Part four of a four-part series on children and gender identity
There is no evidence or proof that discussing gender identity with children and youth causes them to change their gender identity and the idea of social contagion is false, says a group of Prince George healthcare providers and doctors, Physicians for Diversity & Inclusion, who have come together to stand with families of gender diverse children and gender diverse members of the community.
Dr. Ingrid Cosio, whose practice includes time spent at the Northern Gender Clinic each week, provides specialized care to transgender and gender diverse persons living in the Northern Health region.
Only about 25 per cent of children exploring their gender identity before puberty go on to take journey to transition and identify as trans, Cosio said.
When gender incongruence is persistent and sustained over time, which is when a person does not identify with the sex they were assigned at birth and that tends to be during puberty and the person is exhibiting distress, that is the time to take the next steps because things are probably not going to change, Cosio explained.
“At that time, screening around mental health is super important,” Cosio said.
Things to consider during this stage is if there are any medical or mental health concerns. Ideally, those concerns are not interfering with clarity in terms of the diagnosis of gender incongruence, not interfering with their capacity to consent and not interfering with the treatments themselves, Cosio added.
It’s also time to assess the emotional and cognitive maturity of the person, she added.
“So they can think about what’s likely to happen in puberty, how they anticipate how that’s going to make them feel, what sorts of things they would specifically like to prevent, what this might mean for the future," Cosio said. "And then we are looking at how we can support them by decreasing some of the distress with safe and reversible steps.”
Sometimes this means following up on expectations the person may have mentioned in the past like getting more information about testosterone, Cosio added.
Another example is a person could be terrified of getting an Adam’s apple, and their voice dropping, which is irreversible.
The request may come to prevent that from happening while they figure things out, Cosio said.
A puberty blocker may be used in these circumstances. When a person stops the puberty blocker, puberty continues where it left off, so in that sense it is reversible, she added.
“A puberty blocker is something for the kid who is terrified about those puberty changes that are coming up,” Cosio said. “There are criteria that are put out by the World Professional Association for Transgender Health, which is the over-arching international body, that puts out standards of care that we follow for gender affirming care. This is structured, research-based and expert-informed so there is criteria to follow and this helps to make sure we’re in a safe place that is consistent with the standards of care before initiating next steps.”
Cosio said she’s often surprised at the maturity of a lot of kids who have had to think about these things.
“Things that their peers can't even fathom,” Cosio said. “I am so surprised about how much research they’ve done and then they come in with very specific questions about things that they’ve read. So looking at these safe and reversible ways for them to manage the distress they are experiencing, affirm their gender as they come to understand it over time – so allowing them that time to figure it out.”
Social transition could also occur at this time and this allows them to explore their gender expression – how they dress, their haircut, how they speak and move, and figuring out what feels best for them, Cosio added.
“And that’s when name and pronouns can come in as well,” she said. “So having folks interact with you in a way that fits your identity obviously is crucial. All of us want that.”
Other things that are considered are medical issues like someone who was assigned female at birth having monthly periods, which can be very distressing.
“A lot of patients say to me ‘this is a reminder that I was born in the wrong body and this should not be happening and it's angering and depressing,’” Cosio explained. “So there are easy ways that we can stop cycles that are safe and reversible.”
There are a variety of other resources to suit the need.
“We can also use things like chest binders so for those who have been assigned female at birth who have large chests that are very distressing that’s something else we can do to help support them,” Cosio said. “There’s a pharmacy in town that sells them and they can have fittings done there and The Foundry has a free binder program.”
It’s important to know about the resources available in the community.
“So all that is about taking those next steps and supporting them while they are figuring themselves out,” Cosio said.
At this time after taking these affirming steps, they might confirm that this is who they are and they feel better in their skin, she added.
“And then it’s about supporting them along the way,” Cosio said.
For reliable and accurate information about gender identity, visit the BC Children's Hospital gender resource page.
