What gender-affirming care is and how it can be life-saving

With so much misinformation circulating online about gender-affirming care, CTVNewsNorthernOntario.ca took a look at what experts have to say about it.

Alberta Premier Danielle Smith admitted last week that her proposed policies surrounding gender-affirming care are based on speculation and "concern of what will happen" rather than current evidence.

Angelina Wiwczor is a nurse practitioner with the NEO Kids gender diversity clinic at Health Sciences North in Sudbury that works with children and youth up to age 18.

Wiwczor estimates the clinic at the Sudbury hospital has supported more than 200 children, youth and families since it opened about five years ago.

What is gender-affirming care?

"What gender-affirming care is, supportive care, respectful care for children, youth, adults, who are gender diverse, whose gender identity may not be in line with the gender that they were assigned with at birth," Wiwczor said.

Gender transition is a spectrum and can be unique to each individual.

Some transgender people choose a social transition, only changing their names, pronouns and external appearances to match the gender with which they identify.

For some, that means expressing their gender with a different hairstyle or clothing.

Others choose a medical transition with the help of medication -- such as puberty blockers and hormones that mimic puberty -- and sometimes surgery.

"It's very individualized care," Wiwczor said.

"For any surgeries that are other than top surgery -- so that would be bilateral mastectomy and having chest tissue removed -- you have to be 18 or older to pursue."

Must be at least 18 for many surgical transitions

There are many steps involving multiple medical professionals in a medical transition.

"(Gender reassignment) is not something that we do … on a first appointment through clinics," Wiwczor said.

"We have to be thoughtful, we have to be safe about what next steps we help those children and youth take moving forward."

Families with young children who start to question their gender identity are generally referred to community and online support.

Many patients at the Sudbury clinic are adolescents, pre-teens and teens.

"I get referrals as young as 11, 12, 13. There's really no common age so to speak," Wiwczor said. "Children, youth especially, once they start to have body changes that are making them feel uncomfortable, that don't fit with their gender identity is generally when those referrals are triggered to be seen by our team." 

The multi-disciplinary team, which includes social workers, ensures the safety of the child or youth throughout the process.

Why is gender-affirming care important?

"Gender-affirming care for children and youth can be life-saving," Wiwczor said.

Suicide is the second-leading cause of death among Canadians ages 15-24.

Research published by the Canadian Medical Association Journal found that the suicide risk for transgender adolescents is five times higher than their cisgender and heterosexual peers.

They are also 7.6 times more likely to attempt suicide.

"Not affirming or supporting a person's gender identity -- whether it's the gender identity they were born with or the gender that they identify with that doesn't match what they were born as -- can be harmful to children and youth," Wiwczor said.

"If a child's gender identity is not supported, we see a lot of increase mental health concerns day-to-day for them, whether it's anxiety, whether it's stresses, depression, behavioural outbursts because they are not supported with the gender that they identify as."

The nurse practitioner said her clinic sees many children who struggle with attendance when they don't feel or are not supported in their gender identity at school.

"They may avoid going to school," she said.

"So some of these kids who are, you know, entitled to receive an education may choose to not attend school because they don't feel supported or safe there."

Be your child's safe space

Supporting children and youth who are questioning their gender identity is important, the nurse practitioner said.

"I don't see a risk in using chosen name and pronouns in an academic or school environment that can cause harm," Wiwczor said.

"If anything, that child will feel supported and will feel safe to attend school and receive the education that they should receive."

Gender-affirming care can be life-saving and help decrease a person's distress, she said.

Parents are encouraged to be open-minded so that children can feel safe to come out, express their gender identity and have a discussion about their thoughts and feelings.

No referral needed

Children and youth are assessed at the clinic as they come in and are generally seen within a few months at the most.

"When we first started as a clinic, we were accepting referrals by family physicians, nurse practitioners providers in the community, however, these children really need to get the right care, so we're open to receiving referrals in any way," Wiwczor said.

Research shows that once youth start the gender transition process, there is less than a one per cent chance of changing their mind or desisting, she said.

Support is available both in person and virtually for children, youth and their families.