When the world says you don’t exist, do you?
Children are not born knowing what it means to be a boy or a girl. Once a healthcare provider declares a newborn baby a boy or girl, based on their sex organs, that baby’s world will revolve around certain societal expectations of masculine and feminine expression and behaviours.
But gender is a spectrum, with each person expressing or identifying with masculinity and femininity in various ways. Gender identity and expression discovery is a journey everyone takes, and it evolves throughout their lifetime.
How we see ourselves and engage with the world is often rooted in our gender identity and expression. And when our identity is rejected, it can greatly impact our mental health and wellbeing. More than a decade of research has shown that this is exceptionally true for transgender adults and transgender youth.
What the research shows
A study by the Canadian Institutes of Health Research found that transgender youth had a higher risk of reporting psychological distress, self-harm, experiencing a major depressive episode, suicidal ideation, and suicide attempts. The rates of self-harm and suicide were lower in the 19 to 25 age group than the 14 to 18 age group, but “reported overall mental health was the same across these age groups.”
The study concluded that the mental health disparities faced by transgender youth in Canada are considerable and underscored the need for policies and laws protecting transgender people from discrimination.
“Not addressing gender dysphoria or distress related to gender can result in a number of risks associated with worsening mental health such as increasing social isolation, depression, anxiety, self-harm, substance use, disordered eating, and suicidality,” says Marria Townsend, medical director at Trans Care BC.
Trans Care BC is an information service and resource centre that provides gender-affirming healthcare and supports for people across British Columbia.
Townsend says the onset of puberty can be distressing or traumatic for gender-diverse youth.
“By alleviating that dysphoria or distress, the goal really is just to improve that young person’s mental health and their psychosocial functioning.”
At Trans Care BC, a coordination team connects young people and their loved ones to care providers who have experience working with gender-diverse people. They assist with care and planning of any medical or surgical interventions, Townsend says.
The journey begins with an individualized assessment of the person’s gender health needs. It will differ depending on what they need to affirm their gender and live comfortably — and that might just be a different social presentation of their gender, she says.
“With younger patients, some treatment options just depend on the age of the person and their stage of development.”
Puberty blockers are medications that suppress the sex hormones that are produced by the body. It puts puberty on pause, preventing changes like voice lowering, breast growth, and periods. They’re more commonly used for transgender or gender-diverse youth since the 1990s but are known to be used on kids who have precocious puberty when they experience puberty at an uncommonly young age.
Puberty blockers are commonly used for no more than two years and can be stopped at any time. There is no harm if the person doesn’t want to proceed. Whether that’s related to gender affirmation or not, it’s considered a very safe intervention, Townsend says.
“Puberty suppression allows time for that young person and for their family to continue to explore what’s going on, to seek counselling if that’s going to be helpful, and to determine the next step, without being so focused on the anxiety and distress that nothing else can be considered,” Townsend says.
She adds that puberty blockers preventing the development of unwanted physical characteristics allow the person to avoid certain surgeries when they’re older and potential discrimination in the future.
“[For] people who begin transition early before hormones have the chance to cause permanent change in their bodies, it’s much easier for them to have gender-affirming hormone therapy and gender-affirming surgery and live their lives without being obviously read as transgender — and we know that reduces risks related to discrimination, harassment, etcetera.”
Dr. Travers, a sociology instructor at Simon Fraser University, says gender-affirming healthcare isn’t just about puberty suppression, sex hormones, or surgery. It also includes ongoing supportive healthcare like doctors, nurses, and psychologists who support trans people and their families.
A study by the American Academy of Pediatrics concluded that any discrimination based on gender identity or expression, real or perceived, is “damaging to the socioemotional health of children, families, and society.” Included in their recommendations was for “youth who identify as transgender or gender-diverse to have access to comprehensive, gender-affirming, and developmentally appropriate healthcare that is provided in a safe and inclusive clinical space.”
“Research has definitely demonstrated that access to support and gender-affirming care results in improved mental health and psychosocial function,” Townsend says.
Impacts on gender-diverse youth
Last month, an anti-trans protest at the Vancouver Art Gallery drew harsh criticism from trans allies and parents of trans youth who accused the protesters and speakers of promoting hate and spreading misinformation. Speakers at the protest included Maxime Bernier, leader of the far-right populist People’s Party of Canada, ejected former-Conservative MP Derek Sloan, and Chilliwack School Trustee Barry Neufeld, who has been criticized for previous comments comparing gender transitioning to child abuse.
“When [kids] see people politicizing who they are, and demonizing and vilifying and pathologizing who they are, they see hatred. Because, in fact, that’s what hatred is,” says Morgane Oger, founder of the Oger Foundation.
Travers says trans kids know they are pushing against a lot of social forces.
“They already know this. And for a group of adults to make such a point of publicly condemning the support that trans youth have gained, it’s devastating. It’s a horrible message,” they say.
Lower Mainland representative for the BC Green Party Nicola Spurling was threatened to be sued by J.K. Rowling after tweeting that the author could not be trusted around children.
“I had parents reaching out to me saying ‘my child just told me that if J.K. Rowling doesn’t think I should exist, maybe I shouldn’t.’ And so I think [anti-trans attitudes] have a huge impact on people’s mental health, and leads to those increased suicide rates that we see among trans people,” she says.
“We live in a society where everything around us tells us how we’re supposed to look. And when we look fundamentally different than that, society squishes us,” Oger says.
“I don’t think that anyone should be told what they should or shouldn’t do or what’s right for them,” Spurling says.
Under the provincial Infant Act, minors can consent to their medical care without parental approval if they’re deemed mature enough to do so by a medical professional.
Travers says they’re a parent and understand the attachment some parents have to the names they give to their children. But they say that while it’s okay for parents to be sad, angry, or have feelings of loss, it’s important that parents have those feelings in private.
“Don’t have those [feelings] with the child. Have those in a safe environment with people who are close to you where you can talk about those feelings in a way that doesn’t negatively impact [your] kid.”
“Don’t put ideas into their heads. Let them lead,” says Oger. “They can figure it out. The only idea you want to have in their head is that it’s possible that they exist.”
“For kids to have the opportunity to grow up where who they’re attracted to and the gender that they identify with…if it was more open, it would be a lot healthier, it would certainly have much better mental health outcomes,” Travers says.
Sexual orientation and gender identity was first introduced in the 2016-2017 school year in nine B.C. school districts. By the following school year, the B.C. SOGI Education Network was open to all districts, independent schools, and First Nations schools.
“It’s not just important for trans youth to have accurate education about sexual and gender diversity. It’s important for all kids,” Travers says.
SOGI 123 is an education initiative that helps educators create a diverse and safe environment filled with respect for students.
“SOGI 123 is not a curriculum that is targeted at supporting trans and queer kids. It does do that at best, but its main purpose is to educate everyone to the wide range of sexual and gender identities and behaviours that are normal and healthy,” Travers says.
“If we’re making children’s environments more inclusive and supportive for trans kids, that should mean that we’re making these environments more supportive and inclusive for all kids.”
Local support for gender-diverse youth and their parents
Liz Dustan is the coordinator of the Gen-Out program at PLEA in the Ridge-Meadows area. She says her kids feel like they don’t have bodily autonomy and that other people think they know better than they do about their bodies.
“The kids are angry, and they’re sad. They are afraid, because people in the world don’t believe they should be authentically who they are. And it’s awful,” Dustan says.
PLEA Community Services Society of BC is an accredited, not-for-profit, charitable community service that offers services tailored to individual strengths and needs for all people.
PLEA helps queer youth, their family, and friends access the resources and support they need to be informed when making decisions, whatever that decision may be, Communication Manager of PLEA Community Services Jen Graham says.
“When we say support, that can mean practical support, emotional support — whatever that person needs in that moment,” she says.
Dustan says the program is for kids aged 13 to 18, and it’s a safe, supportive space where kids can hang out and talk about queer stuff or anything else they want.
They also have a specific trans support program hosted via private Zoom calls each month for trans youth aged 25 years and younger, run by a youth facilitator, as well as a separate parent support group.
“This is so it’s going to retain that safe space that we had in-person. In-person, people couldn’t just walk in either, they had to make contact first. The safety and comfort of those in the group is first and foremost,” Graham says.
The Gen-Out program is available to kids online. It helps kids find ways to talk to their families or help set them up with a social worker. The organization is in the Lower Mainland, but the focus remains in Pitt Meadows and Maple Ridge.
“Maple Ridge is a bit of a resource desert in the queer world. There’s not a lot out here. We have kids who have families who are transphobic, homophobic. Maybe they don’t know, don’t understand, need more education,” Dustan says.
“We don’t fit individuals into predefined programs, we adapt programs to fit the individuals,” Graham says.
Dustan provides a care package every week for the kids that come to the Gen-Out meetings. She makes the packages of snacks and some supplies they might need for the day’s meeting, like crafts, and she drops it off outside their houses.
“When the world can be this big, scary place that is unsafe and tells them a lot of the time that they don’t matter or that they shouldn’t exist, we are a place that they know that they do fit in and that they belong, and that they’re welcome,” Dustan says.
Acceptance of all kids
“There are harms in not supporting people to be who they are,” Townsend says.
Townsend says some impacts of not addressing gender dysphoria at a younger age can change the course of someone’s life.
“I’ve met many people in their 20s and their 30s and their 40s, sometimes later, who have decades of being in and out of mental health services, substance use services, unable to sustain relationships, unable to succeed academically or occupationally,” she says.
Travers says people in their generation grew up without any support.
“There was a lot of self-hatred. A lot of us made efforts to be heterosexual and to try to fit in, because we didn’t really have the sense that there was anything else that was possible. It’s very damaging,” they say.
“A lot of the issues that trans people face are simply around societal acceptance,” says Spurling.
“The idea that there are only two sexes, and that there are traditional gender behaviours associated with them, is linked to gender inequality and damaging attitudes to girls and women, and to boys who don’t conform to masculine norms,” Travers says.
Dustan suggests parents listen to their kids, and make an effort to learn.
“Understand that gender and sexuality is a journey of self-discovery,” she says. “Treat your kid like an individual, actually care about what they’re saying. Grow with them.”
“The most important thing is that they lived their true lives, and they were supported and not repressed. And they’ve learned that who they are is valued,” Oger says.
“In order to make the world safer for trans kids, we need to make the world safer for all kids,” Travers says.