Canadian pediatricians 'Full Steam Ahead' with Gender-Affirming Model of Care

"Parents and young people deserve a balanced view of the care options ahead of them as they make these difficult decisions."

"This short paper is extremely biased, [leaves out] inconvenient truths [and presents gender-affirming care as the only option]."

Pam Buffone, founder, Canadian Gender Report 

"At the end of the day, if you tell parents if they're supportive it reduces suicide attempts from 57 percent to four percent, that's just putting a tonne of pressure on parents with data that are likely to be highly inaccurate."

"[The new paper is] essentially advocating for socially transitioning children."

Dr. Darrell Palmer, Calgary pediatrician

 

"Jackson [12-year-old fictional character, assigned female at birth, identifying as a boy, using he/him pronouns and engaging in stereotypically masculine activities since age 9] notes chest tissue development and recent monthly vaginal bleeding that are causing significant distress and gender dysphoria, impacting his mental health."

"Recognizing that the local wait time to access a specialized gender-care clinic is over six months, you explore options for menstrual suppression [including hormone blockers] and discuss other forms of care to support his mental and social transition [binding, packing, etc.]."

Advice for pediatricians in new instructional paper 

In the U.K., England's National Health Service has decided to ban puberty blockers for youth outside clinical research, citing a lack of evidence that they help youth with gender dysphoria. Canadian doctors who spoke to CBC news disagree, saying access to the drugs is an important part of gender-affirming care. (Jo Panuwat D/Shutterstock)

 

A  newly published paper in a brief in the Canadian Paediatric Society's flagship journal advises that parents failing to unquestionably affirm their child's expressed gender, can be responsible for harming their child. Pediatricians are advised through the paper to offer parents of gender-uncertain children advice on social transitions along with the benefits of an affirming environment to "support menstrual suppression" using medications such as hormone blockers for a gender dysphoric 12-year-old "if appropriate and desired by the patient".

 

"Gender-affirming practices for the general paediatrician" has rung alarms among those in the profession for whom an urgent reappraisal of the gender-affirming model of care for minors is top of mind, informed by new science questioning its safety and efficacy, alongside a "meteoric rise" in youngsters presenting with gender distress leading to a dramatic shift in the sex ratio, most from natal boys to natal girls. 

The senior authors of the new paper, through their spokespeople at BC Children's Hospital and Toronto's Hospital for Sick Children, were unavailable for an interview, while BC Children's stated that "research conducted over many decades supports the safety and accessibility of gender-affirming care in this province", that the authors had reviewed the research and conclusions led by distinguished British pediatrician Hilary Cass, whose  Cass Review  concluded the evidence base for gender-affirming care for minors to be "remarkably weak", and many unknowns remain relating to the impact of social transitioning, in particular among very young children.

 

Protesters hold signs up in Ottawa on Feb. 5, in response to Alberta Premier Danielle Smith’s recent proposed youth transgender policies including a ban on puberty blockers for youth under 16. (Patrick Doyle/The Canadian Press)

According to the new Canadian paper, gender identity in a very young child is a "fait accompli". The paper presents information on suicide in a misleading manner in citing data from a 13-year-old study of 84 Ontario trans youth that reported strong parental support reduces suicide attempts significantly, according to some pediatricians. Based on the health records of over 2,000 young people who sought care at a gender service over a 20-year time span, a recent Finnish study found while gender dysphoric youth have higher rates of suicide than peers without gender dysphoria (0.5 percent versus 0.3 percent), there was no statistical significance once researchers took a history of psychiatric treatment into account.

 

As a result of the conclusions of the Cass Report in Britain, the United Kingdom permanently banned the routine use of puberty blockers in minors under 16. In contrast, the Canadian authors of the new paper recommended pediatricians "provide advice on social transition: For many TGD (transgender and gender diverse) children and youth there may only be an interest in/need to discuss social transition, which might include using an affirmed name and pronouns and exploring clothing and hairstyles that align with their experienced gender".

 

No clear evidence that socially transitioning children has "positive or negative mental health outcomes", under the Cass review. Cass wrote: sex of rearing "seems to have some influence on eventual gender outcome, and it is possible that social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence. For this reason, a more cautious approach needs to be taken for children than for adolescents."

"In the end, I'd like to think that what we all want is what's best for our kids."

"And I think that's true of my colleagues who are involved in gender-affirming care as well."

"I think it comes down to it being very difficult for physicians to admit when they get things wrong."

Dr. J. Edward Les, Calgary pediatrician

Dr. Les, a senior fellow with the Aristotle Foundation for Public Policy, finds the latest advice for Canadian pediatricians is "blithely ignoring" the work of Cass and other investigations by "neutral doctors", including two recent reviews led by McMaster University researchers. 

In Canada, some specialists have begun to call on doctors to “slow down” and take a more nuanced approach that’s less quick to begin medical transition in children. Photo by Getty Images