Higgs refuses to answer questions about comments made about gender-affirming care

Weeks after Premier Blaine Higgs publicly indicated that it's too easy for children to get gender-affirming care in Canada, he still refuses to answer questions about his remarks, even in a statement. 

In December, Higgs told Radio-Canada and other news outlets that "60 per cent" of children are prescribed hormones or puberty blockers at their "first appointment" and that concerns him. He made the comment while defending changes he made to a school pronoun policy.

The author of the study, Dr. Greta Bauer, said the premier was misinterpreting her data. She said it took an average of a year to get to that appointment, and medical and mental health assessments were required before any prescriptions. 

A spokesperson for Higgs's office said this week that the premier may be available for a scrum Friday, but said on Friday morning that was no longer the case. When asked if the premier can give any written answers about his plans and why he's raising concerns around medical care for youth, the spokesperson said no.

The College of Physicians and Surgeons of New Brunswick said Friday it has not received any complaints or been made aware of any situations in which a patient seeking gender-affirming care did not receive appropriate care from a New Brunswick physician. 

Dr. Lise Babin, president-elect of the New Brunswick Medical Society, said in fact "care currently offered is often difficult to access and a patchwork for [patients], their families and their clinicians."

Premier's office offers psychologists to media, instead

Instead of providing an interview, Higgs's office offered the news media access to two psychologists who had made presentations to government in late November about this issue. 

One was Dr. James Cantor, a Toronto psychologist who has testified in cases in the United States to uphold bans on gender-affirming care for youth. Cantor said he's never treated anyone under the age of 16 for gender dysphoria, and the trans adults and teens he treats don't live in New Brunswick.

The other is Dr. Erica Anderson, who is a United States psychologist who provides therapy for trans youth, but not in Canada. Anderson, a trans woman who transitioned when she was an adult, advocates for caution and delays in providing gender-affirming care, though she said she has no evidence that Canada is not being cautious enough. 

Cantor's presentation to government included the reference to the 60 per cent number. His presentation says the study shows that kids were getting hormones with "minimal assessment."

Dr. Bauer worked at Western University before becoming the director of the Eli Coleman Institute for Sexual and Gender Health at the University of Minnesota's medical school.

She said before getting to that first appointment, youth waited an average of nine months from referral and saw an average of 2.7 other health providers. She said they all had to have mental health assessments and be diagnosed with gender dysphoria — proving that their dysphoria has been consistent and persistent over time.

They would have also needed to complete other medical tests before receiving the medication.

She said her two-year study actually shows "a very logical process of decision-making on the part of adolescents, their parents and physicians."

In the scrum with Cantor arranged by the premier's office Thursday, Cantor said that Bauer is misinterpreting her own data and her words were "not the whole truth." He said his reading of the data is more accurate than hers.

He said the study showed minimal assessment, because the wait times were "not mandatory." He suggested there should be mandatory assessment periods of six months to a year.

He cited changes to gender-affirming care recommendations in Sweden and United Kingdom as a goalpost for Canada. He did not know whether Sweden or the United Kingdom require mandatory assessment periods.  

According to the U.K.'s National Health Service website, a gender clinic is a child's first stop when experiencing gender dysphoria. When they're first referred there, "the team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months."

The psychological assessment would follow the same guidelines as the ones followed by Canadian mental health professionals, which are the standards of care set by the World Professional Association for Transgender Health.

Too easy to get hormones in N.B.? Experts say no

Cantor said that the only requirement for a diagnosis of gender dysphoria is that the child "identifies themselves as trans."

In fact, New Brunswick psychologist Amy Otteson, who is trained in providing this care, has told CBC that before a diagnosis and a letter of hormone readiness are provided, she has to rule out other issues and establish that the child's gender identity has been consistent and persistent over time, and that social transitioning or non-medical interventions were not enough to alleviate the dysphoria. 

Babin said the medical society is not aware of any "systemic issues with New Brunswick patients being prescribed gender-affirming medical treatment with undue haste and has not been contacted by government for input on the matter."

Health-care services for those who are exploring their gender identity, especially during adolescence, "constitute a long journey, informed by detailed international care standards," said Babin.

"Clinicians refer to these protocols, which are updated regularly to reflect any evidence-based changes in scientific thinking —including those in other countries — when guiding patients and recommending a potential course of treatment."

Only two pediatricians are listed in the province in Horizon Health Network's specialized gender-care web page. 

Dr. Marc Nicholson, a Saint John pediatrician, is one of them. He said the care is still under resourced in New Brunswick, especially when it comes to mental health professionals who are trained to assess these patients. 

Nicholson said he wouldn't prescribe medication to an adolescent with gender dysphoria without a hormone readiness letter, which needs to come from a World Professional Association for Transgender Health-trained professional. 

Because he focuses mostly on these children, his waiting list for an appointment is between three and four months. He said he does not accept self referrals, so he only sees kids who have been referred by another practitioner. 

He only sees children who have gender dysphoria and are around the age of puberty because there is no medical intervention for gender dysphoria before puberty.

There are plenty of other children who are transgender or nonbinary but do not have dysphoria that requires medical treatment with hormones, Nicholson said. Those children may just need a social transition or mental health support and no medical support.