NWT promises continued access to gender-affirming care

The Northwest Territories government is promising residents, including youth and children, that they will continue to have access to gender-affirming care even if some services are no longer available in Alberta.

In a Monday press release, the territory’s Department of Health and Social Services said in cases where those services are not available in the NWT, health care providers can refer residents outside the territory. If a required service is not available in Alberta, the department said “alternative pathways for care” are in place elsewhere in Canada.

“All NWT residents have the right to respectful, dignified and culturally safe health care,” the release stated.

The announcement comes after the Alberta government revealed impending changes to gender affirming care in the province last month.

That includes plans to ban hormonal treatment and puberty blockers for children aged 15 years and under, unless they are already undergoing treatment. The province also plans to ban top surgery – augmentation or removal of breast tissue – and bottom surgery – which includes phalloplasty and vaginoplasty – for people aged 17 years and younger.

Centre Métropolitain De Chirurgie in Quebec, where Alberta residents are currently referred for gender affirmation surgeries, already limits bottom surgery to people aged 18 years and older and top surgery to people aged 16 years and older, among other requirements.

Alberta is also planning gender identity-related policy changes outside the healthcare system. That includes banning transgender women from competing in women’s sports leagues and requiring children 15 years and younger to have their parents’ permission to use a different name or pronoun at school.

Alberta Premier Danielle Smith has said the new policies will prevent minors from “making permanent and irreversible decisions” that impact their reproductive health.

“In my view, one of the greatest responsibilities we as parents, teachers and community leaders have is to preserve for our children the right to grow and develop into mature adults so that they are better prepared to make the most impactful decisions affecting their lives,” she said in a video posted to X, formerly known as Twitter.

“It is my view that list of adult choices includes deciding whether or not to alter one’s biological sex.”

The Northern Mosaic Network, other 2SLGBTQIPA+ advocates and some medical experts in Canada, however, have criticized the changes. They argue the policies and the messaging around them are at odds with research on gender affirming care, could increase risk of suicide and self-harm, and undermine the rights of transgender and non-binary youth and children.

“These policies cruelly target 2SLGBTQIPA+ children and youth and put their well-being and lives at risk,” Northern Mosaic Network wrote in a statement.

The organization said it was concerned how the changes could impact NWT youth. It said it was collaborating with the NWT government on an action plan to ensure NWT residents continue to have access to gender-affirming care.

“To our community – we see you, we value you, and we will continue to advocate for you,” it wrote.

The NWT government said hormonal therapy for adults can be prescribed by family physicians in the NWT. Children are referred to NWT pediatricians for gender-affirming care who typically consult with specialist pediatricians in Alberta.

Under territorial guidelines, NWT residents require one assessment to be eligible for top surgery and two assessments for bottom surgery. Other requirements for gender-affirming surgeries include persistent, well-documented gender dysphoria, the capacity to make fully-informed decisions, 12 months of hormone therapy, and being at least 19 years old for bottom surgery.

“It is important to remember that transgender, non-binary, and gender nonconforming children and youth are still experts in their transition and their experience,” the guidelines state. “While there are steps that parents need to provide consent for, it is imperative that transgender, non-binary and gender nonconforming children and youth feel heard and respected during this process.”

The territorial health authority said it was not consulted about the policy changes in Alberta, but it has a “close working relationship” with Alberta Health Services.

A spokesperson for Alberta’s health ministry said they are “early in the development of these policies” and plan to consult with the NWT about implementation.

Elsewhere in Canada, Saskatchewan and New Brunswick have passed policies requiring students under the age of 16 to have parental consent to use different pronouns or names at school.