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2STIGD Youth

The following section outlines the information that pertains to gender-affirming care in relation to surgical options and interventions. This section is comprised of both visual and written material, and should be completed in the following order: 

Watch Trans Care BC’s educational video on supporting gender creative children and their families.


Read and review the written guidelines and information outlined below. 


It should be noted that there are a number of limitations and knowledge gaps with the current WPATH SoC which directly impact Two-Spirit, trans, Indigiqueer, and gender-diverse (2STIGD) youth. These are discussed in the section Children and Youth. 

Informed Consent for Youth

Though there is a more in-depth discussion of the Informed Consent Model in Part 3, there are extra considerations to keep in mind when working with youth. The Medical Consent of Minors Act states that at the age of sixteen, youth are able to consent to medical treatment just as if they had reached the age of majority. According to the act, those under the age of sixteen are also able to consent to treatment if, in the opinion of the legally qualified PCP, they are capable of understanding the consequences and nature of the medical treatment, and if the procedure is in the best interests of the youth, their continued health and well-being. Similarly, the mature minor doctrine states that those able to understand the consequences and nature of a proposed treatment are able to consent to treatment regardless of age, which has been used in court to justify a minor’s right to consent. It should be noted that, while in the past the written opinion of a second legally qualified medical practitioner was required, this was amended in 2000 and is no longer a requirement.


Ideally, a supportive family member or guardian would be available to give consent on behalf of the patient. Unfortunately this is not always the case, and PCPs need to proceed with extra care with the awareness and understanding that in some cases, the patient may not have any adults in their life who support and respect their gender.  In cases where the PCP will need to discern the patient’s capacity to consent, the teach-back technique, or asking the youth to rephrase what they have been told, can be useful, as well as inviting them to ask questions.

Privacy and confidentiality should also be carefully considered when working with youth, as in some cases they may not want their caregivers to be aware of their treatment. “In most situations, a capable young person has the right to determine who will be given access to their personal health information, including parents.” In these cases, it is essential to clearly communicate  with the youth about how you plan to navigate this.

Your Role as a PCP

What can you do?

  • Assess persistence and consistency in gender identity

  • Identify possible confounders: personality disorders, body dysmorphia, history of abuse, external pressures, etc.

  • Assess the severity of gender dysphoria

  • Prioritize referrals: early puberty (Tanner stage 2 is the optimal time to start pubertal suppression) or severe dysphoria

  • Offer menstrual suppression prior to endocrine appointment where applicable.

  • If patient is a candidate for GnRH agonists, order screening labs/BMD prior to pediatric endocrinology appointment

  • Arrange care with a WPATH trained mental health care provider

  • Assist in follow up care including monitoring screening labs/BMD and overall health and wellness.

Referral – Information to Include

  • Age

  • Pubertal stage 

  • Severity of dysphoria (mental health, suicidal ideation/attempts)

  • Support from parents

  • Name of mental health care provider or other professionals

  • Your impression (support, hesitancy/doubts, areas to explore)

  • Baseline labs / investigations (if applicable)

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