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Supporting trans patients through endocrinology and education

In recognition of the 44th edition of Vancouver Pride this July, we’re sharing a three part series that features PHSA staff and partners. In this edition, Dr. Daniel Metzger reflects on the evolution of trans care throughout his career.
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​​​​​​​​​​This profile series offers three perspectives from the PHSA community about their efforts to address past struggles and ongoing challenges faced by the 2SLGBTQ+ community. The first profile features Dr. Daniel Metzger, an endocrinologist at BC Children’s Hospital. Read part 2 and part 3 of the series.

Trans Care BC staff members at the 2019 Vancouver Pride festival.

Trans Care BC staff members at the 2019 Vancouver Pride festival. 
Check out their booth at Sunset Beach on July 31, 2022.

Canada has a unique Pride history. Pride Week was first celebrated in August 1973 in several Canadian cities. In Vancouver, Pride celebrations began when the Gay Alliance Toward Equality (GATE) organized a picnic and art exhibit called “Gay Pride Week '73” in Ceperley Park (at Second Beach in Stanley Park). The first Pride parade in Vancouver was held in 1978.

Poster from Vancouver's first Pride Week, 1973

To mark the 44th edition of Vancouver Pride, perspectives from the PHSA community (including partners and staff) about their efforts to address past struggles and ongoing challenges faced by the 2SLGBTQ+ community will be shared in a series format. Chronicled by Communications Intern Alex Antrobus, the writer hopes that ultimately, these more personal perspectives will help provide opportunities for greater understanding and hope for a more inclusive society. (Pictured to the right is a poster from the first Pride Week in Vancouver, 1973, courtesy of​)​

At PHSA, we continue to acknowledge and celebrate our 2SLGBTQIA+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, and the countless affirmative ways in which people choose to self-identify) colleagues and patients/clients and continue to educate ourselves on practicing allyship.

Dr. Daniel Metzger (he/him)

Dr. Daniel Metzger (he/him) on care for transgender patients

Dr. Daniel Metzger has been working as an endocrinologist since 1993 with BC Children’s Hospital and treated his first trans patient in 1998. Though endocrinology is his primary field of expertise, trans patients have come to him for hormone replacement therapy and recommendations for other providers of gender-affirming care. ​

“The biggest struggle that people are having is around the legal barriers. I think Canada so far has been holding in there. In B.C. in particular, we've had a couple of legal decisions which were quite supportive of trans youth,” Dr. Metzger said. 
On the issue of broad trends in medical treatment for trans people, Dr. Metzger acknowledged the difficulties in accessing care. Currently, there’s a deficit in resources available to gender-affirming care providers.

“It's taking way too long for youth to see [gender-affirming care providers]. And it's partially [due to limited provider time], but it's really the mental health system,” Dr. Metzger said. “[Mental health care providers] are so under-resourced, not just in getting assessments but in dealing with the vast numbers of youth that are having mental health difficulties as a result of COVID-19 and/or their dysphoria, and/or life in general. The mental health system, particularly for kids, is just completely overwhelmed.”

As if that weren’t enough, the issue of proximity to health-care providers afflicts everyone living in areas away from larger cities.

“If you're up north or in certain, more remote or more rural regions, health care is harder to access in general. Family doctors are almost impossible to acquire and trans care can be quite difficult to find as well.”
​Progress is being made, however, and Dr. Metzger said that medical students are aware of the challenges they face but are eager to overcome them. 

“I've been doing a lecture for the first- or second-year medical students for the past five or six years,” Dr. Metzger said. “I always tell them, you know, I'm a pediatric endocrinologist, I can't talk about everything, you need to learn how to do trans-friendly care, and the medical students are all over it. I’ve been told that this is more and more a part of what they learn.”

“With the young crop of medical students that are coming up, I don't think it's going to be a problem.”

Ways to learn in order to support

Although challenges related to accessing trans health care continue to exist, we can do our part to create a welcoming and positive space for all 2SLGBTQIA+ people at PHSA. If you have a few spare moments during Vancouver Pride weekend and the B.C. Day long weekend, please take some time to reflect on what you can do to learn more about and better support 2SLGBTQIA+ colleagues, patients, community and family members. 

To begin, you can check out the following PHSA resources:

Always feel free to reach out to the Trans Care BC team at with your questions, and for more information.
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