BC Ministry of Health Still Intent on Child Gender-affirming Treatment

The Cass Review, WPATH file leaks, and court disclosures so far having no effect on BC gender affirming care policies.

In the UK, the Cass Review has led to a near total stoppage of puberty blockers and hormone therapy in treating gender dysphoria for minors. Finland had previously discontinued the medicalized gender affirmative treatment model, while Sweden, Norway, and Denmark have more recently restricted medical treatment to clinical research settings. In comparison to treatment bans in the US, which are characterized by the mainstream Canadian media as “anti-trans”, one would think that the developments in Europe would be more difficult to ignore. Despite this, in March 2024, the medical associations for all provinces as well as Northwest Territories and Yukon issued a statement that they were “deeply concerned” that access to “evidence-based” care may be restricted. (This was likely issued in response to the statement issued by the premier of Alberta, Danielle Smith, who announced in February 2024 that they would be restricting access to puberty blockers and hormone treatment for minors.) This statement was made after the Interim Report of the Cass Review had been released, and so it is unclear why they would be referring to gender-affirming treatment guidelines as “evidence-based” when the Review had shown that there was very little evidence at all to support them.

Ignoring facts also seems like a favourite pass time of Prime Minister Justin Trudeau. Lamenting a recent federal US announcement in opposition to gender affirming surgeries for minors, he seemed to not see the relevance of the White House spokesperson’s comments, namely that Department of Health and Human Services assistant secretary Dr. Rachel Levine meddled in the World Professional Association for Transgender Health (WPATH) Standards of Care Version 8 (published September 15, 2022) by requesting that minimum age for surgeries be removed. It should be noted that CBC went so far as to justify this intrusion in the WPATH standards development by paraphrasing from the New York Times that Levine “was concerned the inclusion of age limits for certain surgeries could have negative consequences when it comes to anti-transgender legislation and access to care”. How impartial of them to justify the unethical actions of a top administrator.

In addition to European nations becoming more cautious about medicalized gender-affirming care and the White House attempting to smooth over their removal of guardrails from the WPATH Standards of Care Version 8, the WPATH files were leaked and shared widely by Mia Hughes and Michael Shellenberger through Environmental Progress. The leaked files were released in March 2024 and show that WPATH, which is the authority referenced by TransCare BC (an agency of the Public Health Services Authority), was not only providing guidance based on very low-quality evidence but that WPATH members were aware of the inability of minors to consent to life-changing treatments such as hormones or breast removal.

So, with this avalanche of treatment policy changes, information about WPATH, and major doubts being raised about the validity of gender affirming treatment, no change has been noted in the approach being taken in BC. Indeed, of all the provinces and territories in Canada, Alberta’s recognition of the Cass Review and reconsideration of its gender treatment is an aberration. It seems that the other health ministries and decision-makers have been conveniently cossetted from pesky things like news or even major evidence reviews.

For now, health guidelines based off of low-quality studies touting treatments that no minor could ever consent to, developed by an activist organization, are apparently the gold standard in BC. A statement from TransCare BC on July 18th recently confirmed by email:

All care is individualized, and clinicians in BC generally follow the WPATH Standard of Care Version 8 and other relevant clinical guidelines.

If the events of the past year or so have made no impact, it’s hard to understand exactly what it would take for the BC Ministry of Health to reconsider its absolute devotion to WPATH standards. Admittedly, there are no other recognized standards to turn to currently. Given the choice between no guidelines and bad guidelines, one would think that the Ministry would err on the side of extreme caution, in other words hit pause on life-altering treatments until reliable, clinical research has been undertaken. Seemingly however, the guardrails are practically non-existant. One hormone readiness assessment, potentially carried out by one’s primary care provider (GP), is all that’s required to begin to feminize one’s male body or masculinize one’s female body. As the TransCare BC website states:

Some people feel anxious about the readiness assessment. They worry about saying the wrong thing and being denied treatment that is very important to their health and wellbeing. 

It may ease your fears to know that the focus of the assessment is on supporting you.

Thank goodness there are no real barriers! I thought that my substance use or mental health issues might be an impediment, but apparently these issues may result in merely a longer assessment process or counselling. For youth in particular, the following conditions should also be met:

• Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment and understands the implications for starting a therapy that may change their gender expression.

• Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally.

• Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility.

Is it adequate for a doctor to simply inform an adolescent or teen of the reproductive consequences of puberty blockers and/or hormone therapy? Since even WPATH has questioned whether consent can be obtained from youth, one would think that the standards for consent on such important matters would be high. Given the impossibility of obtaining true consent however, it is only necessary to simply inform youth of this possibility (or likely eventuality). It should also be noted that the consequences of taking hormones, which not only alter one’s gender expression but have a range a serious health impacts which the medical community is only starting to understand, are not referenced in this summary on the Transcare BC website. While BC continues to adhere to the orthodoxy of gender-affirming care, the dangers of cross-sex hormones should be stated from the outset of any interaction between a health care provider and patient, even before an assessment goes ahead, and should be clearly listed on the website. At present, some side effects for one type of hormone remain buried at the bottom of the relevant page.

Essentially, youth in BC are being sold a simple and effective treatment, optimistically titled “gender-affirming care”, not realizing the health risks and, depending on when they start treatment, risking sterility and sexual dysfunction. There is no consent form that could save an emotionally and mentally immature youth from making a poor decision, precisely because the treatment is offered in the first place. Compared to all other serious treatments offered by the medical system in BC, the benefits and risks are carefully weighed, down to antibiotics, and doctors tend to be cautious in their prescriptions. The symptoms are discussed first, and only if truly necessary will a drug be prescribed. Based on their experience with healthcare, parents and children would be under the impression that not only must this treatment be necessary, but that the treatment must be safe enough that the benefits outweigh the risks. It is for this reason that children and adolescents are pursuing or accepting treatment, not because they truly understand the risks and believe they are worth the price. Also robbing objectivity from parents and health care providers is the myth of higher suicide rates among gender dysphoric youth which has been propagated in media (also refer to the Final Report of the Cass Review). Parents’ trust in the medical system and doctors is leading them to make decisions that undermine the wellbeing of their children. (It should be noted however that parents in BC have little control over their youths’ ability to undergo treatment if health professionals decide that the youth has the capacity to provide informed consent.)

Doctors of course are just following “expert” advice, given their understandable lack of experience in this area. It therefore falls to leadership at the Ministry of Health to take the findings of studies including the Cass Review seriously, look at the decisions being made by Scandinavian countries, and put politics to the side to make responsible decisions for children and youth in BC.