The AIDS Network is committed to promoting the acceptance and well-being of trans, non-binary, and gender diverse people in Hamilton, Halton, Haldimand, Norfolk and Brant. In keeping with our mission to support the health and well-being of communities impacted by HIV, we acknowledge that trans communities, particularly trans women and racialized trans communities, have been disproportionately impacted by HIV (1). Trans communities have been historically underserved and under resourced in both general healthcare access and HIV prevention (2,3).
The AIDS Network in partnership with the Hamilton Trans Health Coalition is committed to increasing capacity for, and access to, gender-affirming care (including puberty blockers, hormones, and surgeries), for all trans, non-binary, and gender diverse people who wish to access it. Given that trans, non-binary, and gender diverse people also require access to affirming primary care, the Hamilton Trans Health Coalition works to ensure that primary care spaces in Hamilton are safe for, and affirming of, trans communities and identities.
Together, we recognize that access to gender-affirming healthcare is a right of all trans people, and of particular benefit to supporting trans people living with and vulnerable to HIV (2,3).
We acknowledge that access to gender-affirming care has historically been a heavily psychiatrized process, available to only a fraction of people who have needed it (4), and that people continue to face barriers in accessing it (5). In Hamilton alone, 67.9% of trans respondents to the 2019 Two-Spirit and LGBTQ+ research report, Mapping the Void, reported they were leaving Hamilton to access gender-affirming care, and 40.2% were told by their primary healthcare provider that the provider didn’t know enough about trans-specific care to provide it (6).
COVID-19 has exacerbated these issues, with trans people throughout Canada reporting both an inability to find and begin gender-affirming care, and interruptions and delays for those receiving gender-affirming care (7,8,9).
For people who seek gender-affirming care, timely and consistent access has overwhelmingly demonstrated improved mental health outcomes (10,11,12,13).
This remains true for trans, non-binary, and gender diverse children and youth (14,15,16). Gender-affirming care for children and youth (including access to puberty blockers and hormones) is a professionally recognized best practice, both in Canada, and internationally (17,18,19). Considering current attempts to criminalize or delay access to gender-affirming care for trans youth (20,21), we affirm that youth who seek gender-affirming care deserve timely access to providers who are knowledgeable and capable of providing it. We oppose the fearmongering and anti-trans narratives driving the politicization of gender-affirming care for youth. We understand that its underlying goal is to question the legitimacy of all trans people, increasing the oppression and marginalization of trans communities.
We assert that gender-affirming care is an integral part of primary health care. Using the informed consent model, primary care physicians are uniquely positioned to provide gender-affirming care to trans people in their practices (17, 22,23,24). We call on all primary care physicians to commit to working with their trans patients wishing to access gender-affirming care, and to seek support and guidance from available resources around the provision of gender-affirming care in primary care settings.
(1) Mayer, K. H., Grinsztejn, B., & El-Sadr, W. M. (2016). Transgender people and HIV prevention: What we know and what we need to know, a call to action. Journal of acquired immune deficiency syndromes (1999), 72(Suppl 3), S207–S209. https://doi.org/10.1097/QAI.0000000000001086
(2) Reisner, S. L., Radix, A., & Deutsch, M. B. (2016). Integrated and gender-affirming transgender clinical care and research. Journal of acquired immune deficiency syndromes (1999), 72(Suppl 3), S235–S242. https://doi.org/10.1097/QAI.0000000000001088
(3) Poteat, T., Malik, M., Scheim, A., & Elliott, A. (2017). HIV prevention among transgender populations: Knowledge gaps and evidence for action. Current HIV/AIDS Report, 14, 141–152. https://doi.org/10.1007/s11904-017-0360-1
(4) Vipond, E. (2015). Resisting transnormativity: Challenging the medicalization and regulation of trans bodies. Theory in Action, 8(2), 21-44. doi.org/10.3798/tia.1937-0237.15008
(5) Puckett, J. A., Cleary, P., Rossman, K., Newcomb, M. E., & Mustanski, B. (2018). Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals. Sexuality research & social policy, 15(1), 48–59. https://doi.org/10.1007/s13178-017-0295-8
(6) Mills, S., Dion, M., Thompson-Blum, D., Borst, C., & Diemert, J. (2019). Mapping the void: Two-Spirit and LGBTQ+ experiences in Hamilton [pdf]. McMaster University & The AIDS Network. Retrieved from https://labourstudies.mcmaster.ca/documents/mappingthevoid.pdf
(7) Prempeh, K., Rehal, P., Seburn, K., & Mckenzie, L. T. (2020). COVID – Impact Youth Survey [pdf]. Trans Youth Canada. Retrieved from https://img1.wsimg.com/blobby/go/62679b6c-a733-40f9-852e-0967369df816/downloads/Current%20Covid-impact%20Youth%20Survey%20-%20Preliminar.pdf?ver=1615213622457
(8) Trans PULSE Canada COVID Cohort Working Group on behalf of the Trans PULSE Canada Team. (2020). Impact of COVID-19 on health care access for transgender and non-binary people in Canada [pdf]. Retrieved from: https://transpulsecanada.ca/results/report-impact-of-covid-19-on-health-care-access-for-transgender-and-non-binary-people-in-canada/
(9) Donato, A. (2020, March 26). Health-care access was already hard for trans Canadians. Then COVID-19 came. HuffPost. Retrieved from https://www.huffingtonpost.ca/entry/covid19-trans-canadians_ca_5e7b896fc5b6b7d80959c06a
(10) Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(525). https://doi.org/10.1186/s12889-015-1867-2
(11) Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people: A systematic review. Journal of the Endocrine Society, (5)4, 1-16. https://doi.org/10.1210/jendso/bvab011
(12) What We Know. (2018). What does the scholarly research say about the effect of gender transition on transgender well-being? [pdf]. Cornell University. Retrieved from https://whatweknow.inequality.cornell.edu/wp-content/uploads/2018/04/PDF-Trans-well-being.pdf
(13) Keo-Meier, C. L., Herman, L. I., Reisner, S. L., Pardo, S. T., Sharp, C., & Babcock, J. C. (2015). Testosterone treatment and MMPI-2 improvement in transgender men: A prospective controlled study. Journal of Consulting and Clinical Psychology, 83(1), 143-156. https://doi.org/10.1037/a0037599
(14) Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression
for transgender youth and risk of suicidal ideation. Pediatrics, 145(2). https://doi.org/10.1542/peds.2019-1725
(15) Connolly, M. D., Zervos, M. J., Barone, C. J., Johnson, C. C., & Joseph, C. L. (2016). The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health, 59(5), 489-495. doi.org/10.1016/j.jadohealth.2016.06.012
(16) Reardon, S. (2021, April 9). New arkansas law—and similar bills—endanger transgender youth, research shows. Scientific American. Retrieved from https://www.scientificamerican.com/article/new-arkansas-law-and-similar-bills-endanger-transgender-youth-research-shows/
(17) Olson-Kennedy, J., Rosenthal, S. M., Hastings, J., & Wesp, L. (2016). Health considerations for gender non-conforming children and transgender adolescents. UCSF Transgender Care and Treatment Guidelines. Retrieved from https://transcare.ucsf.edu/guidelines/youth
(18) American Psychological Association. (2020). Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth [pdf]. Can be downloaded here: https://www.psychiatry.org/home/policy-finder
(19) WPATH, EPATH, USPATH, AsiaPATH, CPATH, AusPATH, & PATHA. (2020). Response to Bell v. Tavistock Judgment: Statement Regarding Medical Affirming Treatment including Puberty Blockers for Transgender Adolescents. Retrieved from https://cpath.ca/wp-content/uploads/2020/12/FINAL-Statement-Regarding-Informed-Consent-Court-Case-Dec-16-2020.docx.pdf
(20) López, C. (2021, April 7). Every anti-trans bill US lawmakers introduced this year, from banning medication to jail time for doctors. Insider. Retrieved from https://www.insider.com/over-half-of-us-states-tried-passing-anti-trans-bills-2021-3
(21) Weichel, A. (2021, January 18th). Court rejects B.C. mom’s bid to delay transgender teen’s gender-affirming surgery. CTV News. Retrieved from https://bc.ctvnews.ca/court-rejects-b-c-mom-s-bid-to-delay-transgender-teen-s-gender-affirming-surgery-1.5272453
(22) Clark, B. A., Veale, J. F., Townsend, M., Frohard-Dourlent, H., & Saewyc, E. (2018). Non-binary youth: Access to gender-affirming primary health care. International Journal of Transgenderism, 19(2), 158-169. 10.1080/15532739.2017.1394954
(23) Tomson, A. (2018). Gender-affirming care in the context of medical ethics – gatekeeping v. informed consent. South African Journal of Bioethics and Law, 11(1), 24-28. Retrieved from https://www.ajol.info/index.php/sajbl/article/view/175648
(24) Bourns, A. (2019). Guidelines for gender-affirming primary care with trans and non-binary patients [pdf] (4th ed.). Sherbourne Health & Rainbow Health Ontario. Retrieved from https://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2019/12/Guidelines-FINAL-Dec-2019-iw2oti.pdf