Q: McMaster Children’s Hospital first started to provide gender-affirming care in 2016. Why was it important to establish this kind of specialized care?
A: Initially, this was a response to a need observed in the community – children and families were seeking care which was not available. Youth who have gender dysphoria can experience distress when their assigned sex at birth does not align with their gender identity. Studies have shown that access to gender-affirming medical care (pausing puberty, estrogen or testosterone therapy) can potentially save lives and improve the mental and physical health of trans and gender-diverse youth.
Dr. Natasha Johnson, Adolescent Medicine specialist at McMaster Children’s Hospital, noticed that patients and families were having to travel far distances and face difficulty to get their care needs met. It is essential to be able to provide safe and professional treatment to meet the medical and mental-health needs of gender-diverse youth and to provide services close to home in a timely way. We know that children and youth who are not supported and do not receive the care and support that they need face worse outcomes – they may be more likely to have suicidal thoughts or worsened depression.
Q: What kinds of services are currently provided for gender-diverse youth in the McMaster Pediatric Gender Diversity Program?
A: The journey will look different for every youth. Not every young person will follow the same path of care in the Program.
Currently, we provide gender-affirming care within the McMaster Pediatric Gender Diversity Program without dedicated funding. As our hospital and clinicians recognize the importance of providing this potentially life-saving service to youth, we have put together a patchwork of services, borrowing time and resources from other areas of the hospital – largely based on goodwill and a commitment to serving this population. Through ongoing assessment and discussions, we support the young person and family in deciding about options that can help the young person feel more comfortable in their body with the goal of decreasing feelings of gender dysphoria. On our team, we have two adolescent-medicine pediatricians, two pediatric endocrinologists and one-speech language pathologist. We also work with adolescent-medicine social workers and arrange limited consultations with a child psychiatrist within the existing Adolescent Medicine Program.
We are one of the few gender programs in Canada with access to a speech-language pathologist, which can be an overlooked part of care. The patient’s voice is an important part of how they present to the world.
We’ve been offering as much support as possible with the limited resources and funding available.
Q: How has the pandemic affected the health of gender-diverse youth?
A: We know that the pandemic has taken a major toll on children and adolescent mental health in general. With social isolation and disruption of routines, children and teens have been presenting to the Emergency Department in increased numbers. The lack of access to community resources and support groups is also having an effect. Trans and gender-diverse youth have faced even longer delays for access to gender-affirming care. The number of referrals to our services continued to grow during the pandemic, in some cases up to three times the number of referrals we observed prior to the pandemic. Virtual care can sometimes present challenges for teens with confidentiality. Fortunately, we have been able to continue providing care both in person and virtually.
Q: How will the $500,000 grant from TD enhance care in the Program?
A: We are both grateful and excited to put these funds to good use to help support trans and gender-diverse youth. The grant will give us the opportunity to expand our services and provide more comprehensive care for this under-served population. We also envision investing in training to share our expertise and approach to treatment with a broad network of community providers – enabling children and teens to receive more informed and supportive care closer to home. We know that trans and gender-diverse youth need more support for families. Up to now, this is not something we have been able to provide in a dedicated way. We hope to offer parent and family support through groups and individual sessions.
A key priority is addressing our wait list, as there are currently over 100 youth waiting for care – some for 18 to 24 months. With these funds and additional members of our team – we hope to potentially double the number of youth we are assessing per year. That would have a significant impact on this population.
Q: What is the most fulfilling part of the work that you and your colleagues do in the Program?
A: I believe that adolescence is a point in life where we can support youth to be their healthiest selves. Supporting a young person to be who they are is incredibly rewarding. Recently, I had the pleasure of meeting with a mother of one of my patients, who told me: “I am so happy to see my child again. We can now see our child is no longer drowning in depression as we realize we have a daughter now and not a son.” Seeing their happiness and relief as they got their child back – that is the joy in our work.