Gender Affirming Care for Minors: What’s Actually Happening
Written by Joyo Smit
Header and Thumbnail by Artem Kniaz from Unsplash
Introduction
As a Canadian federal election approaches, voters are looking to the representatives of the varying parties to understand their vision for Canada. Their policies, opinions, and goals for the country decide whether or not a Canadian chooses to vote for them. The elected party will have the political power to enact change within the Canadian government. It is important to understand the viewpoints of your representatives, and how they may affect the population in terms of the resulting legislation. In your own observations of Canadian politicians, you may have heard them speak on gender affirming care for transgender minors: some for, and some against. In this article, we will explore what this means and how this kind of care for transgender adolescents happen in Canada.
The Transition Process
A person’s transition includes a vast array of experiences, very few if any of them medical. A transgender child may change their hair, their clothes, or the way they present themselves. They may go by a new name and/or pronouns at school and with family. This is called social transition. Before the onset of puberty, this is the only transition process a child can undergo. No medical interventions are available or necessary before hormonal and physical changes begin. Children are naturally curious about themselves and may go through stages as they process their own identity. This is natural for developing a sense of self for any child. So, if a child later changes their mind, no permanent alterations have been made.
Canada’s Approach
Canada follows the standards for transgender care as outlined by WPATH, a global non-profit organization dedicated to the health of transgender individuals, including minors. Their standards of care, currently on its eighth iteration, are based on years of science-based research. Numerous scientific studies are referenced throughout the standards, stretching over at least two decades. Any Canadian looking into medically transitioning must be evaluated by a WPATH certified psychologist. If they meet the necessary criteria, they will receive a letter of readiness, signifying that their doctor may prescribe them the desired treatments. In this article, I will be referencing the criteria necessary for adolescents to be approved, which are slightly more strict than those for adults. For all treatments, the individual must demonstrate decision-making maturity as well as sustained gender incongruence. Parental involvement in the decision process is highly encouraged, but its enforcement varies by province. In Nova Scotia, the parents/guardians are required to be involved, unless such involvement is not possible or it is deemed detrimental to the child.
Hormone Blockers
So what does a medical transition look like for minors? The first option is to receive hormone blockers, which halt the progression of puberty. According to the WPATH standards of care, these may only be prescribed once puberty has begun (around ages 8-12) and if gender incongruence is maintained during these physical and hormonal changes. These puberty blockers are largely reversible, and are sometimes even prescribed to cisgender patients experiencing early puberty, intense menstrual pain, and other issues. It is worth mentioning that hormone blockers are only useful for those who have not completed puberty. They do not reverse puberty for those who have already completed it. From a psychological perspective, hormone blockers give an adolescent more time to process and figure out what they need while pausing the permanent changes that may be distressing.
Hormone Replacement Therapy
Transgender minors may also be able to take cross-hormones, a treatment where a transgender person’s hormone balance is changed to better represent their true gender. This treatment results in the individual gaining the secondary characteristics of the sex opposite to the one assigned at birth, such as facial hair or growing chest tissue. The effects of this treatment are permanent. The effects of going through the assigned puberty, though, are just as permanent. For a trans individual, going through the body’s natural puberty can be devastating mentally. There is no specific age at which a child is able to take these, as pubertal effects can vary vastly from child to child.
Gender Affirming Surgery
Surgical options are rarely available to trans adolescents. Only chest surgery for individuals assigned female at birth are considered before the age of majority (18 in Canada). However, the rate of this occurring is extraordinarily low. The individual must have been in the medical transition process for some time and usually must demonstrate significant distress caused by gender dysphoria. Since this distress can lead to suicidality, waiting until adulthood may put the individual at risk. In these cases, family, physicians, and the individual may together decide that surgery is the best option. In Canada, only those over the age of 18 years old can receive bottom (sex reassignment) surgery.
Political Response
What are Canadian politicians saying about this? Most notably, Danielle Smith, the Premiere of Alberta, has introduced three bills, including the ban of medical intervention for youth under 16, limiting sex education and pronoun use, and preventing trans women from participating in sports. In terms of candidates for Prime Minister, they have varying opinions on gender-affirming care for minors. Below is a list of statements from each party leader on this topic (Justin Trudeau is listed in place of the Liberal leader who will replace him in the upcoming election).
Pierre Pollievre (PC)
Pollievre publicly agreed with Danielle Smith, in that hormone blockers for minors should be banned. He believes such choices are “adult decisions” that should not be made until the age of 18.
Jagmeet Singh (NDP)
The NDP condemned Pollievre’s statements, saying it goes against what healthcare experts are saying. Further, the policies blocking access to these resources “cause irreversible and irrevocable harm” to transgender adolescents.
Justin Trudeau (Liberal)
Justin Trudeau made a statement criticizing Danielle Smith’s proposed bills. He points out that trans youth are vulnerable, and should be protected by the government. There are other things, such as the housing crisis and climate change, that he believes deserve to be fought against instead.
Elizabeth May (Green): No statement is currently available.
Yves-François Blanchet (Bloc Québécois): No statement is currently available.
Policy on gender affirming care for minors varies from party to party. Therefore, in the coming election, transgender minors will feel the effect of your vote as policies are put in place. There are many things to consider during this coming election, such as housing, food prices, and international policy. However, it is important to remember that vulnerable groups may be harmed as a result of a party’s opinions. Your voice matters, and it will contribute to how Canada will run in the coming years.