Timeline of Gender Affirming Care in Canada and around the World

The following is a running timeline of major policy shifts and events that signal the evolution of gender affirmation care. This document will be updated from time to time. Hyperlinks to references are active in the content but may not be immediately visible unless you hover over them. We will try to rectify this in a future version. Last updated: December 2024

Canada – New Brunswick December 2024	The new Liberal government in NB revises Bill 713 to remove the condition for parental consent to change of name and pronouns for children under 16. The revised policy “encourages” schools to involve parents in their child’s gender transition but does not require them to do so. The policy requires schools to have one private universal washroom facility.
United States December 2024	US Supreme Court hears arguments concerning the Tennessee ban on puberty blockers and other medical interventions. The outcome will determine whether State bans across the US will be upheld as appropriate medical oversight, or whether the justices will side with the “civil liberties” argument that gender affirmation treatments are sex-discrimination and therefore medical oversight is unwarranted. Believe it or not, those are the fundamental arguments being made.  Significantly (given the culture war that’s been raging on this issue), even the editorial board at the Washington Post is now recognizing the limitations of the evidence supporting gender medicalization of minors given the implications of the upcoming Supreme Court ruling.
New Zealand November 2024	New Zealand Ministry of Health issues new guidance “Additional Safeguards for Puberty Blockers”“The Ministry of Health is today releasing an evidence brief and position statement on the use of puberty blockers for gender identity issues and outlining a more cautious approach to their use. The evidence brief shows a lack of good quality evidence to back the effectiveness and safety of puberty blockers when used for this purpose.”
Italy November 2024	The Italian Association of Psychologists releases a statement after evaluating evidence for gender affirming medical treatments. They called for a national level of monitoring of youth being treated for gender dysphoria and reiterated the need  to study long term and multi-dimensional aspects of care, including psychology as an intervention and alternative to medical interventions. They acknowledge that it is difficult to assess the effectiveness of medical interventions (or withholding medical interventions) on the basis of classical experimental models and therefore the need for a national level of consistent data capture and open access analysis of this information is necessary.
Canada – Alberta October 2024	The government of Alberta introduces new legislation to restrict puberty blockers, hormones and surgeries and requires schools to inform and seek parental support before socially transitioning children by name and pronouns at school.
Canada October 2024	Numerous detransitioners in Canada have turned to crowdfunding to pay for breast reconstruction surgery and other procedures to reverse the effects of gender medicalization while they were minors.
Canada 2024	The Canadian Paediatric Society (CPS) doubles down on gender-affirming care with a new statement that contains several concerning assertions and falsehoods. Canadian clinicians representing the CPS position statement on gender-affirming care openly disparaged the Cass Review, calling it a “critique” and the work of a “single individual” and misrepresented the quality of the methodology used to gather and assess the available evidence on gender-affirming care.
United States July 2024	Half of the US states have bans on using puberty blockers and cross-sex hormones on minor children.
Chile June 2024	Minister of Health discreetly orders the public health system to halt prescribing puberty blockers and cross-sex hormones to youth.November – Senate of Chile votes in favour of prohibiting the spending of public funds on hormonal interventions for gender-distressed youth.
Germany May 2024	The German Medical Assembly passed two non-binding resolutions: one restricting puberty blockers, cross-sex hormones and surgeries for under 18’s to controlled trials and the other to limit gender self-id laws to those over age 18.  Germany’s gender self-id laws are the most similar to Canada’s. Still, this self-governing body of physicians has recognized that there is an unacceptable risk in viewing gender through a solely human rights lens when applied to children and young people. There is likely to be further debate in Germany as there is continued opposition to these newly proposed restrictions on gender self-id and gender transition for children.
France  May 2024	The French Senate voted to restrict treatments with puberty blockers and has imposed a two year wait period. This followed a critique of gender-affirming care by the French medical association a year prior.
Netherlands May 2024	The Netherlands, (birthplace of the Dutch protocol, the practice of treating gender dysphoria in youth with puberty blockers) becomes concerned about the exponential and unexplained increase in youth accessing puberty blockers and other gender medical interventions. The Dutch government orders the Health Council to conduct and independent investigation into gender affirming care due to “increasing criticism about the use of puberty blockers and hormones”.
Canada – Alberta  April 2024	Alberta Premier Danielle Smith announces that the use of puberty blockers, cross-sex hormones and sex phenotype altering surgeries in minors will be limited/restricted.
England April 2024	The National Health Service in the UK ends the “gender-affirmative care model” for youth, replacing it with multi-disciplinary approach that includes supportive psychotherapy as a first line of treatment. Cass Review Final Report is published. It includes 9 new systematic reviews of evidence and new recommendations for the National Health Service that severely limit the use of medical interventions to treat gender-related distress in minors.
Canada – Saskatchewan Fall 2023	The Saskatchewan government implemented a new policy (Bill 137) requiring parental consent for children under the age of 16 who wish to change their name and pronouns at school. UR Pride, with funding from Canada’s premiere trans-rights group, EGALE, brings forward a court challenge arguing infringment of children’s rights under the Charter. Premier Scott Moe invokes the Notwithstanding clause to implement the policy anyway.
UK September 2023	New analysis of a study initiated in 2011 to study the effects of puberty blockers on children reveals that many children suffered deterioration in mental health, and that puberty blockers may “lock in” children to a medicalized treatment pathway as 99% of children went on to take cross-sex hormones. Interestingly, as of the end of 2024, the NHS Tavistock website still has the previous interpretation of the results, which is that puberty blockers are a “well received” intervention. The Tavistock gender identity service for children was recently closed by the British government further to the Cass Review because they deemed their practices were “unsafe”.
Canada – New Brunswick  June 2023	Conservative premier Blaine Higgs introduced Bill 713 requiring parental consent for children under the age of 16 who wish to change their name and pronouns at school. This is the first such policy to be introduced in Canada and the government comes under heavy fire.
Denmark August 2023	The Journal of the Danish Medical Association confirms a shift in the country’s approach. Most youth with gender dysphoria will no longer get a prescription for puberty blockers, hormones or surgery but will instead receive therapeutic counselling and support.
Canada Winter 2023	Canadian detransitioner Michelle Zacchigna launched a lawsuit against her MDs in Toronto. Michelle transitioned as a young adult despite several mental health co-morbidities that she says her medical team failed to assess as contributors to her gender dysphoria.
USA/Global September 2022	WPATH SOC 8 is released with much criticism for removing ethics chapter and reducing and removing age limits at the last minute under political pressure. Emails are later subpoenaed for a US court case which reveal the US Health Secretary, transwoman Rachel Levine, and others influenced WPATH to remove age restrictions. WPATH also scuttled a research review by John’s Hopkins University because the results were not the “positive” evidence they needed.
Canada – Ontario August 2022	The Human Rights Tribunal of Ontario (HRTO) rules that a 6-year-old girl who became distressed after gender identity indoctrination in her Grade 1 classroom did not meet the criteria for “direct discrimination” because she was not denied access to education services. The HRTO did not allow the applicant to bring forward testimony from an expert witness in queer theory to argue that the repeated indoctrination in gender identity theory resulted in a poisoned environment. They heard arguments from the school board and agreed with their position that statements from the teacher such as “there’s no such thing as girls and boys” were adequately corrected when the teacher used a gender spectrum as a further teaching tool with 6-year-olds. There was never any recognition of biological sex as a relevant and important personal characteristic by the teacher and the HRTO did not acknowledge this as a necessary factor. They declared in their ruling that “everyone has a gender identity” which is an unsupported assertion and ideologically based position. The family brought the suit forward to request a public interest remedy that would put guardrails on how gender identity theory can be taught to children.
France March 2022	Observatoire la Petite Sirene (a group of psychiatrists and psychologists in France) calls for attention and review of the practice of gender-affirming care in minors.
Sweden February 2022	A systematic review of evidence and new guidelines for care of gender-distressed youth were developed at the request of the governing left-leaning Social Democratic party of Sweden. This came after the government had intended to lower the age of gender surgeries to 15 but faced a swift backlash from the medical community.  The new guidelines significantly curtail the use of puberty blockers and cross-sex hormones and implement a national monitoring system under clinical trial protocols for the few limited scenarios where puberty blockers are administered.
Canada November 2021	A paper published by the Trans Youth Can project reveals that 64% of youth receive a prescription for puberty blockers or cross-sex hormones at their first appointment at a gender clinic. This is consistent with anecdotal reports in Canada and information gleaned from clinics such as Sick Kids Hospital.
Canada June 2021	Bill C6 – an amendment to the Criminal Code to end Conversion Therapy is passed into law. The Bill was largely advertised to protect LGBTQ individuals from coercive conversion therapy that is realistically no longer practiced in Canada. In effect, the Bill includes gender identity as well as sexual orientation. It is therefore expected to have a chilling effect on any form of therapy that seeks to question or explore whether a child’s gender transition is really in their best interest. Parents can be punished with up to 5 years in prison if they try to remove their child from Canada to seek therapy elsewhere. Supportive psychotherapy has become (as of 2024) the first line of treatment for gender dysphoria in most of the Western world. A conversion therapy ban was one of the CPATH recommendations in the publicly available briefing to the Federal government (see May 2019).
England 2020	The British government commissions the Cass Review to study the evidence and develop new recommendations for care of gender-distressed youth.  NHS England commissions the UK National Institute for Health and Care Excellence (NICE) to conduct an evidence review on puberty blockers. Released prior to Cass Review here: NICE puberty blocker evidence review Keira Bell announces case against the NHS and Tavistock
Finland July 2020	The Finnish Health Authority completed a systematic review of evidence on treatments with puberty blockers and cross-sex hormones. As a result, the Finnish Healthcare system abandoned WPATH’s guidelines and issued its own. These new guidelines indicate that supportive psychotherapy is now the first line of treatment for gender dysphoric youth.
Canada May 2020	The College of Physicians and Surgeons of Ontario rules that the McLean Clinic is making unfounded claims in contravention of the Medicine Act as a result of a complaint filed by Canadian Gender Report. The McLean Clinic is the most prolific plastic surgery centre in Canada performing double mastectomies on minors. It advertises on Instagram and its website. The Clinic was not required to remove their Instagram advertising but instead, elected to make their account “private” so they could better control who is able to access the patient photos and information provided there. The Clinic was required to update its website to remove false claims.
Canada May 2019	CPATH, the Canadian arm of WPATH publishes a briefing to the Standing Committee on Health requesting: – Unfettered access to gender affirmation treatments without the need for mental health assessments which they deem “stigmatizing” (no differentiation between adults and children is made) – A ban on conversion therapy for gender identity – Equal access across Canada for gender affirmation treatments
Canada 2018	A study of youth referred for puberty blockers and cross-sex hormones in Canada begins under the brand “Trans Youth Can”. The study is intended to report demographics and outcomes of self-selected participants across 10 gender clinics at children’s hospitals across Canada. Early presentations of the group reveal that half of Canadian gender clinics no longer require mental health assessments for children and adolescents who wish to begin medical gender interventions.
Global/USA 2018	Concerns begin to be felt globally about the number of young people starting to claim that they are a gender that differs from their birth sex.  Lisa Littman publishes a groundbreaking paper “Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria”. The trans-affirming mob immediately attacks her and her university to try to discredit her and this new theory.
USA AAP  October 2018	American Academy of Pediatrics issues a policy statement: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and AdolescentsThis policy instantiates the idea of affirmation and providing medical interventions such as puberty blockers but ignores previous evidence that indicates gender dysphoria resolves in the vast majority of cases under the watchful waiting protocol. [Update: Following much media scrutiny in 2023, the AAP has agreed to conduct a systematic review of evidence, however the criteria for this review has not yet been disclosed] Canadian Clinical Psychologist and research expert James Cantor published a “fact check” rebuke of the AAP policy later in 2018 and has become an expert witness in the US critical of the AAP recommendations because they are not based on evidence.
USA September 2017	American Academy of Pediatrics issues a policy statement: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and AdolescentsThis policy instantiates the idea of affirmation and providing medical interventions such as puberty blockers but ignores previous evidence that indicates gender dysphoria resolves in the vast majority of cases under the watchful waiting protocol. [Update: Folllowing much media scrutiny in 2023, the AAP has agreed to conduct a systematic review of evidence, however the criteria for this review has not yet been disclosed] Canadian Clinical Psychologist and research expert James Cantor published a “fact check” rebuke of the AAP policy later in 2018 and has become an expert witness in the US critical of the AAP recommendations because they are not based on evidence.
Canada June 2017	The Federal Liberal government passes Bill C-16 which adds “gender identity and gender expression” to the Federal Human Rights Code. All Canadian provinces have already made this addition to provincial human rights codes by this time. The Bill, however, also adds “gender identity and expression” to provisions of the Criminal Code hate speech law. This addition comes under fire from academic Jordan Peterson as crossing a line into totalitarianism by imposing compelled speech.  The Human Rights Code changes are significant for encouraging childhood gender transitioning because schools and the general public are encouraged to view gender self-identity as a human right for children, rather than a complex developmental process that requires thoughtful care and has medical implications.
USA 2016	The largest LGBTQ+ rights group in the United States, the Human Rights Campaign publishes a guide entitled “Supporting and Caring for Transgender Children”. The guide promotes social transition for young children, using Jazz Jennings (the reality TV star) as a poster-child throughout. They also promote medical interventions for “early adolescents” and surgical interventions for older adolescents “as appropriate”. The guide was co-branded with the American Academy of Pediatrics and the American College of Osteopathic Pediatricians. The term “transgender” begins to be colloquialized and replaces the previous term “trans-sexual” which cannot be easily applied to children.
Canada 2015	CAMH conducts a review of the specialist youth gender clinic in Toronto which many now recognize as a witch hunt to discredit world-renowned gender specialist Dr Ken Zucker. The review was commissioned due to criticism that the clinic was practicing “conversion therapy” because they employed a cautious approach to childhood gender transition and worked with families to support joint decision-making to determine whether medicalization was really the best option.  The clinic was closed soon after the review was published. Zucker subsequently sued CAMH for wrongful dismissal and won his lawsuit, including an apology from CAMH and over half a million dollars in damages. The damage to the Canadian approach to medical gender transitioning of children had been done, however, as the elimination of Zucker’s cautious CAMH clinic paved the way for the new “affirm now and ask questions never” approach that has become the standard of care for children who express a desire to transition in Canada.
Global/USA  2013	DSM-5 is published and replaces gender identity disorder with gender dysphoria.
USA 2012	WPATH SOC 7 is published. It includes significant changes in the general ethos of care: – Removes references to biological sex, referring to “adolescents with male genitalia” and “adolescents with female genitalia” – Removes acknowledgement that adolescents’ gender identity development can rapidly and unexpectedly evolve – Removes a critical passage that includes the recommendation to delay physical interventions as long as clinically appropriate – Removes the recommendation for the multi-disciplinary approach to distress adolescents seeking urgent treatments. – Weakens the recommendation for extensive psychological exploration by adding a clause that states that the duration of exploration can be abbreviated – Adds a strong narrative of the importance of biomedical interventions for social and emotional functioning.
Canada – Ontario 2012	“Gender identity and gender expression” is added as a protected characteristic to the provincial human rights code. Most other provinces in Canada enact similar legislation.
Netherlands 2011	The Netherlands research team has begun to publish more low quality studies about pubertal suppression in adolescents. de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011 Aug;8(8):2276-83.
USA  2009	The Endocrine Society publishes the first guideline “Endocrine Treatment for Trans-sexual individuals” that included support for pubertal suppression while highlighting the evidence for this treatment was very low quality (therefore inconclusive and could lead to greater risk than benefit).
USA  2007	Harry Benjamin International Gender Dysphoria Association (HBIGDA) rebrands itself as the World Professional Association for Transgender Health (WPATH).
Netherlands 2006	First published evidence of using puberty blockers in the treatment of gender dysphoria for youth who meet an early childhood onset criteria and where social transition was not a part of the protocol (the “Dutch protocol”). These youth would have needed to be very insistent that they were the opposite gender for a number of years prior to treatments with puberty blockers being initiated. They were also not socially transitioned as children, but monitored under a “wait and see” protocol to determine whether their insistence that they were another gender would persist into adolescence. Over 85% of cases did not persist.
Canada 2005	The first treatment of youth with puberty blockers in Canada is initiated in a similar manner to the Dutch protocol being experimented with at the same time. The youth must have “persistent, consistent and insistent” determination to be the opposite gender. Less than one dozen youth across Canada would have been treated with puberty blockers in a typical year. Most youth are treated at the CAMH clinic in Toronto that is directed by Ken Zucker.
USA/Global	HBIGDA SOC 6 is published including a chapter titled: Assessment and Treatment of Children and Adolescents.  Only 7 children under the age of 16 have been treated with pubertal suppression world-wide by the year 2000.
USA 1998	Harry Bengamin International GD Association SOC 5 is published with sections titled: Children with Gender Identity Disorders and Treatment of Adolescents for the first time.
Global 1994	DSM IV published and replaces the diagnosis transexualism with gender identity disorder.  Utrecht Clinic in the Netherlands reports averaging only 9 children per year in the first seven years.
USA  1979	The first version of the Harry Benjamin International Gender Dysphoria Association (HBIGDA) “Standard of Care” (SOC) 1 was published. It was later renamed the World Professional Association for Transgender Health (WPATH). Several new versions are published in the 80’s and 90’s.