Review of Healthcare in Manitoba for Transgender Youth

Abstract

Gender Dysphoria (GD), the distress caused by a difference between one’s gender identity and natal sex, has an estimated prevalence of 0.005-0.014% in natal males and 0.002-0.003% in natal females with the incidence increasing in recent years. (1–3) Trans is an umbrella term that includes a wide spectrum of identities, including transgender individuals who seek transition from one natal sex to the other. (4) The term trans is used in this study to be inclusive of all youth referred to the GDAAY program. Developing a gender identity is an aspect of normative child development with most children developing a cisgender identity, where natal sex is in keeping with their gender identity and expression. (1) Gender identity exists on a spectrum, including masculine, feminine, aspects of both (gender queer), or neither (agender). (1) The mental health of trans children often suffers when gender norms and messaging based on natal sex are not congruent with who they perceive themselves to be. This likely plays a role in the high rate of attempted suicide in this population. (1,5,6) Studies report higher rates of anxiety, depression, and self-harm in the trans population compared with cisgender youth. (7,8) Studies show that increased social inclusion, reduced transphobia, and access to medical transition can reduce the risk of suicide ideation and attempts. (7,9,10) Unfortunately many trans individuals avoid the healthcare system based on fear of, or previous negative experiences. (9,11,12) Since inception in 2011, the Gender Dysphoria Assessment and Action for Youth (GDAAY) program has provided Manitoba’s trans youth with access to trans-specific healthcare. The program is composed of a pediatric endocrinologist, a pediatric endocrine nurse, a pediatric clinical health psychologist, a child and adolescent psychiatrist, and an adolescent gynecologist. Prior to GDAAY, those under 18 years old in need of trans-specific healthcare had no comprehensive pediatric program to access these services. There are limited data published regarding health programming for trans youth and their healthcare experiences. The aim of this study was to describe the GDAAY program’s patient population and explore their healthcare experiences in Manitoba.