Health Committee on May 2nd, 2019

[Don Davies, NDP, Vancouver Kingsway, BC]

I don't know if anybody knows the answer to this, but it would seem to me that a child of 10, 11 or 12 who is expressing a clear gender identity would feel relatively certain.

What percentage of those children, after going through puberty and maturing, end up changing their mind? What I'm trying to find out is, how reliable is that expression of gender at that age? Should we really be relying on it?

[Loretta Fearman]

I don't know any who have changed their mind. That's why I think putting children on blockers is probably the safest thing to do, because if they do change their mind, then as soon as they go off the blockers, they'll just go into puberty as they normally would have.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

It would strike me that it would be unlikely that there would be a change of mind. It sounds like it would be a fairly clear expression.

Ms. Fach, in a brief to the committee the Quebec Lesbian Network said that sexually diverse women tend to be made invisible, both outside and within the LGBTQ2+ community, and that double discrimination, based on gender and sexual orientation, creates a number of issues related to the physical and psychological health of these women.

Do you have any evidence to give? Is that the reality of women from sexual and gender minorities? Is the reality that they are little known or invisible inside those communities? What can you tell us about that?

[Crystal Fach]

Well, I think that's with all women. We're sexualized in our community. We're not taken seriously by the main population. Often, our population is fetishized on TV, so that's what people see.

I know when I am out with my partner I am approached all the time by people in a bar or in a restaurant. They say very sexually inappropriate things to us because we are women and because we are queer women.

I think that a lot of times the focus, historically—and not that it should be, but it has—has been on gay men's health and there hasn't been a lot of talk about queer women's health.

Our movement has moved in a very precarious way. Our movement started with transwomen of colour and then the gay rights movement happened, and now we're back 20 years with the trans population again. Women's rights go along with our community, like feminism. It is embedded through every oppressed population.

[Don Davies, NDP, Vancouver Kingsway, BC]

Perhaps I could just drill particularly into lesbians' experiences, from your knowledge, with the health care system. We've heard that gay men often do not come out to their own physicians, and this presents a real barrier in terms of their accessing proper health care.

What do you know about the prevalence of lesbians feeling comfortable to come out to their doctors with their sexual orientation?

[Crystal Fach]

Sometimes it's not even necessarily about comfort, but I think we have opportunities to be outed more with the questions we're asked. For example, every time I go to the doctor, they'll say things like, “Are you sexually active? Might you be pregnant?” I'd say, “No.” “Well, are you using protection?” “No.” “Are you on the pill?” “No.” “Well, then how do you know you're not pregnant?” “Well, I'm gay.” I have to out myself on a regular basis to get health care.

I don't know. In my experience, I'm forced to be out more than I necessarily want to.

[Don Davies, NDP, Vancouver Kingsway, BC]

Doctor, we heard Dr. Eyolfson about the state of education when he went to medical school, and I'm disappointed to hear it doesn't sound like much has changed. I presume that you went to medical school more recently than Dr. Eyolfson did.

[Dr. Tinus Wasserfall]

Thank you.

[Voices]

Oh, oh!

[Don Davies, NDP, Vancouver Kingsway, BC]

That was an underhanded shot at Dr. Eyolfson, actually. No, I'm teasing.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

I can never tell.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to ask about HPV vaccination. We know that HPV is also present in 90% of anal cancers.

What recommendations do you have, if any, regarding HPV vaccinations, particularly for boys and men aged 9 to 27 and for men over 27 who have an ongoing risk of exposure to HPV?

[Dr. Tinus Wasserfall]

That's a great question, one of my favourite topics to talk about. I'm giving a talk on it Monday.

HPV infection in men is different from HPV infection in women. It's not the same thing. Men tend to get less disease from HPV; women tend more to get disease. I'm not talking about the gay population; I'm just talking in general. Women tend more to get disease from it, but women clear the virus better. Men do not clear the virus very well, so the virus keeps hanging around. There have been great studies on this. Men up to their fifties and sixties have persistent staph oropharyngeal HPV infections that they don't clear. Men don't form good antibodies naturally to HPV infection.

Coming back to your question about the vaccine, what is the recommendation? Well, definitely boys should get it, because it's probably the only vaccine that prevents cancer. The vaccine is really about cancer prevention. The argument for young boys and girls is that it's not a sexualized vaccine; it's a cancer-preventing vaccine that everybody should get. In the MSM population, we highly recommend it because of what I told you about anal cancer rates. Those are important things, even though it's post-exposure, as I said. In the general population it's a question mark.

[The Chair, Liberal, Bill Casey]

Time's up. Thanks very much.

Now we go to Mr. Ayoub.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I would like a little more information on this quest for identity. When we were talking about young people at the beginning, my colleague Mr. Davies touched on the subject that really interested me, but I want to go a little deeper into it.

The search for identity takes place over time from childhood, through adolescence, and even into adulthood. When growth is slowed down by drugs that act on hormones, a possibility you raised, the search for identity can take longer and this is where it is most important to support young people on their journey. We were talking about the age at which these people are able to make decisions that will affect the beginning—or even the rest—of their lives. How do you see this support in terms of parents and society?

Dr. Wasserfall, you work in the medical field. Maybe you don't have young people in your clientele, but mainly adults?

I think this support involves several participants, several groups of people to support these young people and ultimately help them make the best possible decisions.

This is the subject I would like to explore a little further, Ms. Fach. You have told us a lot about what you have experienced and all the services you offer. Can you give me more guidance, give me a little more information about this?

[Crystal Fach]

I think you're absolutely right. Trans youth especially need that wraparound support. There already are some great physicians out there who are working with trans kids and their families. I think the family support, if they're willing to accept it, is the key as well. We know that these youth and children need their families around them, so providing those groups or the education for parents—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I'm sorry to interrupt, but you said “if”. The problem is when there is no acceptance of the problem, and they don't recognize the problem—

[Crystal Fach]

Yes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

—if it is a problem. It is a problem for those parents who don't recognize it.

What should we do? What do we do with those kinds of...?

[Crystal Fach]

I think it's starting to change. With local child protection agencies I've worked with it becomes an issue of neglect at some point. It becomes harmful to allow your child to suffer with dysphoria. I think that child protection at that point needs to step in and provide that supportive environment for those young people. Maybe that will be the aha moment for those parents to say what's going to happen is they're going to lose their children. I've seen them lose their children to suicide.

At any cost, we need to make sure that these kids are supported first, and then how we can support their families.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

The support should be from school, from kindergarten, or....

[Crystal Fach]

It should be from trans-led organizations.

I know there are a lot of pride organizations, and they do great work—don't get me wrong—but they're often led by cisgender people. They have the token transperson who does the group once a month. There are trans-led organizations doing that work, and we need to better support the trans educated people in our community to start leading these groups and having their families support the families that are becoming attached to these kids. That's where money needs to be funnelled.

These trans-led clinics are needed. The trans kids clinics do great work, because they do that holistic wraparound approach as well.

[Dr. Tinus Wasserfall]

I don't know if you agree with me, but it's my personal opinion that in sexuality there is more fluidity than in gender identity, although there could be some fluidity, but I agree with what the previous speaker said.

None of my trans patients have ever come back and said it's been a big mistake and they want to.... It's a very—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Is there any science report, or any research report that could show that?

[Dr. Tinus Wasserfall]

I'm not aware, but I've never come across that.