Premier Danielle Smith’s actions as “playing politics with children’s lives.” And former federal Employment Minister and Edmonton MP Randy Boissonnault blustered: “I don’t see ‘MD’ after Pierre Poilievre’s name or Danielle Smith’s. So, it’s none of their business.”
Unlike Mr. Boissonnault I do have an MD after my name. I’ve been a pediatrician in Alberta for more than 20 years. So, this is certainly my business.
In June 2025, an Alberta judge issued a temporary injunction halting key sections of the legislation pending a full constitutional review, citing potential Charter violations and harm to affected youth. While the legislation faces ongoing legal challenges from LGBTQ+ advocacy groups Egale and Skipping Stone and by the Canadian Medical Association (CMA), the province has doubled down on its broader gender-policy agenda. In September 2025, Alberta expanded restrictions to include new rules barring transgender athletes aged 12 and up from competing in female amateur leagues and requiring parental notification for preferred pronoun changes in schools – moves that have drawn both national praise and outrage.
The Alberta Medical Association (AMA), via the Section of Pediatrics and the Section of Pediatric and Adolescent Psychiatry, issued statements sweeping aside concerns about the transition of gender-conflicted children and expressing grave concerns with Premier Smith’s actions – concerns echoed by the Canadian Pediatric Society (CPS).
But I’ll be crystal clear: On this issue, the Alberta Medical Association and the Canadian Pediatric Society do not speak for me. Nor do they speak for many of my colleagues – although most remain deathly afraid to say so for fear of professional condemnation and career harm, so toxic has the debate over youth gender transition become.
There is scant scientific evidence for the stance taken by the AMA or the CPS. Countries such as Norway, Sweden, the UK, Finland, and Denmark have all come to that realization as they firmly tap the brakes on youth gender transition, recognizing the grievous harms that have been caused. Britain’s Cass Review, published in April 2024, laid bare the scarcity of evidence underpinning the so-called “gender-affirming” model of care, as did a series of Canadian-authored meta-analyses and systematic reviews published in early 2025.
Even the New York Times, once one of the most prominent voices in favour of youth gender transition, openly sounded the alarm in a 5000-word piece titled “As Kids, They Thought They Were Trans. They No Longer Do.”
Yet even now Canada carries on apace.
The mantra that sprung up around “gender-questioning” youth in recent years is that they should be “affirmed” in their chosen gender identity for the sake of their mental health. The consensus view adopted by the American Academy of Pediatrics (and shared by their Canadian counterparts) is that a prepubescent child who is insistent, consistent, and persistent in his or her opposite-gender identity for more than six months must be affirmed in that identity; and as soon as puberty threatens (at age 11, on average, for girls, age 12 for boys), invited to begin puberty-blocking drugs – the first step in a potential medical transition pathway.
Let’s look at that affirmation gospel for a moment by taking a step sideways into the world of anorexia nervosa. Despite being thin as reeds, affected individuals believe with every meager ounce of their being that they are overweight. Despite objective evidence that they are grossly underweight, they relentlessly starve themselves in a quest to become thinner. It’s a perilous pursuit: body energy reserves deplete, metabolism slows, heart rates plummet, and cardiac arrhythmias can kill suddenly if congestive heart failure doesn’t do the job first. Anorexics require intensive psychiatric care to correct their distorted self-image, as well as careful nutritional rehabilitation.
What we do not do, as physicians caring for these patients, is enable them in their delusion so long as they are insistent that they are fat, consistently believe that they are fat, and persist in the belief that they are fat. We don’t affirm them in their “fatness” and help them down the road to starvation by withholding food, starving them of counsel, or stapling their stomachs. That would be gross malpractice, if not criminally negligent homicide.
Yet this is how Canadian medical experts would have us approach gender dysphoria. Does that make any sense whatsoever?
The binary nature of human biology remains indisputable; we are born either XX or XY, with rare exceptions (known as disorders of sexual differentiation). The exceptions don’t negate the binary, just as children born with polydactyly (extra fingers or toes) don’t negate the fact that the normal human condition comes with ten of each.
XX codes for big gametes, and XY for little ones. At reproductive age, those gametes can join up and more little humans are made. That’s how it works, and it’s not difficult to comprehend.
From that genetic binary springs the gender binary, wherein boys are boys and girls are girls, with each side of that binary represented by a bell curve. Within each bell curve we certainly see a spectrum of expression from feminine to masculine, from Barbie-loving to rough-and-tumble males, from girly-girl to tomboyish females. This is perfectly normal (and desirable – imagine the blandness of a world without it), and the range of expressions within the binary carries, for the most part, through to adulthood. But that spectrum of expression isn’t the same as “gender fluidity,” the nonsensical term that spawned the notion that there are hundreds of genders and that sprouted a fertile factory of newly invented “pronouns.”
The human species is binary, just as surely as two plus two equals four. But we are being led to believe, like the hapless protagonist Winston Smith in Orwell’s 1984, that the sum of two plus two is five.
The anorexia analogy isn’t exact: some gender dysphoric individuals, after all other avenues are exhausted, undergo transition to relieve their distress – there simply isn’t any other solution, and these patients must be cared for, respected, and supported like anyone else. But transitioning, with its serious, life-long implications, is plainly unnecessary in the vast majority of cases.
In this, Canada increasingly stands apart from its peers. The US Department of Health and Human Services released a May 2025 review acknowledging the limited evidence for youth transition and urging “cautious, data-driven practice” similar to the UK’s emerging model. Canada’s federal institutions, by contrast, have not yet initiated comparable reviews.
We in the medical profession used to recognize gender dysphoria (previously gender identity disorder) as a disorder. This isn’t a moral judgment: pathology isn’t bigotry, it’s simply a departure from the healthy order of things. If I diagnose someone with a disorder like diabetes or appendicitis or schizophrenia, I don’t think any less of them. We go so far in my profession as to label disturbances of health as “disease.” Only amidst the insanity of our current discourse have these time-honoured and useful terms become politically charged and pejorative.
Transgendered individuals have been with us for millennia, but they’ve always been relatively rare. And I’ll say this again, as loudly as I can: they deserve our utmost respect, compassion, and care.
But here, again, transgenderism shares common ground with anorexia. Anorexia, too, has been with us through much of history as a manifestation of mental distress. Like transgenderism, it’s mostly been rare; it hasn’t always been “popular.” Anorexia cases spiked for a time in the late 19th century when it became a feature of the celebrated diagnosis of hysteria, a fabrication also characterized by intermittent blindness, seizures, amnesia, paralysis, and histrionic behaviour. That fabrication eventually faded away as completely as the antiquated notion of evil humours as the chief cause of disease.
Anorexia cases lingered in the background at a low baseline rate until the 1970s. Cases increased as Western ideals of thinness and beauty took root and glamourized images of slender and beautiful young women captured the public’s imagination. The death of famous pop star Karen Carpenter from anorexia in 1983 at the age of 32 drew white-hot attention to the illness from both professionals and the media, and cases subsequently skyrocketed. For a fascinating account of the rise of anorexia, read Ethan Watters’ 2010 book Crazy Like Us: The Globalization of the American Psyche.
Anorexia’s history points to the disturbing reality that awareness often begets adherents. When the rates of anorexia nervosa shot up, it wasn’t that we were recognizing all the anorexics that had always been under our noses. We had a direct hand in creating and exacerbating the phenomenon.
So too with transgender identification. Trans cases have historically been rare, and mostly (adult) male to female. That changed with the efforts of Dutch researchers and the infamous – and now largely discredited – protocol they published in 2011, which brought puberty blockade and youth gender transition into the mainstream. The legitimacy bestowed upon the process by the medical profession was seized upon by activists and media; and combined with the meteoric rise of social media, that led to the dystopian mess we find ourselves in today. Gender transitioning has become the outlet of expression for mental distress for thousands of troubled kids and adolescents – not because of evidence, but because it’s “the thing.”
But here’s the key difference between anorexia and transgenderism: despite the explosion in cases of anorexia nervosa, doctors have never stopped viewing it as a disorder. Not so with transgenderism: it’s now forbidden to call the abnormal “abnormal.” Do so, and expect to be tarred and feathered as a heretic, a transphobe, a hater of children. As the aforementioned New York Times piece details, parents who bring their gender-confused youth to gender “experts” are often met with abominable phrases like “Would you rather have a dead daughter or a live son?” in the process of being bullied down the transition highway. If that isn’t craziness, I don’t know what is.
It’s important to address puberty blockers and the avowals of the AMA and the CPS that they are harmless and wholly reversible: neither assertion is true.
It is true that puberty blockers have been used successfully – and appropriately – for many years by pediatric endocrinologists to treat the condition of precocious puberty. But grave concerns have been raised about osteoporosis and declines in IQ scores with the use of these drugs in interrupting normal pubertal development – concerns that the AMA and the CPS simply ignore.
As for “reversible,” we’re told that if a child who begins this medication has a change of heart two or three years later, he or she can simply stop the drug, and the pubertal cycle will “re-awaken” and carry through normally to completion – no harm done. But here’s the thing: children who start puberty-blocking drugs don’t change their minds. Roughly 98 per cent persist in their desire to transition, and progress to cross-gender hormones. Chemical blockade of puberty isn’t “reversible,” and it’s not hard to see why: imagine the dystopian psychosocial environment created for these children, frozen in prepubescence as their peers move through the complex changes of puberty. They are left behind, stranded on an arrested-development island populated by adult voices “affirming” them in their cross-gender dysphoria. Shifting into reverse after the decision is taken to block puberty is, for all practical purposes, impossible: the die is cast.
Expecting pre-pubescent youth to make the radical decision to move down this pathway makes a mockery of informed consent, the bedrock principle that has always guided ethical medical interventions. One does not know what one cannot yet know: puberty brings profound perceptual changes that children cannot fathom before they go through it. It’s impossible for pre-pubescent children to be acquainted with what their world will look like after puberty.
Again: the Alberta Medical Association and the Canadian Pediatric Society aren’t speaking for me on this issue. They may think they are speaking up for our kids, but they most assuredly are not – they’re speaking against them.
I don’t mean to suggest for a minute that their motivations arise from a place of malevolence. Not at all. But they’ve been thoroughly captured by an ideology that has blinded them to biological reality.
Nor is this the first time this sort of thing has happened. In the 1980s and early 1990s, for instance, “recovered memories of sexual abuse” were all the rage. Thousands of children were coached to bring forth memories of being sexually assaulted by their fathers, coaches, teachers, or camp counselors. Entire professional and academic careers were built upon the phenomenon before it was all exposed as a fraud – but not before many lives were ruined, with families torn asunder and many innocent men imprisoned or dead from suicide. In 2005 Harvard psychology professor Richard McNally dubbed the recovered memory movement “the worst catastrophe to befall the mental health field since the lobotomy era.”
But the transgender scandal, in scope and scale, is far worse than that sad chapter in medical history. In this fraught age of social media, it stands as a particularly horrific model of toxic pop psychology, an almost-impossible-to-resist, terribly contagious virus that has infected the minds of thousands upon thousands of troubled youths (and misguided parents). And all of it, sadly, enabled by physicians.
At long last, thankfully, the tide is beginning to turn internationally. In much of Europe, policymakers and clinicians have adopted a more cautious, evidence-based stance toward youth gender transition. In Canada, however, the conversation remains politically polarized. Alberta’s legislation has become a flashpoint in a national reckoning that is still unfolding.
The tide will turn here as well, as surely as night turns into day. Premier Smith’s initiatives, all the angry histrionics aside, reflect a growing discomfort on the part of the Canadian public with the speed and ideology of gender medicine – a debate that will shape child health policy for years to come.
But I have some questions for my fellow physicians: When will you wake up? When will you see that you’ve been fooled? When will you return to the time-honoured Hippocratic dictum that has always governed our profession: “First, do no harm”?
And for my colleagues who agree with me but who remain silent: When will you speak up? When will you realize, as Albert Einstein observed, that to be silent is to be guilty of complicity?
Dr. J. Edward Les is a pediatric emergency physician in Calgary and author of Cloudy with a Risk of Children: Straight Talk from the Pediatric ER.
