Transgender Teens | The truth about medical transitions

How many minors undergo genital surgery each year to change their sex in Quebec?

The answer is almost certainly…zero. And it’s probably the same thing across Canada.

This is one of the things I learned while delving into the question of gender identity. Information which is unfortunately drowned out in the din of the cookie-cutter opinions which are surging these days.

“A Conservative government will protect children by banning medical and surgical procedures for minors under the age of 18 […] to treat gender confusion or gender dysphoria,” was proposed at the party’s last annual conference.

The motion was adopted by 69%.

This started (another) trench war. A war reignited by the debate on the gender of toilets, then by that on what we teach about trans people at school.

My first instinct was to write a scathing column to denounce the exploitation of young people who are among the most vulnerable in our society, all by politicians who seek to divide in order to get votes.

I decided to change my tone, at least to start.

Rather than raising even more dust, I wanted to get back to the facts. What happens when a young person says they don’t feel good about their body? What are the possible interventions? Who makes the decisions, and how?

For simplicity, I looked at the Quebec situation. Those in other provinces are not that different – ​​and, otherwise, opportunities for trans youth are generally more limited there.

First, the numbers. In North America, surveys reveal that 1 to 2% of adolescents identify as transgender, non-binary or questioning their identity.

These people are far from all finding themselves in the doctor’s office demanding surgery.

There are actually three categories of transition.

1) Social transition, where the adolescent changes his clothes, his first name or his pronouns to affirm his gender identity.

2) Legal transition, which involves changing your first name or gender on your official documents.

3) The physical transition, targeted by the Conservative motion.

A child or adolescent who feels bad about their body will generally first confide in a professional such as a psychologist or sexologist.

When the discomfort persists, a specialist doctor intervenes.

I contacted one who devotes his practice to gender transitions with adolescents.

A sign that the debate has completely gotten out of hand, he agreed to speak to me, but on the condition that he not be named. Past media appearances have earned him a deluge of hate messages and he now fears the risks for himself and his patients.

We’ll tell each other, it’s hard.

This doctor explains to me that he takes time before performing a medical procedure on a teenager, even if the teenager asks for it impatiently and has already been the subject of long follow-up by other stakeholders.

“The first step is to repeat all the stages of the young person’s identity journey. We listen to him, we hear the opinions of family members. Over a good period of time, you get to know the person,” he explains.

If deemed appropriate, the doctor may then offer the adolescent hormone blockers. Objective: to put a pause on puberty and the changes in the body that often cause distress. A person born a boy, but who feels like a girl, for example, will see with anxiety his voice change, his beard grow and his muscles develop.

“It allows the child to breathe, not to be stressed with the changes. We buy time,” Annie Pullen Sansfaçon, professor at the School of Social Work at the University of Montreal and specialist in interventions with transgender children and adolescents, also explains to me.

This intervention is reversible – if you stop the blockers, puberty resumes. It also allows the child to gain maturity and become more capable of making potentially more serious decisions. Because the speakers place enormous emphasis on the notion of “informed consent”.

Who decides, anyway? In Quebec, the legal age to consent to care is 14 years old. The Civil Code, however, specifies that the consent of the parents or guardian is obligatory when the care is “not required by the state of health”, that it represents a “serious risk” or that it can cause “serious” effects and permanent.

This is the case for interventions following hormone blockers.

The next possible step is taking either feminizing or masculinizing hormones. In this case, the changes caused are irreversible. The voice changes and will not be able to “unmove”. The breasts appear. Fat and muscle are distributed differently in the body.

A very small minority of trans minors will also undergo an “upper body operation” – a mastectomy, or the removal of their breasts.

Lower body operations? They are practically impossible to obtain for those under 18. First, parental approval is required. Then, they are not reimbursed by the Régie de l’assurance santé du Québec.

“I don’t know any doctor who agrees to practice it,” the doctor interviewed also told me.

These are the facts.

Medical interventions for gender transitions are far from commonplace. Some cause irreversible effects. It is normal to ask questions and remain vigilant to ensure that they are not offered casually.

However, there are regularly updated guides and standards of care that those who work with young people follow.

We need to get our minds off the idea that little boys are being transformed into little girls and vice versa in doctors’ offices across the country.