Gender Affirming Care Must Be Accessible to All. Without it, Lives Are at Risk
Everyone has the right to gender affirming care, at any age. But for some people in Canada, including youth and 2SLGBTQ+ populations, that right is at risk right now, and so people’s health is at risk as well.
Everyone is entitled to culturally safe, person-centred care when receiving health care. This saves lives and helps people who face barriers to survive and thrive. This includes access to gender-affirming care, including transition support, for people who identify as transgender. Canada has high rates of bullying (77%) among sexually and gender diverse youth, and gender affirming care is essential to address the existing poorer mental health among this population. High rates of bullying and poorer mental health also contribute to a rate of suicidal ideation in transgender youth that is five times higher than cisgender peers; their rate of suicide attempts are 7.6 times greater (Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada | CMAJ)
In light of this, it is dispiriting to see two Canadian provinces – Alberta and British Columbia – moving to restrict gender affirming care for their youth. The policy changes of these two governments include denying people access to puberty blockers. These essential medicines delay the onset of hormonal changes and give trans and gender-questioning young people more time to consider and explore their options before they make permanent decisions about their bodies. It must be up to a physician or nurse practitioner and their patient to determine the appropriate course of treatment. Other forms of transition support under threat include the right of a young person to change their name or pronouns at school. Denying access to any of these forms of care furthers the risks faced by young people who are often already vulnerable.
The missing piece of so much of the current debate is that transition support is one part of the spectrum of broader, gender-affirming, person-centred care. There are other kinds of gender-affirming care, for other populations, that are commonplace and accepted without debate. These include breast augmentation or reductions, hormone replacement therapy during perimenopause and menopause, or interventions for people experiencing hair loss, low libido, or sexual dysfunction. These interventions are not subject to the same public debate because, unlike trans care, they are not tied to stigma, misinformation, or fear and hatred.
We commend Canada’s doctors and health system leaders who have raised the alarm about policies that restrict access to health care decisions that are between a primary care physician or nurse practitioner and their patient/client, and who have taken a strong stand in support of ensuring that gender-affirming care is accessible, safe and timely, particularly for youth and 2SLGBTQ+ people. These trained health professionals take very seriously their duty to care for Canada’s children and youth, and they are standing together in forceful opposition to attacks on gender-affirming care for transgender youth. In 2024, the Canadian Medical Association declared their opposition to policies that would restrict access to gender-affirming care; the Ontario Medical Association called for gender-affirming care to be prioritized, calling it “lifesaving;” and Ontario Health released quality standards specifically for Gender-Affirming Care for Gender-Diverse People.
Across Ontario, local initiatives are putting these bold statements into action. Here are just four examples:
- In Thunder Bay, a partnership between the NorWest Community Health Centre and Foria Clinic, a transition-support clinic, is making it easier for 2SLGBTQ+ individuals in Northwestern Ontario to access mental health services, virtual hormone appointments, and psychotherapy as part of the full spectrum of gender-affirming care.
- In the Niagara region, providers address barriers to offer a broad spectrum of gender-affirming care to Trans and 2SLGBQ individuals.
- Rainbow Health Ontario, based in Toronto, is training health care providers province-wide so they can confidently offer their clients gender-affirming care in the best and safest ways possible.
- In Ottawa, Centretown Community Health Centre is amplifying this work at the community level by offering on the ground mentoring and leading the process to have the first in Canada elective for a trans health medical residency in primary care residents at the University of Ottawa.
Despite these excellent examples, it is not enough. In Ontario there continues to be long wait times for gender affirming care and the opposition to this care is prolific. We cannot allow misinformation, fear and stigma to drive the debate around evidence-based primary care for youth and 2SLGBTQ+ people, especially transgender people. Those who claim to rally “for kids” are in fact advocating for policy changes that we know – and evidence shows – will harm children and youth. Every person’s health care needs are best decided between them and their physician or nurse practitioner.
As we move towards another Transgender Day of Remembrance on November 20, and followed by the 16 Days of Action Against Gender-based Violence, let’s remember, and remind people and policymakers alike:
Trans care is gender-affirming care. And gender-affirming care is primary care. Everyone has the right to this care, and blocking access to it puts lives, including the lives of children, at risk.
