Trans teens and youth say gender-affirming care is 'life-changing.' So why is it so hard to find in Canada?

Crow Heyden-Kaye was in Grade 8 when a worksheet handed out during class asked students to consider how they would describe their gender.

It was the first time it occurred to Crow that "girl" didn't actually fit with how he felt. Over the next few years, he began using the pronouns they and them. In Grade 10, he came out as trans. His pronouns are "he" and "they." 

"Immediately, it was like something clicked," said Heyden-Kaye, who is now 18 and lives with his parents and sibling in Ponoka, a central Alberta town of about 7,300 people.

At 16, he asked his mom to make an appointment with their longtime family doctor so he could get a referral to a gender clinic. He wanted to start exploring the possibility of hormone replacement therapy.

But during the telephone appointment, the family doctor began asking questions Heyden-Kaye felt were inappropriate. 

"What if I wanted to get pregnant someday? What if I had a husband someday? Not related at all," he said. "I think he asked me 'What if you want to keep your boobs?' " 

A week later, a staff member from the doctor's office called back and said the physician was also recommending that Heyden-Kaye read a book that discouraged transitioning. 

"A referral was all that we wanted and then it would be out of his hands. He refused to do that for us."

Demand for gender-affirming care — which can range from mental-health counselling to hormone replacement therapy or even just learning what treatments are available — is becoming more common across the country. But experts and advocates say a lack of local access to such care and the country's current political landscape around the topic puts trans and non-binary youth at risk of mental health challenges, including suicide.

The need for improved access to gender-affirming health care for trans or non-binary teens has become even more pressing given the political climate of the country, said Helen Kennedy, the executive director of Egale Canada, a LGBTQ research and advocacy group.

She points to provincial governments instituting policies related to students changing their names and pronouns at school without parental consent as one example of that.

Kennedy said research has shown that trans and non-binary youth are at a much higher risk of suicide than their peers, and that having support from family and community can significantly improve health outcomes.

"It's a massive problem in in Canada, and it's one that I think the governments at every level need to take more seriously," Kennedy said.

In June, the Canadian Paediatric Society published a position statement endorsing affirming care and offered practitioners across the country advice for how to provide it.