Latest news with #transhealth
CBC
4 days ago
- Health
- CBC
Advocates say P.E.I. near top in Canada for gender-affirming care, but better aftercare needed
Social Sharing At a time when large provinces such as Ontario and Alberta are not covering key procedures and therapies, advocates say Prince Edward Island has some of the best access to gender-affirming care in Canada. "On P.E.I., we should actually be really proud," said Anastasia Preston, the trans community outreach co-ordinator at PEERS Alliance. "On policy, we have the best health care in the country outside of the Yukon. So out of all the provinces, we have the best health care, which I think is a huge boon for P.E.I." Health P.E.I. has worked closely with the trans community on the Island to improve access to care, Preston said. "Where we run into problems often with gender-affirming care is aftercare," she said. "Once you receive services, it can be really hard to get proper aftercare." P.E.I. leads Canada in access to gender-affirming care, but more supports still needed 9 hours ago Duration 2:21 As other parts of Canada dial back access to gender-affirming care, Prince Edward Island and Yukon are leading the country in that metric. Advocates say they are proud of the work being done in this province, but want more support following medical procedures. CBC's Tony Davis reports. Gender-affirming health care — an approach that affirms a trans person's gender identity instead of trying to change it — is endorsed by medical associations in Canada and around the world, including the Canadian Psychological Association and the Canadian Pediatric Society. Affirming care ranges from social and psychological support, like using someone's chosen pronouns, to transition-related medical treatments, from puberty blockers and hormones to gender-affirming surgeries. Provincial regulations While P.E.I. and the Yukon are improving Canadians' access to gender-affirming care, other jurisdictions are limiting it. In 2024, Alberta politicians passed Bill 26, which restricts anyone under the age of 16 from accessing gender-affirming health-care services, including hormone therapy. Legislation like Bill 26 can have a negative effect on trans people, particularly trans youth, said John McIntyre, a lawyer and co-founder of McIntyre-Szabo, a boutique health law firm in Toronto. "That would have a significant impact on their future and potential gender dysphoria in the future, and so it's stopping them from being able to make those decisions for themselves," McIntyre said. Other jurisdictions, such as Ontario, typically don't help cover procedures like facial surgeries, meant to align the appearance of the face with a person's gender. McIntrye said those kinds of surgeries have a significant impact on gender dysphoria since they affect how people present themselves on a day-to-day basis. The path forward for P.E.I. Over the years, P.E.I. has expanded its gender-affirming care policy to include coverage for things like hormone therapy and expanded surgical services, said Candice Rochford, a Charlottetown nurse practitioner who works in primary care. The province also offers coverage for non-surgical services and procedures — including hair removal, hair replacement and access to speech and language pathology services — through the public system. "Gender-affirming care isn't cosmetic. It is medically necessary," Rochford said. "A person's decision or method to transition is really individualized… People don't always require medical transition or surgical transition, but things like facial appearance [and] voice can impact someone greatly." When it comes to the kind of aftercare support available in the province, Health P.E.I. said the gender-affirming clinic provides some follow-up care after surgeries. Typically the clinic discharges patients to a primary-care provider, but if patients don't have a doctor or nurse practitioner, the clinic will oversee their care until they recover. While the trans community is happy P.E.I. has solid access to care, advocates like Preston say there is a need for more support following procedures and more education for health-care practitioners. "I think that the P.E.I. health department is doing great work on this and that there's more work that we can do by listening to community and their needs."
National Post
4 days ago
- Health
- National Post
Mia Hughes: Canadian Medical Association wants to force Alberta to ignore science on gender care
Article content The entire field is built upon research out of the Netherlands that has been shown to be methodologically flawed, and the diagnosis of gender dysphoria is shaped by political lobbying intended to reduce stigma and distress. Article content What's more, the Canadian Pediatric Society bases its recommendations on the field's standards of care which are set by the discredited World Professional Association for Transgender Health (WPATH). In a recently withdrawn legal challenge to Alabama's youth gender medicine ban, WPATH was forced to disclose over two million internal emails that revealed the organization blocked independent systematic reviews that showed low-quality evidence, consulted 'social justice lawyers' when drafting its medical guidelines, and, at the Biden administration's request, removed almost all lower age limits from its adolescent chapter to avoid undermining state-level legal battles. Article content Reimer also stated, without irony, that medical decisions should be based on 'the best science.' Yet the best science — specifically the systematic reviews from Sweden, Finland, England, and a team of researchers in Canada — has all concluded the evidence base for paediatric medical transition is of very low certainty. Alberta's Bill 26 reflects that consensus. The CMA's position contradicts it. Article content This isn't the first legal challenge to Alberta's legislation. Late last year, Egale Canada — originally a gay rights charity that expanded into trans advocacy in the early 2000s — teamed up with the Skipping Stone Foundation and five families to contest the law. That move is surprising given early research conducted by leading figures in gender medicine, Psychologist/Sexologist Kenneth Zucker and Psychiatrist Susan Bradley, found that most children with early-onset gender dysphoria would grow up to be gay or lesbian if left untreated, and same-sex attracted teens are overrepresented in the adolescent patients who began flooding gender clinics in the 2010s and among detransitioners. That a gay rights group would back medical interventions that have the potential to sterilize homosexual adolescents is a tragic reversal of purpose. Article content In an interview, Dr. Jake Donaldson, one of three Alberta doctors who filed the challenge alongside the CMA, inadvertently highlighted the questionable rationale for these extreme medical interventions. He believes that puberty blockers and cross-sex hormones help gender-distressed youth blend in better as members of the opposite sex, which makes them 'safer and happier.' But even if that were true — and there is no high-quality evidence to suggest that it is — this approach only offers a superficial, short-term fix that ignores the deeper psychological struggles of these youth. And it can come at such immense long-term cost in the form of sterility, sexual dysfunction, and lifelong medical dependence. Article content 'Medicine is a calling,' explained the CMA president in her statement. 'Doctors pursue it because they are compelled to care for and promote the well-being of patients.' Article content Yet noble intentions are no safeguard against harm. History is littered with medical scandals. At the centre of each one, there were well-intentioned doctors who left a trail of devastation in their quest to help patients. The doctors who prescribed thalidomide didn't do so with the intention of causing major birth defects; the obstetricians who sent expectant mothers for prenatal X-rays didn't deliberately set out to cause childhood leukemia, and Walter Freeman famously believed his prefrontal lobotomies were a humane alternative to the deplorable conditions in insane asylums. Article content At this point, there is little doubt that paediatric gender medicine is destined to take its place in history alongside these medical catastrophes. Therefore, Alberta is not acting unreasonably; it is acting responsibly. By restricting unproven and irreversible treatments for minors, the province has commendably joined a global wave of governments re-asserting evidence and ethical principles in the face of medical groupthink. It is the CMA — not the Alberta government — that must reckon with its conscience. Article content Mia Hughes specializes in researching pediatric gender medicine, psychiatric epidemics, social contagion and the intersection of trans rights and women's rights. She is the author of ' The WPATH Files,' a senior fellow at the Macdonald-Laurier Institute, and director of Genspect Canada. Article content
RNZ News
5 days ago
- Health
- RNZ News
Prominent medical bodies call for release of delayed gender affirming healthcare guidelines
Te Whatu Ora was due to release the guidelines in March. Photo: RNZ / Angus Dreaver Prominent medical bodies are calling on the government to allow the release of updated gender affirming healthcare guidelines after a small section on puberty blockers caused it to be delayed. The guidelines were due to be released at the end of March but it's is now unclear when they will be. The Professional Association for Transgender Health Aotearoa, who was asked by Te Whatu Ora to update the guidelines, believes the delay is "due to unprecedented and inappropriate political interference". Te Whatu Ora says it'll publish the guidelines "once decisions are made by the government following the ministry's consultation process". Public submissions on the matter closed 20 January. But PATHA says the advice on puberty blockers in the guidelines was updated in November to reflect the Ministry of Health's new position and this was approved by Te Whatu Ora's National Clinical Governance Group. It says this advice makes up only six pages out of the total 182 pages of the document. The guidelines cover all aspects of gender-affirming care to support trans and non-binary people and their families to navigate healthcare. This includes whānau support, creating inclusive clinical environments, non-medical and non-surgical gender affirmation, speech and language therapy, fertility and sexual health, mental wellbeing, gender-affirming hormone therapy, and detransition, as well as specific guidance for Māori, Pasifika, and refugee and asylum seeker trans people, PATHA said. More than 300 medical bodies, community organisations, and individual healthcare professionals have signed an open letter calling for the government to allow Te Whatu Ora to release the guidelines. These include General Practice New Zealand (GPNZ), Royal New Zealand College of General Practitioners, The Paediatric Society of NZ, New Zealand College of Clinical Psychologists, New Zealand College of Primary Health Care Nurses, College of Child and Youth Nurses and New Zealand Nurses Organisation. PATHA president Jennifer Shields said delaying the release impacts on the ability to improve healthcare delivery and health outcomes for the transgender and non-binary population. "Less than 24 hours before the date of publication, there was an unnecessary, indefinite and unexplained delay in the publication of these clinical guidelines, we believe due to unprecedented and inappropriate political interference." In November, the government released its evidence brief on puberty blockers and a position statement which sets out its expectations for their use. It signalled its intention to consider regulating them in gender affirming care and tasked the ministry with consultation, opening up public submissions. Regulatory measures could include restricting prescribing puberty blockers in the context of gender affirming care for young people but not its use in other contexts, the ministry said. Further measures being considered by the ministry included updating clinical guidance and increasing monitoring of prescriptions. The Green Party has denounced the signalled change of approach. Medical practitioners are currently working with guidelines published in 2018. PATHA said Te Whatu Ora contacted it in 2023 to update these. "It is standard practice for guidelines to be periodically updated to ensure their content is kept up to date. PATHA submitted the updated guidelines in October 2024 and they followed the standard process for publication of a clinical guideline, and were approved by Te Whatu Ora's National Clinical Governance Group." Vice president Dr Rona Carroll said clinicians are asking for up-to-date guidance to provide appropriate and safe healthcare. "The need for this updated guidance is clear and something I hear from health professionals on a daily basis. We just want to be able to publish these guidelines so the clinicians who need them can use them." Health NZ Te Whatu Ora national clinical director primary and community care Dr Sarah Clarke said it acknowledges the guidelines currently being used are from 2018 and that the evidence base in this area continues to evolve. "In the interim, and ahead of the updated guidelines being published, our advice is that health professionals continue to provide effective care based on the best available evidence and consult and take advice from colleagues more experienced in this care when appropriate." Puberty blockers can be used as part of gender affirming care to delay the onset of puberty by suppressing oestrogen and testosterone. They are also used for precocious puberty in children, and the ministry says the same medications can be used in adults to treat endometriosis, breast and prostate cancer, and polycystic ovary syndrome. The evidence brief released in November and subsequent public consultation only looked at the use of blockers specifically as they related to gender affirming care. The ministry says overall, the evidence brief found "significant limitations in the quality of evidence for either the benefits or risks (or lack thereof) of the use of puberty blockers". Following the release of the evidence brief, the ministry directed clinicians to exercise caution in prescribing puberty blockers. At the time Shields said this was already in line with New Zealand best practice and it was reassuring to see the ministry recognise this.
ABC News
21-05-2025
- Health
- ABC News
Does the gender-affirming model provide trans youth the healthcare they need? There are good reasons to think it doesn't - ABC Religion & Ethics
Over the last 10 to 15 years, the number of children and adolescents seeking medical help for gender dysphoria has rapidly increased in Australia. In the context of uncertainty over how to respond to this phenomenon, the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (ASOCTG) was developed by an interdisciplinary team of physicians and researchers at the Royal Children's Hospital Melbourne, and published in 2018. The development of these guidelines contributed to the widespread adoption of what is called 'gender-affirming care' across state medical bodies — as well as by the Australian Professional Association for Trans Health (AusPATH), which defines it as follows: Gender affirming healthcare emphasises affirming language, psychological and peer support, support for social affirmation, and/or medical affirmation (e.g. puberty blockers for young adolescents, or feminising or masculinising hormones and/or surgery for older clients), as medically necessary and clinically relevant. It is important to note, however, ASOCTG was not endorsed by the National Health and Medical Research Council (NHMRC), which has been asked by the federal government 'to develop new national guidelines for the care of trans and gender diverse people under 18 with gender dysphoria'. These proposed national guidelines will not be finalised until March 2028. In the interim, medical bodies in Australia have an opportunity to reconsider the evidentiary basis for the gender-affirming model of care. This comes at the same time that, due to growing evidence of harms, several European countries — including Finland, Sweden, Norway, Denmark and the UK — recommended that aspects of the practice of gender-affirming care be restricted. As recently as 1 May 2025, the United States Department of Health and Human Services released its 'umbrella review' evaluating 'the direct evidence regarding the benefits and harms of treatment for children and adolescents with gender dysphoria', which concluded that: many U.S. medical professionals and associations have fallen short of their duty to prioritize the health interests of young patients. First, there was a rapid expansion and implementation of a clinical protocol that lacked sufficient scientific and ethical justification. Second, when confronted with compelling evidence that this protocol did not deliver the health benefits it promised, and that other countries were changing their policies appropriately, U.S. medical professionals and associations failed to reconsider the 'gender-affirming' approach. Third, conflicting evidence — evidence that challenged the foundational assumptions of the protocol and the professional standing of its advocates — was mischaracterized or insufficiently acknowledged. Finally, dissenting perspectives were marginalized, and those who voiced them were disparaged. Gender ideology and the risks of gender-affirming care The ideological premises of gender-affirming care are that, irrespective of age: children know their gender and healthcare needs; their gender identity will remain stable; affirmation (social, medical and surgical) is necessary to assist mental well-being; incongruence between gender identity and biological sexed reality is normal; and any distress experienced by youth is the result of intersectional vulnerabilities and prejudice. Australian governmental institutions have embraced gender ideology, as is evidenced by the changing definitions of commonly used terms on governmental websites, the replacement of 'sex' with 'gender' as a protected characteristic in anti-discrimination legislation, the implementation of anti-conversion therapy legislation, and the threat of discrimination claims from the human rights commissions if doctors fail to use preferred pronouns during consultations. This legal restriction that Australian doctors now face compels them to affirm a child's gender identity and disregard the importance of neutral exploration of a child's symptoms, the changing capacity for abstract concepts with maturity, and the time-frame of identity development which extends into adulthood. Recommendations to support distressed children with a psychotherapy first-line — what is sometimes called 'watchful waiting' — are, in turn, criticised by some activists as 'medical gatekeeping', despite there being evidence that a normally timed puberty leads to resolution of symptoms in 85 per cent of children with gender dysphoria. (Though it should be noted that the authors of the study in question 'recognized that the boys … were seen during a period of time when treatment recommendations, if such were made, often aimed to reduce the gender dysphoria between the child's felt gender identity and biological sex'.) AusPATH rejects stand-alone psychotherapy, even though such a stance is antithetical to usual child psychiatric practice and psychiatrists reject claims that equate psychotherapy with conversion therapy. ASOCTG also encourages the social transition of children — which includes changing names and pronouns of children — in home or school environments, according to the wishes of the child. In the case of older adolescents, this might include breast binding and genital tucking, or the use of padding and prostheses. According to the guidelines, medical transition is, in turn, facilitated by the prescription of puberty blockers and cross-sex hormones. Despite arguments that puberty blockers simply 'pause' puberty, they are most often a step towards cross-sex hormone treatment that will irreversibly change a child's physical features. Although children are promised an opportunity to 'change sex', the reality is potentially life-long medicalisation. Moreover, medical transition can cause potentially serious physical complications — including bone density loss (osteoporosis), sexual dysfunction (anorgasmia), metabolic and cardiovascular complications, thromboembolic (stroke) risk, mood changes, pelvic floor dysfunction and surgical complications. There is also evidence that puberty blockers can interfere with pubertal hormonal changes necessary for brain development. The risks of infertility and permanent sterility require children to decide upon ethically challenging fertility preservation at a time in their lives when many have not experienced their first romantic relationship. Is gender-affirming care truly 'life-saving' care? The assertion that medical transition is 'life-saving' and urgently required is a frequently made claim that can have the effect of coercing parents, policy makers and institutions to suppress some of their questions and deeper concerns. And yet an independent review of data on rates of suicide among young gender dysphoria patients of the Tavistock and Portman NHS Foundation Trust, following the 2020 restriction of puberty blocking drugs, suggests that medical transition is unlikely to mitigate suicide risk among trans-identified youth. On the contrary, a large Finnish study concluded that it is other co-occurring mental health conditions that are associated with suicide — as a result, the authors stressed the need for professionals to treat other conditions, such as trauma or autism, rather than rush to provide medical transition or surgery. Despite the clear need for holistic care, scientific reviews, an independent service review and a recent Family Court finding have all demonstrated that some Australian specialist gender clinics do not, in fact, offer the comprehensive treatment — including for that of co-occurring conditions — they promise. Doctors are unable to confidently predict which child will, and will not, persist in their gender identity. Detransitioners, or those experiencing regret, often present several years after interventions are commenced and fail to notify their original treatment provider. Their experience is not taken into account by ASOCTG, and hence guidelines are not provided regarding how best to support a young person wishing to cease their medications — an omission mirrored by lack of governmental funding for organisations, such as Genspect, that support detransitioners. Notwithstanding mounting evidence of harms and international practice changes, the Australian Society of Plastic Surgery recently lobbied the federal government to provide Medicare rebates for 28 gender-affirming surgeries. AusPATH has encouraged those advocating for this change to refer explicitly to the 'life-saving' properties of such medical interventions. The suppression of dissent With the release of the review by the US Department of Health and Human Services, the United States is simply the latest country to reject the premises of the gender-affirming model of care. The document highlights the way that major US medical and mental health associations (MMHAs) have become susceptible: to institutional biases, including groupthink and the disproportionate influence of vocal, specialized subcommittees. These specialized groups may receive broad deference from the larger organization, especially when their initiatives are framed in the language of civil or human rights. Consequently, MMHAs can inadvertently become echo chambers where dissent is suppressed, confirmation biases go unchecked, and professional deference is exploited. Australia is not immune to this same condition. When poorly evidenced treatments with what may turn out to be irreversible effects and serious side-effects are provided to children, usual medical practice is to provide treatment within clinical trials or with the support of hospital ethics committees. Despite serious child protection challenges inherent to experimental treatments, the involvement of hospital ethics committees or treatment provided within the clinical governance offered by clinical trials is not standard practice in any public gender clinic in Australia. Private practitioners have no established governance to routinely monitor decision making. Due to lack of infrastructure, there are still no means for authorities to identify the total number of affected children who have been treated in the public and private sector to date. Returning to a better form of care Vulnerable Australian youth deserve sensitive, good quality, evidence-based guidelines. I do not believe the ASOCTG has been written to a sufficient standard that should guide the profession in this complex area of healthcare. In future, 'Australian Standards' should be a protected title only to be used with reference to governmentally endorsed documents produced to the highest standard. Excellence in paediatric healthcare requires a general setting free from ideological coercion, where decisions are made on the basis of good quality evidence-based medicine. Doctors need a federal commitment to establish universal safeguards, monitor long-term outcomes, and return to a model of holistic care provided within general mental health settings that includes care for detransitioners. Meaningful change to support the improved health of trans youth requires an uncompromising return to the highest standard of evidence-based medicine. But when we do, we will also need to brace ourselves for the harm that may have already been caused. Dr Catherine Llewellyn is a fellow of the Royal Australian and New Zealand College of Psychiatrists (FRANZCP) and completed advanced training in both Child and Adolescent Psychiatry and Addiction Psychiatry. She is also a fellow of the Australasian Society of Lifestyle Medicine (FASLM).
