The Background:

The most recent Canadian census (2021) found that 0.73% of Canadians ages 15-19 years identify as transgender and non-binary (TNB) [1].

Many TNB youth endorse gender dysphoria, defined as the distress that arises from an incongruence between an individual’s assigned and experienced gender [2].

TNB adolescents are at elevated risk compared to cisgender peers of a number of adverse health outcomes, including:

• Depression

• Anxiety

• Eating disorders

• Exposure to violence, self-harm and suicide [3–6]

This elevated risk is not intrinsic to having a gender-diverse identity; rather, it is at least partly attributable to the experiences of gender dysphoria as well as exposure to “minority stress”— the “distinct, chronic stressors minorities experience related to their stigmatized identities, including victimization, prejudice, and discrimination.” [7,8]

Gender-affirming care, defined by the World Health Organization as the range of “social, psychological, behavioural, and medical interventions designed to support and affirm an individual’s gender identity” is broadly recognized as integral to promoting optimal health and development for TNB adolescents. [9]

Where PRIDE Comes in…

Thus, it is imperative that structures be put in place to develop robust, contextually relevant, long-term research on the experiences and outcomes of adolescents engaging in gender-affirming care in Canada, to ensure that:

1. Canadian care providers are equipped to respond to calls for an enhanced evidence base

2. Canadian care providers are positioned to implement iterative, evidence-informed modifications to existing clinical pathways in order to provide Canadian TNB adolescents with the highest quality of care.

References: [1] Statistics Canada. https://www.statista.com/statistics/1366080/share-transgender-non-binary-persons-canada-age/. Accessed May 10, 2024. [2] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Ed. (DSM-5). 5th ed. Arlington, VA: American Psychiatric Association; 2013. [3] Clark BA, Veale JF, Townsend M, Frohard-Dourlent H, Saewyc E. Non-binary youth: Access to gender-affirming primary health care. Int J Transgenderism. 2018;19(2):158-169. [4] Chiniara LN, Bonifacio HJ, Palmert MR. Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different fromThose in Initial Reports? Horm Res Paediatr. 2018;89(6):434-441. [5] Chodzen G, Hidalgo MA, Chen D, Garofalo R. Minority Stress Factors Associated With Depression and Anxiety Among Transgender and Gender-Nonconforming Youth. J Adolesc Heal. 2019;64(4):467-471. [6] Sorbara J, Chianara L, Thompson S, Palmert M. Mental Health and Timing of Gender-Affirming Care. Pediatrics. 2020;146(4):e20193600. [7] Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Prof Psychol Res Pract. 2012;43(5):460-467. [8] Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-697. 9. World Health Organization. https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd. 2024. Accessed May 10, 2024.