Medical Affirmation & Transition

Information on gender-affirming medical care for children and youth in B.C.

Gender-affirming medical care is necessary for some trans and gender diverse people. If your young person is feeling distressed about their body or anxious about the changes that will come with puberty (e.g., breast growth, menses, voice change, facial hair), it is important to know what medical care options are available.

Readiness assessment
Starting puberty blockers or hormone therapy, or having gender-affirming surgery are big decisions, and support from family and health care providers is important. Assessment and care planning may be provided by a number of professionals who have received advanced practice training in this area of care. These may include a pediatrician, family doctor, psychologist, psychiatrist, social worker or nurse practitioner.

The role of the clinician doing the readiness assessment is to:

  • Support decision-making around interventions.
  • Confirm that the WPATH criteria for care are met.
  • Confirm psychosocial readiness including readiness of family, school environment, etc.
  • Confirm the plan for ongoing care and support.
Regardless of whether treatment is started, the clinician should provide recommendations, including what education, support, further assessment or treatment can be provided.

Sometimes the clinician who completed the readiness assessment is also able to prescribe treatment. Other times, the readiness assessor will write a letter of recommendation for treatment to a physician or nurse practitioner who will provide treatment and care. Sometimes clinicians work in teams with different members of the team holding different roles in the care all in one place. 

You have the right to accurate, evidence-based information about gender health and care options. If you or your family member are having trouble locating gender-affirming care please contact us for information about options in B.C.
Puberty blockers and hormones

Puberty blockers

Puberty blockers are medications that suppress the sex hormones that are produced by the body. These medications may be started soon after puberty begins. They put puberty on pause and can prevent changes such as voice lowering, breast growth and periods. Effects will vary, depending on how far puberty has progressed before starting the blockers. There are no known irreversible effects of puberty blockers, so if your child were to stop taking them their body would continue through puberty, picking up where it left off. These medications have been safely used for decades to treat children with precocious puberty, and were first used with trans youth in the 1990's.

There are three main reasons that youth use puberty blockers:

  1. The onset of puberty and the idea or reality of developing secondary sex characteristics that do not fit with their gender identity can be very distressing. Puberty blockers can help alleviate this distress. 
  2. If a child is still exploring their gender, puberty blockers allow additional time to explore without worrying about unwanted physical changes. 
  3. Preventing unwanted physical changes can eliminate the need for some surgeries and procedures later on, such as male chest contouring and electrolysis.

Puberty blockers are often prescribed by a pediatric endocrinologist. However pediatricians and family physicians who are knowledgeable about trans care may provide this care as well. For more detailed information, see our Puberty Blockers page.

Hormone therapy

Some youth who take puberty blockers early in adolescence go on to start hormone therapy. Youth who have not taken puberty blockers may also take hormones. 

Hormone therapy allows people to develop secondary sex characteristics that are in line with their gender identity, such as breast growth, softer skin, facial hair, or deeper voice. While not all trans and gender diverse youth will need hormone therapy, it is important that youth who do require this care have access to it. 

Like puberty blockers, hormone therapy can be effective in alleviating a person's distress about their body and how they are perceived by others. Research shows that youth who have access to needed hormone therapy have mental health outcomes similar to their cisgender peers, and a recent study documented that suicide attempts and emergency room visits decreased after trans youth had their first appointment with the pediatric endocrinology team at BC Children's Hospital.

Younger youth and their families or caregivers may work with a pediatric endocrinologist for their hormone therapy. Youth, especially those who are older, may be able to access this care through a knowledgeable family doctor. Family doctors can provide care planning, prescribing and monitoring of hormones if they have training in this area.

Gender-affirming surgeries

Gender-affirming surgeries are called irreversible interventions, since these changes to people's bodies cannot be undone. For the most part, people wait until they are at least 19 years old to have gender-affirming surgeries. However, upper body surgeries (chest construction or breast construction surgery) are sometimes performed for youth under age 19.

For some people, gender-affirming surgeries are important for living in their authentic gender. Bringing one's body into alignment with the true gender self may be necessary for reducing distress. Some options include upper surgeries (e.g., breast construction, chest construction) and lower surgeries (e.g., hysterectomy/oophorectomy, orchiectomy, vaginoplasty, metoidioplasty, phalloplasty). A more complete description of surgery options and how to be referred for surgery is available on our surgery pages. 

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