e-2443 (Health)

The Government of Canada is committed to working towards a more equitable, diverse and inclusive country, where everyone is free to be themselves and participate fully in society.

As part of this work, the Honourable Bardish Chagger was appointed as Minister to the newly created Diversity and Inclusion and Youth portfolio in November 2019. In addition to other areas, the Minister’s mandate letter includes five LGBTQ2-specific commitments, namely:

• Continuing the work of the LGBTQ2 Secretariat in promoting equality, protecting rights and addressing discrimination;
• Additional investments for LGBTQ2 organizations;
• Working with the Minister of Health to end the blood ban for men who have sex with other men;
• Consulting LGBTQ2 civil society representatives to lay the groundwork for an LGBTQ2 Action Plan; and,
• Supporting the Minister of Justice and Attorney General of Canada to amend the Criminal Code to ban the practice of conversion therapy.

The Minister’s updated mandate letter asks for the acceleration of an LGBTQ2 action plan that will “guide the work of the federal government on the priorities of LGBTQ2 Canadians.”

As part of its commitment to promoting equality and protecting LGBTQ2 rights, the Government of Canada has taken concrete measures in recent years that protect trans youth from discrimination. LGBTQ2 rights are human rights. Everyone in Canada deserves access to quality and compassionate healthcare – and that includes access to gender affirming surgery.

Canada has in place robust laws to protect children from all forms of abuse, including the criminal law at the federal level and child protection laws at the provincial and territorial level. In 2020, it introduced Bill C-6: An Act to amend the Criminal Code (conversion therapy), with work continuing to progress on the proposed legislation. Amongst other offenses related to the practice, this amendment will protect trans youth from undergoing coercive efforts to change their gender identity to cisgender.  Launched on November 27, 2020 with a national online survey, the Minister of Diversity and Inclusion and Youth is also currently undertaking a comprehensive engagement process with LGBTQ2 communities across Canada to inform a federal LGBTQ2 Action Plan. There is the potential that this engagement will help to identify further ways through which the federal government can address discrimination against trans communities, including youth. This builds on Bill C-16: An Act to amend the Canadian Human Rights Act and the Criminal Code, which received royal assent in 2017. This amendment added gender identity and expression to the Canadian Human Rights Act as prohibited grounds for discrimination.

Treatment for children and youth who experience distress as a result of their gender identity not matching their sex assigned at birth is a matter that falls within provincial and territorial responsibility for health care (with the exception of eligible First Nations and Inuit peoples, members of the Canadian Armed Forces, veterans, resettled refugees and some refugee claimants, and inmates in federal penitentiaries). However, the Public Health Agency of Canada (PHAC) has integrated components specifically designed to address needs of LGBTQ2 populations within a number of its community-based grants and contribution programs. In this context, the following is relevant research and evidence, as well as some of the measures the Government of Canada has taken to advance gender equality, which is an important determinant of health.

It is well established that many obstacles faced by gender diverse individuals can lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may in turn cause gender diverse people to suffer with anxiety, depression or related disorders at higher rates than non-transgender persons, leading to higher rates of suicide among transgender Canadians.[1] Creating conditions where transgender and gender diverse people are recognized, feel valued, and are free from discrimination is an important step towards supporting their health and wellbeing.

Research has shown that transgender youth are over-represented in the foster care system, at a rate approximately twice that of cisgender youth.[2]^,[3] While transgender youth enter the child welfare system for reasons similar to those of other children and youth, conditions are exacerbated for transgender youth when their families reject, neglect, or abuse them because of their gender identity. It is estimated that 43% of LGBTQ2 youth experiencing homelessness are forced from their homes because of conflicts with their families about their sexual orientation or gender identity; 32% of homeless LGBTQ2 youth have experienced physical, emotional, or sexual abuse at home over their sexual orientation or gender identity.[4]

To promote the health and welfare of transgender and gender diverse persons in all cultural settings, evidence-informed protocols and guidelines in the care of transgender, gender dysphoric and gender non-conforming people have been developed by individual clinics, and national and international professional associations alike. These guidelines include providing psychoeducational and social support to young people and their parents, as well as appropriate psychological evaluation. Treatments available to youth who meet criteria for gender dysphoria and who are determined to be appropriate for physical interventions include puberty suppression, cross-sex hormones in later adolescence, and gender-affirming surgical procedures (which are generally available when a person reaches the legal age of majority to give consent).[5] Standards of care are updated and revised as new scientific information becomes available.[6]

PHAC’s commitment to address the health needs of transgender populations is also supported by the Government of Canada-wide mandatory use of sex and gender-based analysis plus (SGBA+) in all research, program and policy development. SGBA+ is a tool to assess the potential impacts of policies, programs, and initiatives on diverse groups of men and women, boys and girls, and to mitigate those impacts. Using SGBA+ while considering other identity factors, such as gender identity, supports PHAC’s commitment to health equity, and allows for coordinated action to address health inequalities of LGBTQ2 populations.

These important steps will benefit all Canadians by creating a more gender equitable and inclusive society that supports mental, physical, emotional and spiritual wellbeing throughout the life course. Our government will continue to work closely with LGBTQ2 communities and all our partners to achieve greater equality, inclusion, and safety for LGBTQ2 Canadians.

[1] Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60(1), 44-49. https://doi.org/10.1016/j.jadohealth.2016.09.014

[2] Fish, J. N., Baams, L., Wojciak, A. S., & Russell, S. T. (2019). Are sexual minority youth overrepresented in foster care, child welfare, and out-of-home placement? Findings from nationally representative data. Child abuse & neglect, 89, 203-211. https://doi.org/10.1016/j.chiabu.2019.01.005

[3] Wilson, B. D., Cooper, K., Kastanis, A., & Nezhad, S. (2014). Sexual and gender minority youth in foster care: Assessing disproportionality and disparities in Los Angeles. https://escholarship.org/uc/item/6mg3n153

[4] Durso, L. E., & Gates, G. J. (2012). Serving our youth: Findings from a national survey of services providers working with lesbian, gay, bisexual and transgender youth who are homeless or at risk of becoming homeless. https://escholarship.org/uc/item/80x75033

[5] Strang, J. F., Powers, M. D., Knauss, M., Sibarium, E., Leibowitz, S. F., Kenworthy, L., & Pervez, N. (2018). “They thought it was an obsession”: Trajectories and perspectives of autistic transgender and gender-diverse adolescents. Journal of autism and developmental disorders, 48(12), 4039-4055. https://doi.org/10.1007/s10803-018-3723-6

[6]https://www.wpath.org/about/ethics-and-standards