A Review of the Transgender Clinic at SickKids Hospital
by Collin Wynter
A drastic rise has occurred in the number of children seeking gender affirming care through medical clinics. It is a trend that has been increasing over time and throughout western liberal democracies, although not limited to them. Specifically, the United States, Canada, Sweden and the United Kingdom have seen marked changes in this demographic. Once gender dysphoria seemed mainly associated with older heterosexual males, there has been a shift towards adolescent females, including a pointed effort to include pre-adolescent children.
Gender affirming-only care refers to the recent therapy model of how to approach gender dysphoria. This is an affirmation-only method in regards to a child’s proposed gender identity, rather than to question it.
In Canada, Bill C 6 seeks to update to the criminal code in regards to conversion therapy. This will have consequences for therapeutic techniques that do not use an affirmation-only model. The bill proposes to include gender identity and gender expression as protected characteristics that a therapist may not attempt to ‘convert’ to the previous gender identity. Hence, any child experiencing gender dysphoria will have their dysphoria affirmed. From the act:
320.101 In sections 320.102 to 320.106, conversion therapy means a practice, treatment or service designed to change a person’s sexual orientation to heterosexual or gender identity to cisgender, or to repress or reduce non-heterosexual attraction or sexual behaviour. For greater certainty, this definition does not include a practice, treatment or service that relates
(a) to a person’s gender transition; or
(b) to a person’s exploration of their identity or to its development.
As is stated, the bill denies a therapist from enacting a treatment that may alleviate the dysphoria via questions about the patient’s perceived gender. They may only provide services to affirm “gender transition” or “exploration”. The act also explicitly states that conversion therapy is not synonymous with affirmation therapy: “For greater certainty, this definition does not include a practice, treatment or service that relates [to gender transition, etc].”
Where can a child receive affirming transgender therapy and medical transition? One such place is the transgender clinic at the Hospital for Sick Children (SickKids). The hospital is located in Toronto, Ontario, Canada and ia affiliated with the University of Toronto. It is “Canada’s most research-intensive hospital and the largest centre dedicated to improving children’s health in the country.” Their mission statement states:
“As leaders in child health, we partner locally and globally to improve the health of children through the integration of care, research and education.”
SickKids provides a myriad of clinics. To obtain access to a clinic, a child must receive a referral. A few of the clinics are: an eating disorders program, psychiatry, and of course, the transgender youth clinic. On the trans clinic homepage, they highlight that they work with pubertal youth experiencing gender dysphoria and that they assume an affirming position:
“The primary function of the interdisciplinary SickKids Transgender Youth Clinic (TYC) is to provide information, options and care to pubertal youth experiencing gender dysphoria, which includes assessment and treatment planning. Our clinic takes an affirming [emphasis added] approach to gender identity and care. Through ongoing assessment and discussions, we support the young person and family in deciding about options that can help the young person feel more comfortable in their body with the goal of decreasing feelings of gender dysphoria.”
Since, there was no apparent definition on the transgender youth clinic homepage for gender dysphoria, the one from psychiatry.org is defined below:
“Gender Dysphoria: A concept designated in the DSM-5 as clinically significant distress or impairment related to a strong desire to be of another gender, which may include desire to change primary and/or secondary sex characteristics. Not all transgender or gender diverse people experience dysphoria.”
Considering that SickKids only works with children who are experiencing gender dysphoria, but the psychiatry.org definition states that all transgender people may not experience the disorder, it is unclear as to whether the services at the SickKids transgender clinic would be available to the children not experiencing gender dysphoria, but still claim a trans identity. It is also vague as to what medical options they will receive:
“Care of each person is individualized with topics discussed including options for hormone blocking when appropriate, with further medical options discussed on an ongoing basis.”
SickKids does provide, however, a coterie of medical practitioners for youth attending their clinic to assist them with the affirmation-only therapy. The “interprofessional” team from adolescent medicine and endocrinology consists of: Staff Physicians, Nurse Practitioner, Nurse, Social Worker and a Clinic Coordinator.
During the first visit the patient will receive a general medical assessment. At this time, the clinicians meet with the patient and their parents, and then with the patient and parents separately.
“Members of the team will first meet with you and any parents/guardians at the appointment together, followed by an opportunity for the you and your parents/guardians to meet separately with members of our team.”
They do not define guardian as being a legal guardian. So it does bring forth the question of what adult may accompany the minor to the transgender clinic? Although it is highly improbable that a medical clinic would allow a non-legal guardian to sign off on medical treatments for a child, the lack of clarity on the webpage is disconcerting.
An experience shared on the Gender Canada Report webpage from parents who visited the SickKids transgender youth clinic brought up some concerns from their experience. This report is anonymous, but it bears investigation. For example, the parents were denied a private conversation with the clinicians. SickKids does claim to be focused on “family-centred care” and encourage parents to be involved in their child’s health and well being.
“Parents and caregivers are encouraged to be active participants in their child’s care and to assist the health-care team in developing the best possible treatment plan.”
The parents also claimed that the child was affirmed for puberty blockers from the first visit. Although, the transgender youth clinic is clear about the prescription of puberty blockers:
“A treatment plan may begin to be developed; however, medications are rarely [emphasis added] prescribed at the initial visit.”
Behind closed doors, it seems, there may be opportunity for the “team” to intervene. Did the parents have some opposition? Was the child not fully committed? Was there some suggestion from the “team” to move things along? This does not have to be nefarious. This can simply be apart of the “affirmation-only therapy” model.
SickKids clearly states that they are a teaching hospital and that the patient may be seen by a medical student. “Be assured these students are well supervised by our professional staff”, they clearly state. This may not be a negative as students are often on the cutting edge of research. However, considering the fact that within the universities there is a preponderance of critical social theories directing policies, this may be warrant examination. One may hope that any students’ impetuousness will be tempered by the wisdom of a supervisor. But considering the socially acceptable cancel culture that has arisen, some career health care providers may guard their opinion for fear of losing their position of authority- and their income.
Research is an important endeavour in science and medicine. SickKids proudly states that the hospital “conducts important research to help improve the lives of children.” At this time, there was no accessible information on the website if any research was being conducted on the medicalization of children experiencing gender dysphoria and the outcomes of the affirmation-only model. There were no details of any research on the webpage. There were links, through, to apply to assist in many fields of research both as a medical professional and as a lay person volunteer.
Additional information links are provided to such organizations as: Rainbow Health Ontario Care, GenderCreativeKids , Central Toronto Youth Services (CTYS)-accredited as a Children’s Mental Health Centre, Toronto District School Board (TDSB) (link was not active at the time of this writing), PFLAG Canada, The Youth Line, and Trans Care BC. This should be obvious, but still vital to note, each and everyone one of these resources leads to affirmation-only resources and policies.This in no way means to suggest that people seeking out information on transgenderism, gender identity, expression or dysphoria should be led to sources that denigrate individuals. But it is apparent that throughout the mainstream of society there is only one narrative to accept; and that is the gender self identification that a child proposes.
This seems to be all the information available through the SickKids hospital website. However, by a fluke of a web search, another page was discovered using the words “sick”, “kids” and ”trans” entitled: FAQs about the SickKids Transgender Youth Clinic. This was the third item listed on a Google search, so that calls into question why it was not included on the main webpage. But it certainly is odd that it was not searchable on the SickKids website, nor linked on the transgender youth clinic page. However, there is a link from the FAQs page to the main website.
FAQs about the SickKids Transgender Youth Clinic
There are two things that are a cause for examination. First, in the top left menu bar, the option of “Why we need you”, is symboled by a raised fist. This symbol was first used by communist groups. It has been adopted by other organizations such as Black Lives Matter and Antifa. It is meant to symbolize solidarity. It is unfortunate, from its appearance, that SickKids is using ideological visual imagery associated with organizations whose mandates are to disrupt, dismantle and deconstruct.
The second odd thing to note is the call to action to help “spread the word” of the transgender clinics FAQs page. Youth mental disorders have the potential to spread easily on social media, therefore, prompting the dissemination of the page may in fact be fuelling the rise of cases.
It may be wise for SickKids to re-think their ‘recruitment’ efforts, for it doesn’t end there. The frequently asked questions provide a bit more insight into what affirmation-only therapists think is appropriate to inform children. The creators of this site divulge this terrifying trigger:
“For transgender youth, puberty can be terrifying. Their bodies change in ways at odds with their identity. Those between the ages of 14 and 18 are at high risk for self harm and suicide. But SickKids is here to support them.”
This utterance is fallacious on many fronts. First, puberty can be terrifying for any youth. There are many changes the body and mind is going through. That is why sexual education is important in school and should not be received via social media. The transgender ideology being touted online that a person is born into the wrong body is psychologically damaging to a child. While the claim of suicide is dire, it is important to be rational and examine the information. Children are more at risk for suicide than adults. Homosexual children more at risk than heterosexual children. Gender non-conforming children are grouped in with homosexual children often times in studies. There is no link to a study to support these comments.
Another concern about making the statement that kids seeking transgender health care are at risk for suicide is that is provides a raison d’être for making the claim. First, it may set up the child to believe that if they are trans, they must also be suicidal. Thus, they will claim to be suicidal at the intake appointment. Second, they may think that they need to claim to be suicidal to receive puberty blockers. This may also prompt parents into a state of fear and desire to rush the perception of such drugs. “High risk” may be used as justification for clinicians to medicate children after their first visit.
The next question delves into why there is a need for a transgender youth clinic. They highlight that “Since opening in 2013, referrals to the SickKids Transgender Youth Clinic have surged.” And that in Ontario they now receive “20 to 30 new referrals per month.” This is shocking. Not because they only have room for “14 new assessments per month”, but that they are providing affirmation-only therapy to children who may or may not be experiencing actual gender dysphoria. This type of therapy leads to puberty blockers and further pharmaceuticals and surgical procedures. They fail to mention what year the increase of cases started to occur and provide no evidence for what is causing the apparent desire for a child to receive transgender medical treatment. However, this trend does line up with what has been seen at the Tavistock clinic in the United Kingdom as noted by Transgender Trend. Abigail Shrier has documented this in her book Irreversible Damage, as well.
SickKids is not content with remaining inside their own wheelhouse as was shown with their call to action above. They clearly outline their vision with this statement:
“To provide care to transgender youth and to remove barriers so they can access the gender-affirming care they need more easily—not just at SickKids, but also in their home community and in the wider health-care system, which we can support through education and capacity building initiatives.” [emphasis added]
As you can see there is an initiative to take the affirmation-only model and socially normalize it.
The term, “removing barriers”, stems from a critical social theory approach to inequities and has roots in socialism.
A contradiction is presented with the frequently asked questions compared to a child receiving puberty blockers. As stated above in regards to puberty blockers that they would rarely be provided at the initial visit. However, on the FAQs page, they intone that the patient will receive “personalized” care. The frequently asked questions deserves to be read in its entirety.
“For some, puberty/hormone blocking is a first step. This is a reversible treatment that puts physical changes associated with puberty on pause and gives patients and their families time and space to figure out the path they want to take. For those who make the decision to move forward with gender transition, the next step is usually hormones that start a second puberty in the direction the youth wants. Many of the youth we see eventually progress to wanting surgeries. We don’t do surgeries here, but provide links to further information about this process, and we help them to complete the application forms.”
Associating the idea of puberty blockers being the first step along the path to transition, coupled with the “high risk” of suicide for a child seeking transgender health care and the fact that they claim puberty blockers simply put “puberty on pause”, makes the idea that a patient will not receive the drugs at the initial visit seem naive. Data must be examined to find out exactly how many children are being recommend life changing drugs during their first visit.
This point on the FAQs clearly states that there is a first step, a second step and a third step in transgender reassignment. What they deign to leave out, is the life long medical treatment a person will nw require from these steps. Puberty blockers are not reversible. That is why they are prescribed for precocious puberty. To stop it. Testosterone is not reversible. Hormone levels may be rebalance in some ways with proper endocrinological treatment, perhaps, but the physiological effects on adolescent development will be permanent to the extent of the effects that are produced. Plastic surgeries are not reversible. But additional plastic surgeries can be done.
SickKids clearly states that they will assist the patient along this process. This also has the consequence, as mentioned above regarding suicide, of priming the child on what to request and what to expect. Along the series of steps, a suggestion to “move forward”, implies that a transgender person will take each of these steps. It feeds into the psycho-social transgender ideology the child is immersed in. The clinicians and developers of this website should be questioned as to their understanding of mental disorder trends in youth.
To shine a ray of light on the lifelong pharmaceutical and surgical path that these clinicians are putting children on, they use such affirmations as:
“[The kids] open up, blossom in from of us, and grow into themselves.”
And that they:
“start to see a future they’re excited about and the make plans for school.”
At the risk of stating the obvious, kids during adolescent years are in the exact developmental point of maturity in which they blossom and grow. That is what happens during these years. Many kids do start seeing their future at this time and they do get excited about it. This is not a novel experience to youth in the transgender clinic. The difference is the youth in the clinic are receiving medical care that may not be necessary. The watch and wait approach has been successful in the past and should be continued in the future.
The tgasngedner youth clinic once again uses critical social theory terminology by stating thorough their treatment, kids are able to “speak their truth” and develop “open lines of communication.” Congruent with what was stated above, this is the time in all children’s lives that they develop their own voice. It is something to be guided by adults through education. And rarely does it require medication.
The greatest point of contention is the frequently asked question: What’s the impact of not having access to this clinic? So, it too, will be useful to read in full:
“From the time a youth discloses their identify to the time they get care—a period that can last over a year—youth are at the highest risk for self harm and suicide. They have revealed who they are, but often don’t get the support they need from those around them. Some youth are kicked out of their homes. Many stop going to school, or they go to school but won’t go to the bathroom. During puberty, they can’t stop their body from changing in ways that are deeply distressing to them. Those between the ages of 14 and 18 have a five times greater risk of suicidal thoughts than their peers, with almost two-thirds having seriously considered suicide and three-quarters reporting self-harm. In short, the lack of services and long waitlists put youth at high risk. Improving access to this clinic, is a lifeline.”
The first sentence reveals something interesting, “from the time youth disclose their identity…are at the highest risk for self harm and suicide.” It is not clear if suicide was present before or originated the onset of their transgender ideation.
Any child that is at risk for harm or suicide needs acute cognitive-behavioural care in psychiatric or affiliate unit. This is exactly not the time for a child to be making any decisions that may affect their entire life. This is also not the time for parents or clinicians to accept the demands from the child. Nor is it time for them to implement any physiological changes. The underlying causes must be explored and the self harm or suicidal ideation must be psychologically examined.
The psycho-social trauma of adolescence, using public bathrooms, conflict with the family, and pubertal changes are all something to be explored with a medical professional if a child is feeling angst because of these issues. that does not mean the child needs to be transitioned medically to another sex. That may exacerbate issues.
They conclude this section with the authoritative statement that only they can succeed in the well-being of the child:
“In short, the lack of services and long waitlists put youth at high risk. Improving access to this clinic, is a lifeline.”
Their idea of a lifeline is only to a life long attachment to the medical industry.
One final point. They provide the LGBT Youth Line at the end of the page. The youth line is described as a “Queer, Trans, Two-Sprit youth-led organization that affirms and supports the experiences of youth (29 and under) across Ontario.” To many, this may seem innocuous. To the gay community, one might question; where is the term gay or homosexual? A retort perhaps would be that it is assumed that this organization would cater to the gay and lesbian community. Or that the L and the G are representative of those persons. There is controversy to this.
A strong feeling is building within the gay and lesbian community is that gender atypical children who would grow up to be homosexual are being erased via medical transitioning. This is occurring through homophobic parents, societal pressure calling sexual orientation outdated and transgender activist groups claiming homosexuality is a medical term. There seems to be an inversion in society, where homosexuality is once again being ‘treated’. Caught up along with gay kids are other gender non-conforming and neuro-atypical children. It is time to sound the alarm, and pull back the curtain on all the organizations and clinics complicit in these acts. The time to act is now.
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