Some provinces in Canada have put forward restrictions on access to care for transgender and non-binary youth. Saskatoon child psychiatrist Dr. Tamara Hinz spoke with the CMA ahead of Pride month about the potential harm to these young patients, and how physicians can support them and the 2SLGBTQI+ community.
What are some of the existing barriers for transgender youth seeking health or mental health care in Canada?
Patients I'm treating are facing up to two-year waits for an outpatient assessment with a child psychiatrist, overcrowded emergency departments and a lack of primary care — similar to what we see system-wide. What’s different is that they have additional hurdles finding health care providers they feel will be accepting, inclusive and non-discriminatory. There are even further barriers for transgender youth who do not feel it is safe or acceptable to come ‘out’ as they may not have support to navigate the healthcare system to access the care they need.
Unfortunately, many of these patients have awful stories of times they were, intentionally or unintentionally, made to feel invalidated or marginalized based on their sexual or gender identity so they may be reluctant to seek out healthcare.
What are the biggest concerns you hear from patients who identify as transgender or non-binary?
There are issues around bullying and peer acceptance and many patients experience tension or difficulties at home. For example, I have patients who’ve asked me to call them by a certain name and set of pronouns when we meet one-on-one, but then I have to switch to a different name and set of pronouns when family is around because the patient hasn’t felt it’s safe enough or they aren’t ready to come out at home. I have other kids who’ve been kicked out based on their sexual or gender identity, so they’re facing housing and financial insecurity. And we know these kids and teenagers are already at higher risk of mental health conditions like depression, anxiety, eating disorders, and suicide attempts.
Last summer, the Saskatchewan Ministry of Education announced a policy requiring parental consent for students under 16 to use different gender pronouns at school. This follows a policy introduced in New Brunswick in 2023. The Saskatchewan policy was passed into law in February 2024. What was your initial reaction?
I was horrified. I felt sick to my stomach. This is already a vulnerable population, and it felt unfair to target them this way when they're at such high risk for so many awful outcomes.
What impact have you seen?
It pushes more kids further into the closet, and into corners, and makes their world smaller. It makes them second-guess if they can be their authentic selves, who they can trust, or who might be forced to break their trust.
Kids are aware that, by law, teachers must now share or disclose gender pronouns to parents. Some also assume their doctors must share this information with parents.
So, I've had a number of conversations with kids to doubly or triply reassure them that this health information is still confidential — and still have patients who won’t answer questions about gender identity and sexual orientation, which are standard parts of any youth medical assessment.
In addition to announcing its own pronoun policy, the Alberta government has proposed legislation to restrict access to medical care for transgender and non-binary youth — including hormonal treatments, puberty blockers as well as restricting or altogether banning gender-affirming surgery for minors. What would that mean for transgender youth?
The thin edge of the wedge might be trans care in minors, but this precedent-setting legislation should concern every person in Canada because it introduces a level of government intrusion into the doctor-patient relationship that we have not seen. It's troubling that non-medical professionals — politicians lacking extensive training in these fields — are approving or blocking health care decisions that should be made between a physician and a patient.
Medical associations across the country, including the CMA, have made the same argument against these restrictions. As an expert in child psychology, what else would you tell governments about these policies?
Listen to the experts, read the evidence and literature and don’t buy into the hysteria or the manufactured fear around some of these topics. There’s a significant body of evidence that demonstrates that socially transitioned youth who feel accepted have dramatically lower rates of depression, anxiety, eating disorders and suicide attempts. Safe parental involvement is a huge protective factor. But not every child is lucky enough to come from a home where they’re going to be safe and accepted, so we need to protect safe spaces, whether that’s with a therapist, a physician or a teacher, because every additional place these kids feel like they can be their whole and authentic selves reduces rates of mental illness and lowers risks for self-harm and suicide.
What can physicians do to support transgender youth and their families?
At the individual patient level, it could be as simple as wearing a rainbow pin on your lanyard. Patients who are trans or LGBTQ notice those things and a small gesture like that might signal that you are a safe person. Normalize introducing yourself with your pronouns and make it a habit of clarifying the preferred name and pronouns of your patients.
If a patient comes for an appointment and says their name is different, accept that, move on and meet patients where they're at. Apologize when you inevitably slip up, because we all do, and not making a big deal about it is also important.
At a population level, I think the public needs to hear from trustworthy, evidence-backed voices, and physicians, based on their training and position of privilege, can provide this education and advocacy.
What would you like to see change in care for 2SLGBTQI+ Canadians, particularly those who identify as transgender or non-binary?
I would love for governments to enact policies that make health care easier as opposed to potentially creating or exacerbating problems. It should be a clear and straightforward process to receive gender-affirming care wherever you live without excessive delay or government intrusion. And whether you're trans, cis or non-binary, you still need a family doctor, you still need to be able to see specialists in a timely way, you need care that is safe and respectful. So any policy that makes our health care system truly universal, accessible and inclusive is also going to benefit this patient population.
This is the first Pride month since policies aimed at transgender youth have been put forward. How do you think they’ll affect events across Canada?
It underscores why Pride month is still so important. I think there had been a period where people became complacent, they felt ‘Why do we need Pride? You know, gay marriage is legal and these rights are protected.’ What this legislation really shows is how precarious those rights are, how there is still such disparity and discrimination in these marginalized groups and why it's important, now more than ever, to make sure that people who are 2SLGBTQI+ are protected and included and celebrated. Because that's ultimately what Pride is about — it isn’t just about acceptance, it's about inclusivity and joy. Everybody should feel free and safe to express their authentic self and that shouldn't begin at age 17 or 18. Those rights belong to minors as well.
This interview has been edited and condensed for clarity and length.
Dr. Tamara Hinz has worked as a child and youth psychiatrist in Saskatoon, Saskatchewan, since 2014. She does a mix of inpatient, outpatient and acute care emergency work and is an assistant professor in the College of Medicine at the University of Saskatchewan.