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NP View: Canada must slow down and reform transgender treatment for minors

Some doctors have been advised to put children on puberty blockers before they have had their first appointment at a gender clinic

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The modern revolution around gender identity is an inspiring triumph of personal freedom: people are much more free to be who they are than they ever have been.

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But recent events urge a little caution regarding miners who can be rushed into decisions that may be difficult to reverse as they mature and evolve. Canada needs to reform its policies on the treatment of youth who identify as transgender and end the blind “affirmative” care that pushes children into medical transition. Instead, it should embrace the UK’s new treatment model, which emphasizes mental health and recognizes that some young people identify as transgender to cope with trauma.

The UK recently closed its only gender clinic for young people (the Gender Identity Development Service, known as Tavistock) after the release of a scathing interim report by Dr Hilary Cass, who led an independent review government-commissioned UK Youth Gender Identity Services.

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In Canada, there are serious concerns that many of the criticisms raised in the Cass report also apply to Canadian health care.

The Cass Report criticized Tavistock for instituting a “hard-core affirmative approach” where young people who identify as transgender are automatically assumed to be fully and permanently so. According to the report, this approach contradicts the standard assessment and diagnostic practices used in almost all other clinical encounters.

Dr Cass also noted that Tavistock, by focusing on transition affirmation, failed to meet the other needs of trans-identifying patients and ignored their mental health issues, leaving the youngsters distressed under -supported.

An outrageous lack of patient outcome data collection, as well as a dogmatic atmosphere that punished reasonable discussion of the affirmative approach, were also among the many issues flagged in the report.

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Earlier this week, the National Post reported that Dr. Joey Bonifacio, a respected Canadian pediatrician who specializes in LGBTQ youth, believes the issues seen in Tavistock are also prevalent in Canada.

Dr Bonifacio is a former medical director of the Gender Clinic at SickKids Hospital in Toronto and believes that, like the UK, Canadian healthcare providers need to “slow down” and provide “neutral” care that are less eager to begin the medical transition.

The parallels between Canada and the UK are not surprising – both countries are seeing identical booms in teens identifying as transgender.

In Canada, the Trans Youth Can! research project shows that patient volumes at 10 participating clinics increased from almost zero in 2004 to over 1,000 in 2016. In the UK, the number of referrals Tavistock has grown from 50 in 2009 to 2,500 by 2020. In both countries, the majority of new cases are born as girls (80% in Canada), with neurodivergent children, particularly children with autism, also being strongly over-represented.

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These demographic quirks warrant scrutiny, but activists often end the discussion by claiming that the increase in trans self-identification is simply because young trans people now feel safer to come out. out. However, this explanation is only conjecture and does not take into account the incredible gender asymmetry and overrepresentation of young neurodivergents.

Some of the criticisms made in the Cass report are universally applicable. For example, Dr Cass noted that the anarchic development of gender care for young people, spurred by growing demand, means that it “has not been subjected to some of the usual control measures that are usually applied when new or innovative treatments are introduced.”

If this is true in the UK, then it is almost certainly true in Canada too – medical knowledge, and gaps in that knowledge, know few national boundaries. Canada’s approach to empowering gender equality is like skiing down a mountain blindfolded and ignoring calls to slow down.

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In some respects, the situation in Canada appears more dramatic than what was seen in Tavistock – perhaps because in Canada there has been little public debate about dealing with gender issues among young people.

For example, some Canadian doctors have been advised to put children on puberty blockers even before they have had their first appointment at a gender clinic. The rationale is that wait times are long and medication can alleviate distress in the meantime. It goes beyond anything seen in the UK.

  1. The Tavistock Clinic in London was Britain's only specialist gender care center until it was closed amid controversy.

    Canadian specialist urges doctors to ‘slow down’ treatment of transgender patients after UK clinic closes

  2. The Tavistock Center NHS clinic is seen in London on July 28.

    Adam Zivo: UK leading the way for sensible gender identity service reforms

Both Sweden and Finland have limited medical interventions for trans-identified youth. Last year, Sweden bans puberty blockers and cross-sex hormones on most minors, citing a lack of evidence to support the treatment. Finland is move towards a model that prioritizes psychosocial support for trans-identifying young people, prohibit gender reassignment surgeries for minors while allowing limited medical interventions in special cases.

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Canada should learn from these countries as well as from the United Kingdom.

With the closure of Tavistock, the UK will open two regional gender clinics which will take a more cautious approach to the gender care of young people, prioritizing mental health support rather than immediate medical transition. These clinics will also have more resources and professional oversight.

The new UK model will weed out children at risk of falsely identifying as transgender, providing them with the mental health support they need, while ensuring that genuinely transgender children receive specialist care – which, as in Finland , may include medical interventions in limited cases. where due diligence has been carefully exercised.

Canada should ban surgeries for minors and follow the UK’s balanced approach to curbing the excesses of Canada’s status quo, protecting children from irresponsible treatment while giving doctors the ability to provide medical intervention in limited cases, but with safeguards to ensure that any medication is given only when really needed.

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