Evidence of meeting #141 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was know.
A recording is available from Parliament.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
What do I know? In a case where someone born a female identifies as a male today, would they, from a doctor's perspective...? I'm thinking of a mammogram. What do you do for something like that?
I'm just curious. I don't know how they would even begin to know or what.
Family Doctor, Spectrum Health, As an Individual
It goes the other way around as well.
The patient I talked about was male born who transitioned to female. With prostate exams or prostate biopsies, it's the same thing. I don't know about the rest of the country, but in B.C. it doesn't really matter. There are some billing codes that are male or female related, but it doesn't matter for all the rest.
Conservative
Family Doctor, Spectrum Health, As an Individual
For the driver's licence in B.C., you can now opt out.
Family Doctor, Spectrum Health, As an Individual
You can choose X. I think that legally the terms are becoming—from my point of view, I'm just a doctor—less important. It's more about the way that person acts.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Maybe some of my colleagues already know this stuff; I have no idea. You're a doctor and that's why I'm asking you.
If somebody who has been in a major car crash comes into emergency, what are they to do at that point in time?
Family Doctor, Spectrum Health, As an Individual
They can speak for themselves.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
I'm just wondering how you would know how to address somebody. I know you wouldn't want to offend anybody, if possible. Dr. Eyolfson was an emergency room doctor. He wouldn't want to offend anybody. Maybe he can answer that. How would you do it?
I have no idea. I'm just trying to think of a sensitive way for these people to be able to do that.
Family Doctor, Spectrum Health, As an Individual
If they can't speak for themselves and they don't have family members or next of kin who can speak for them, the common thing to do, in medicine in any case, if you do make a mistake and you realize you have made a mistake, is to disclose that mistake as soon as you can, to rectify it. In that situation I don't think it's life-threatening or whatever. I don't think it's the end of the world.
Family Doctor, Spectrum Health, As an Individual
It's more reasonable that, once the patient is able to speak and say, for example, that they are a female and they've been addressed as a male or their records are under male, we say that we are so sorry, that these were the reasons and that we'll rectify it. That's how medicine works.
Co-Founder, Diversity ED
Even if their records or their ID doesn't say they are female and they're female and they're telling you that they are, you still need to call them a female. That's important as well.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Yes, okay.
I wanted to ask another question. I can't remember who brought it up. Maybe I have this incorrect, but it was about GPs prescribing hormones for transpeople. Are our guests here today asking that all GPs in Canada be knowledgeable about that, or are they saying if a transperson—maybe I'm using the wrong term—or if somebody comes to a GP and says that they're interested in hormones, if the GP doesn't have a clue what to do, they refer them to so-and-so specialist? What are we saying here today?
Family Doctor, Spectrum Health, As an Individual
In B.C., we have a specific assessment schedule or requirements that need to be gone through. We have specially trained physicians.
The question you have asked really becomes difficult with adolescents or pre-teens because we know there is actually harm to be done with pre-teens who are really gender dysphoric, do not get hormone therapy and then go through puberty in the sex that they do not feel comfortable with. In B.C., we definitely have specialty doctors who do the initial assessments and then give their recommendations. It's quite an extensive assessment. It's not just saying, “I want this or I want that”.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
If a doctor was in rural and remote B.C. and someone came to them, would they have any clue what to do or who to refer to? Is there a thing through the B.C. health association or something that would say this? What is it?
Family Doctor, Spectrum Health, As an Individual
There are quite extensive online resources for doctors specifically around this topic. With adults it's easier, but with pre-teens and teens we prefer that they be assessed by a specialist. The specialist can make recommendations and we, as GPs, prescribe onwards.
Co-Founder, Diversity ED
I've specifically experienced with youth that a lot of times they are not heard, or they are told they are bipolar, or it is just a phase or a contagion. Then those next steps aren't happening. It's the same thing with adults who are trans. A few of my adult trans folks have been diagnosed with bipolar disorder or had doctors saying they are not comfortable prescribing hormones, but they already prescribe hormones to cisgender women all the time. It's nice if they can be sent to an endocrinologist, but that just adds a wait period, which puts them at risk again for suicide.
We just need to make sure that people's voices are heard and validated and not continuously questioned and doubted.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair.
Thank you to all the witnesses.
Dr. Wasserfall, what is the youngest age that a Canadian child can be in order to start receiving hormone therapy or gender assignment surgery? Is there a minimum or maximum age?
Family Doctor, Spectrum Health, As an Individual
There isn't an age. The question around that is more about age of consent. We've had that discussion in our group.
Puberty does not start at a specific age for every person. There is a range, so I don't think there is a set age, but definitely, the specialist—I am not a specialist in this field—who treats these kids really wants to try to treat them way before they start puberty.
I'm just going to guess, probably 10 years in boys, and maybe younger in girls.
NDP
Don Davies NDP Vancouver Kingsway, BC
The committee did a bit of cross-Canada travel on this. We went to Montreal, Winnipeg, Calgary and Vancouver.
I'll direct this question to Ms. Fearman. I think that in Alberta you require the authorization of two psychiatrists, who must sign off before gender assignment surgery is permitted.
Is that the case, and if it is the case, is that warranted?
Chapter Facilitator, Barrie-Simcoe County, Pflag Canada
In Ontario—because I live in Ontario—for genital surgery, yes, they need two physicians. If it's for breast removal, then they need only one physician, but they also have to be on hormones and they have to see some kind of psychologist who will give approval and say that yes, the person is experiencing dysphoria, and then put them on hormones.
However, for young children who have not started to go through puberty yet, they can go on hormone blockers, which gives them some time. It gives them time to really know who they are. It just puts their puberty on hold. That's the safest way to go for young children.
