2SQTP-NB (Two-Spirit, Queer and Trans Pathways New Brunswick) / P2SQT-NB (Pistes bispirituelles, queers et trans au Nouveau-Brunswick) is an educational platform and resource bank developed through Imprint Youth Association’s 25-month project, funded by Women and Gender Equality Canada ($372,920), Building Capacity for Sustainable Trans Health Care in New Brunswick. This project aims to build and strengthen access to gender-affirming health care in New Brunswick through the development of a training and mentorship program for primary health care providers (i.e., nurse practitioners, physicians, and residents). The training program consists of a self-directed education package and 40 hours of clinical mentorship, and has been developed in consultation with Two-Spirit, trans, Indigiqueer, and gender-diverse (2STIGD) communities, and gender-affirming care providers throughout Wolastokuk, Peskotomuhkatik, and Mi'kma'ki, or what is currently called New Brunswick. By the project's conclusion, 2SQTP-NB/P2SQT-NB aims to train 7 primary health care providers to actively provide gender-affirming, culturally sensitive care to 2STIGD individuals across the province.
As with all terminology, language evolves over time and is used in a variety of ways by different people and communities. The purpose of the terms provided, in particular for the definitions of various identities, is not to limit these terms, nor to give primary care providers (PCPs) license to choose labels for their patients. Instead, we are aiming to give PCPs a general idea of what a patient may mean should they identify with a given identity. In all cases, rather than make assumptions, we encourage PCPs to ask patients what they want to communicate about their identity. As such, it should be noted that there will at times be variations between how individuals identify and the definitions provided below, and PCPs are encouraged to always follow their patient in their individual use of terms and definitions.
A collective term that is used to describe people who are Two-Spirit, lesbian, gay, bisexual, transgender, queer, Intersex, asexual, and more. Previously, LGBT had been used as the standard acronym.
A form of descrimination against people either with, or perceived to have, disabilities. It is embedded in the way society is structured to accommodate able-bodied people’s needs and without Disabled People in mind.
A form of discrimination based on negative attitudes and stereotypes about the aging population. It also involves the way that society is structured based on the needs of young people and thereby failing to respond appropriately to the needs of aging individuals.
Someone who does not identify as having a particular gender or who feels an absence of gender.
A term to describe a non-autistic person.
An ally is someone who supports the autonomy, agency, and livelihood of equity-deserving groups and acts in ways that demonstrate their solidarity to those groups. This is not a self-identified title, and is an ongoing process.
Aromantic / Aro
A term describing someone who does not experience romantic attraction and/or doesn’t find romantic relationships desirable. Aromantic people may also be asexual, though they are two separate identities.
Asexual / Ace
An umbrella term to describe someone who is on a spectrum of experiencing little to no sexual attraction regardless of gender. Asexual people may also be aromantic, however they are two separate identities. Examples of identities which may fall along the asexual specturm are demisexual and gray-asexual.
Assigned Female At Birth (AFAB)
A term used to describe people who were designated female on their birth certificate. This word is often used to describe people who were born with a vagina and/or ovaries.
Assigned Male At Birth (AMAB)
A term used to describe people who were designated male on their birth certificate. This word is often used to describe people who were born with a penis.
A term some Autistic folks use to describe their gender identity and how it is interconnected with and inseparable from their autism. See also Neurogender.
The process of tightly wrapping someone’s chest or wearing a binder to reduce dysphoria and minimize the appearance of breasts.
An acronym that stands for Black, Indigenous, and people of colour. While this can be a useful acronym in some settings, we urge caution as these are various distinct identities. More often than not, a more specific and accurate identity would be more appropriate, particularly when referring to an individual.
Bisexual / Bi
Someone who is attracted to people of their own gender and people of other genders. Bisexual people typically are attracted to more than two genders, despite having a “bi” prefix implying “two.”
A word used to describe a range of gender-affirming genital surgeries.
Cisgender / Cis
A term to describe a person whose gender identity corresponds to the gender assigned on their original birth certificate (i.e. someone who is not trans or gender-diverse). Cisgender people identify as either male or female / man or woman. Two-Spirit and Indigiqueer individuals may or may not identify as cisgender.
A form of discrimination based on negative attitudes and stereotypes about the aging population. It also involves the way that society is structured based on the needs of young people and thereby failing to respond appropriately to the needs of aging individuals.
Cis man / Cisgender Man
Someone who was assigned male at birth and identifies as a man.
The privilege received when a person’s gender identity or expression matches their sex assigned at birth. For example, they are not denied access to health care, discriminated against in the workplace due to their gender identity, misgendered when addressed or spoken about, questioned about their gender, asked what their "real" name is, or fearful of violence because of their identity.
Cis woman / Cisgender Woman
Someone who was assigned female at birth and identifies as a woman.
A group of Canadian health care professionals who seek to discuss and advance trans health care research. For patient referral letters, note that CPATH letters are also accepted by Medicare for approval.
Culturally Sensitive Health Care
An approach which integrates the culture and language of all involved, focusing on the patient and emphasizing cultural indicators of respect. This creates a partnership between the patient and the primary care provider (PCP), increasing trust as the provider is aware of and knowledgeable about their patient’s culture, understands the difference between culture and pathology, and integrates those concepts into their care of the patient.
Demisexual / Demi
A sexual orientation that describes someone who is only sexually attracted to someone with whom they already have a close emotional connection; sometimes considered to fall under the asexual umbrella.
This is an older term that many people still use to self-identify as someone who is transitioning or has transitioned from female-to-male, or in other words, a trans man.
A form of manipulation to gain power by challenging the validity of someone’s personal experience, intending for them to question themself, and their mental soundness In a medical setting, this happens when a patient's concerns are not believed, dismissed or deemed insignificant, or are labeled a psychological rather than biological problem.
Intentional or unintentional exclusionary measures that restrict who “is” and who “is not” allowed opportunities. In a health care setting, this is when PCPs create unnecessary and unfair hurdles for those accessing care, for example, 2STIGD patients to “prove” their gender diversity in order to access gender-affirming care.
A sexual orientation that describes someone who is sexually and/or romantically attracted to people of their own gender. The term can be used regardless of gender identity but is commonly used to describe men who date other men, i.e. gay men.
Gender-Affirming Health Care
An approach which is patient-centered, falling into two distinct branches: delivering transition-related care, as well as addressing all the other primary care needs of 2STIGD patients in a way that is sensitive to the unique needs of these individuals and affirming of their gender identity.
Gender-affirming hormone therapy (GAHT) / Hormone replacement therapy (HRT)
Refers to a life-saving and life-affirming treatment process for people seeking to physically change their bodies to fit their gender identities. Estrogen HRT and testosterone HRT are two types of hormone therapy. HRT and GAHT can be interchangeable terms; however, GAHT is more specific to 2STIGD people because HRT can refer to cisgender people.
Refers to a number of life-saving and life-affirming surgeries for people seeking to physically change their bodies to fit their gender identities. Notably, not all 2STIGD people choose gender-affirming surgeries for various reasons.
The ideological concept and belief that there are only two genders, male and female, and that a person must neatly fit into one category or the other.
An umbrella term that is used to describe gender identities beyond the binary framework. This includes, but is not limited to, trans, non-binary, agender, and gender fluid folks.
Emotional and physical distress experienced by some 2STIGD people whose genders don’t match their sex assigned at birth. Gender dysphoria can cause depression, anxiety, mental unrest, and severe psychological and social distress. It is often made worse by unaddressed transphobia and gendered microaggressions in work, family and public life. Although the diagnosis of gender dysphoria is often required to receive gender-affirming health care, it is not a term or experience with which all 2STIGD people identify.
Emotional and physical elation experienced by some 2STIGD people when their gender is acknowledged or apparent. This can be a result of social factors (being acknowledged by others through use of one’s name, pronouns, or other gendered or non-gendered indicators), or a result of physical presentation (seeing evidence of one’s gender in the mirror, receiving acknowledgement/compliments about appearance in line with one’s gender). While healthcare is often approached from a deficit perspective, emphasizing Gender Dysphoria, we encourage using a strength-based perspective focusing instead on gender euphoria.
An umbrella term to describe anyone whose gender expression is outside of the gender binary. This can be a more flexible term to describe people who aren’t cisgender but don’t necessarily identify as trans or non-binary.
How a person chooses to express their gender through behavior, hair, clothing, make-up, etc. Gender expression is not the same as gender identity. The way someone presents themselves to the world around them can be fluid and can change over time, day to day, or situationally. Everyone expresses their gender in some way, whether they are Two-Spirit, trans, Indigiqueer, gender-diverse, or cisgender.
Gender Fluid / Gender-Fluid / Genderfluid
Someone whose gender identity is not fixed, and may shift through a binary and/or non-binary framework.
A person’s internal sense of their gender or who they know themselves to be (i.e. a man or woman, both, neither, or another gender).
A term to refer to language and ways of being that are not explicitly gendered. This can mean using gender-neutral language such as “folks” or “all” instead of “guys'' or “ladies and gentlemen.” It can also mean not prescribing gender to things that are not inherently masculine or feminine, i.e. behaviors, activities, clothing, body parts, etc.
A term to describe a person whose behavior, appearance, or characteristics do not conform to the prevailing gender norms or social expectations of what is appropriate for a masculine or feminine identified person.
Similiar to gender fluid, this term describes a person whose gender identity is not solely male or female. Genderqueer can describe a person who “queers” gender, meaning their gender can shift and change at any given time.
A term describing how people are expected to behave (including dress, approach to sexual relationships, and more) based on their perceived gender. Gender roles are rooted in gender norms, which is a social code for restricting gender identities into what is considered to be socially acceptable.
Gray-Asexuality / Graysexual
A sexual orientation that describes someone who rarely experiences sexual attraction, often only under specific circumstances, or who fluctuates between periods of experiencing and not experiencing sexual attraction.
A set of practical strategies and ideas aimed at reducing negative health, social and legal impacts associated with drug use, sex work, eating disorders, self-harm, etc., without requiring abstinence from the behaviour itself.
The assumption that heterosexuality (including heterosexual people) is the default and the standard for defining “normal” sexual, cultural, and social behavior, resulting in heterosexual privilege.
Prejudice, discrimination, or bias against queer or gay people from heterosexual people based on the belief that heterosexuality is normal, natural, and innate.
Heterosexual / Straight
A sexual orientation that describes women who are sexually and romantically attracted to men, and men who are sexually and romantically attracted to women.
An irrational and systematic hatred of or aversion to queer people or people who are perceived as such.
Indigiqueer / Indigequeer
A term coined by Thirza Cuthand to title the Vancouver Queer Film Festival’s Indigenous/Two-Spirit program in 2004. They used it as a way to acknowledge that not all LGBTQIAA+ Indigenous People feel that Two-Spirit describes their identity. It’s sometimes used alongside the Two-Spirit identity, but is used more often by those who do not identify as Two-Spirit as a way to describe the intersection of being queer and Indigenous.
Treating someone like a child or in a way that invalidates, ignores or denies their autonomy, maturity, age and experience. It is a disrespectful and emotionally damaging experience for many Autistic and Neurodivergent individuals. For more information see Gaslighting and Disability and Neurodivergence.
In health care, this is when a provider outlines details about risks, benefits, and alternatives of a procedure or intervention and allows the patient to make a decision based on all the information presented.
Trauma experienced by a person or group of people that gets passed down through subsequent generations, and can occur from a single traumatic event (e.g. an assault), a repetitive traumatic experience (e.g. poverty, domestic violence), or within the context of historical trauma, as it is often used in contexts discussing Indigenous Peoples in relation to their historic and current mistreatment in Canada.
This includes, but is not limited to, internalized ableism, ageism, classism, homophobia, misogyny, racism, sexism, transphobia, and xenophobia. It should be noted that systems of oppression have caused internalized phobias not just for those outside of individual communities, but for those within communities as well. This can result in gatekeeping (for example, biphobia within the queer community, or nonbinary exclusion within the trans community), lateral violence within communities, and negative mental health outcomes impacting one’s own self-worth. Particularly within gender-affirming care, it is important to carefully navigate conversations where patients may struggle with this internally, as 2STIGD patients may be navigating internalized transphobia even as they are seeking gender-affirming care.
A Black feminist theoretical framework with origins as early as the 1850s. Officially coined by Kimberlé Crenshaw in 1989, intersectionality refers to the complex, cumulative way in which an individual's unique identities combine, overlap, or intersect to produce the effects of multiple forms of discrimination (such as racism, sexism, classism, etc.).
Intersex is an umbrella term for differences in sex traits or reproductive anatomy. Intersex people may be born with these differences or develop them in childhood. There are many possible differences in genitalia, hormones, internal anatomy, or chromosomes, compared to the more common two ways that human bodies develop.
A sexual orientation that describes a woman who is romantically and/or sexually attracted to other women, whether the women are 2STIGD or cisgender.
This is an older term that many people still use to self-identify as someone who is transitioning or has transitioned from male-to-female, or in other words, a trans woman.
Masking (or camouflaging)
A term to describe when a Neurodivergent person develops coping mechanisms to appear neurotypical in social settings. This may be conscious or subconscious. Oftentimes folks do this in social environments to avoid ostracization from peers, colleagues and within other systems of power where they may feel unsafe while being themselves. Masking is extremely exhausting and can lead to burnout.
An action or statement that is subtle, unintentional, or indirect causing discomfort or harm to whom it is directed. Most often experienced by those belonging to marginalized groups.
Refers to someone using gendered language, pronouns, or forms of address that do not correctly reflect the gender that a person is, identifies with, and wishes to be known as. When misgendering occurs, thank the patient if they have corrected you, repeat what you had said with the correct pronoun, and move on.
Refers to a romantic/sexual relationship that takes place exclusively between two partners, or describes a person who wishes to have an exclusive romantic/sexual relationship with a single partner.
An umbrella term to describe those who think or act differently from what is considered by society to be “typical,” and can cover a broad range of mental and neurological diagnoses (e.g. ADHD, autism, dyslexia, etc).
A term some Neurodivergent folks use to describe their gender identity and how it is interconnected with and inseparable from their neurodivergence. See also Autigender.
A term to describe when a person has no presentation of atypical patterns of thought or behavior.
Non-Binary / Nonbinary / NB / Enby
A term to describe people who do not identify as men or women. Some non-binary people also identify as trans while others do not. Non-binary can be thought of as an umbrella term to describe people whose gender(s) fall outside of the gender binary.
A sexual orientation that is not limited in choice by gender identity or sex assigned at birth. Some describe this as being attracted to all genders.
A term used to describe when someone who is not cisgender is perceived as cisgender. Can also be used to describe a spectrum, that is, the degree to which someone passes (or is perceived as) their gender (rather than as their gender assigned at birth).
Polyamory is one of the most well-known types of ethical non-monogamy. It involves having romantic and/or sexual relationships with more than one person at the same time. Polyamory can be done in many different ways. For example, several people may all be in a relationship together, or a pair of two individuals may each be committed to additional partners of their own, and these relationships may have varying levels of commitment.
A word that is used to refer to someone instead of a name or noun phrase. Different gendered pronouns include she, him, their, and many more. For a complete list of pronouns, check out this guide by Egale Canada. For additional resources on pronoun usage, see the resources compiled by Trans Wellness Ontario. When Misgendering occurs, thank the patient if they have corrected you, repeat what you had said with the correct pronoun, and move on.
An acronym that stands for queer and trans people of colour
A sexual orientation that can be thought of as an umbrella term that means “not straight.” This word is often used by people who think of their sexuality as outside of heteronormative societal norms. Some people view the term queer to be more inclusive and political than more traditional categories of sexual orientation, while other people do not use the word to self-identify because of its historical context as a derogatory slur.
Sex Assigned At Birth
The label a medical professional gives to a baby when it is born. A medical professional may say a baby is male or female depending on an external biological evaluation. Notably, Intersex babies are still assigned male or female at the time of birth despite not falling neatly into either category.
How a person characterizes their emotional, romantic and/or sexual attraction to others.
Sex work refers to the consensual exchange of sexual services between adults for money or goods. Peers Victoria, “an organization of sex workers for sex workers,” has put together a number of resources for better understanding sex work. Specifically, we would like to draw attention to Who Are Sex Workers, Stigma and Sex Work, and Health and Sex Work. Within the context of the 2STIGD community, see We Belong: Addressing Service Inequity for Trans, Non-Binary, and Two-Spirit Sex Workers.
A self-regulating behavior (verbal or nonverbal) that can include rocking back and forth, flapping hands, flicking or snapping fingers, bouncing, jumping, twirling, repeating words or phrases, rubbing the skin or scratching, etc. Stimming can be a response to excitement (happy stims), or to stress and anxiety as a self-soothing technique.
A word used to describe a range of gender-affirming chest surgeries.
Transfeminine / Transfemme
A word to describe a trans and/or gender-diverse person who identifies as feminine, but may or may not identify as a woman. Two-Spirit and Indigiqueer People may or may not use this terminology to describe themselves in addition to Two-Spirit or Indigiqueer.
Transgender / Trans
A term to describe a person whose gender identity and assigned sex at birth do not align. Also may be used as an umbrella term to include other gender identities outside of the gender binary, however not all gender-diverse individuals identify as trans. Two-Spirit and Indigiqueer People may or may not use this terminology to describe themselves in addition to Two-Spirit or Indigiqueer.
Transgender Man / Trans Man
A trans person who identifies as a man. Trans men are men, just like cis men, only they happen to be trans.
Transgender Woman / Trans Woman
A trans person who identifies as a woman. Trans women are women, just like cis women, only they happen to be trans.
For people who are not cisgender, this refers to the process of coming to recognize, accept, and express one’s gender identity. Most often, this refers to the period when a person makes social, legal, and/or medical changes, such as changing their clothing, name, appearance, or sex designation. Notably, not all folks transition or will only choose some aspects of transition (e.g., socially transition, but not medically transition).
Transmasculine / Transmasc
A word to describe a trans and/or gender-diverse person who identifies as masculine, but may or may not identify as a man. Two-Spirit and Indigiqueer People may or may not use this terminology to describe themselves in addition to Two-Spirit or Indigiqueer.
The intersection of transphobia and misogyny as experienced by trans women and transfeminine people.
The discrimination against or hatred of trans or gender-diverse people, or those who are perceived as such.
A term used in medical literature or by some trans people to describe those who have transitioned through medical interventions. Some find the term to be outdated, while others still self-identify as such. This term should only be used if the individual has already self-identified as transsexual.
Trauma-Informed Health Care
An approach that prevents further and re-traumatization by emphasizing safety, trustworthiness, opportunities for choice, collaboration, and connection. Trauma-informed care is implemented in policies, procedures, and practices.
The process that some people will undergo by hiding one’s genitals with tape, tight shorts, or specially designed undergarments to reduce dysphoria and the appearance of a bulge.
Two-Spirit / Two Spirited / 2 Spirit / 2S
The term "Two-Spirit" originated in Winnipeg, Canada in 1990 during the third annual intertribal Native American/First Nations gay and lesbian conference. It comes from the Ojibwe words niizh manitoag (two-spirits), that is reflective of the history and complex understandings of gender roles, spirituality, and sexual and gender diversity in Indigenous cultures. Individual terms and roles for Two-Spirit People are specific to each Nation, and the term Two-Spirit is not meant to replace any culturally specific terminology or concepts already in use within Indigenous communities. Two-Spirit is a term that can encompass Indigenous LGBTQIAA+ People, but is used most often in contexts of gender identity. It is also important to note that not all all Indigenous People who hold diverse sexual and gender identities consider themselves Two-Spirit. An individual may identify as Two-Spirit, Indigiqueer, LGBTQIAA+, some/all of those terms, or none. Due to its cultural, spiritual, and historical context, "Two-Spirit'' is an identity only to be used by Indigenous Peoples.
The current worldwide standard of care for transgender health care. For patient referral letters, note that CPATH letters are also accepted by Medicare for approval.
Addressing WPATH Knowledge Gaps
The World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin International Gender Dysphoria Association (1978–2007), was formed by Dr. Harry Benjamin with the purpose of creating an international group of professionals who specialized in “treating gender nonconformity”. The Association published the first Standards of Care (SoC) in 1979, which, alongside the Diagnostic and Statistical Manual of Mental Disorders (DSM), served as the primary pathway to guide medical providers in understanding and caring for Two-Spirit, trans, Indigiqueer, and gender-diverse (2STIGD) people. Since 1979, there have been 7 editions of the SoC, each edition responding to socio-cultural, legal, and medical changes in understanding gender diversity.
The seventh version of the SoC, published in 2012, aimed to address the concerns of community activists who had criticized previous WPATH standards as being overly restrictive and pathological. In addition to loosening the requirements for access to care, that revision established clearer advocacy on trans issues and no longer referred to gender diversity as a disorder. However, despite over a decade worth of calls to decentralize DSM criteria from the SoC, SoC-7 continued to promote assigning a diagnostic category to gender diversity (i.e., currently listed in DSM-V as Gender Dysphoria). Although many 2STIGD people do experience dysphoria, community activists (such as TPATH) have argued that pathologization should not be the precursor to “promoting optimal health” for gender-diverse people.
Now, a decade after the release of SoC-7, WPATH has released version 8 of the SoC. On December 14th, 2021, WPATH published the draft guidelines for SoC-8, making it available to the public for open comment. Although the SoC-8 draft revealed some progressive elements (i.e., lowering the minimum age of care and introducing a section on non-binary folks), there were some additions that have been noted to contain regressive and harmful elements. However, the future remained uncertain for how/if WPATH would amend the sections containing harmful elements. It should be noted that the project team has reviewed the released SOC-8 and are sadly able to confirm that no amendments were made regarding the below concerns.
According to WPATH, the goal of SoC-8 is to provide clinical guidance to health professionals to assist 2STIGD people with safe and effective pathways for maximizing their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (i.e., assessment, counselling, psychotherapy), and hormonal and surgical treatments. While the SoC-8 is primarily a document for health professionals, it may also be used by individuals, their families, and social and legal institutions. Therefore, while the SoC is intended to be a set of flexible guidelines, the SoC have become the ‘gold standard’ for how to care for 2STIGD folks around the world. Due to the far reaching impact of the SoC guidelines on the health, wellbeing, and care of 2STIGD people, it is important that providers have the ability to think critically about how they are interpreting and following SoC guidelines. To assist providers in doing so, the sections below outline the limitations of SoC-8.
Community consultation / approach to research
In 2020 Eli Coleman, current chair of the SoC-8 committee and former WPATH president, presented an update on the methodology used for the development of SoC-8, noting that the new guidelines sit at the praxis of scientific research and evidence, clinical expertise, and patient factors and clinical circumstances. Working within this paradigm, the SoC-8 revision started by WPATH identifying a multidisciplinary team that would come to decide on chapter topics, aid in systematic literature reviews, and draft clinical recommendations. To determine team membership WPATH used the following eligibility criteria:
Longstanding WPATH Full Member in good standing
Well recognized advocate for WPATH and the SoC
Well known expert in transgender health
Extensive experience in leading consensus building projects and guideline development
Accomplished clinician, scholar, and/or researcher in trans health with a publication record
Able to assess the evidence-based and peer review literature and contribute specific recommendations from an evidence-based perspective.
The eligibility criteria for involvement in the construction of the SoC-8 required contributors to be an ‘expert’ on trans issues and hold a professional designation (i.e., PhD, MD, MSW, RN, etc.).
While approximately 40 of the 152 contributors to SoC-8 are openly identified as 2STIGD, these individuals were still required to meet WPATH’s eligibility criteria of professionalism (i.e., MSW, PhD, MD, etc.). As such, it is important to remain conscious of how the intersection of privilege, and in particular, classism and colonialism, limits the dialogue around these topics and actively excludes some of the most marginalized voices. This lack of community consultation has resulted in a top-down process for determining the care needs and desires of 2STIGD people. Remember that the real experts are those who live through these experiences.
As a result of this top-down process, the SoC-8 continue to reflect limiting views on gender identity (i.e., binary-focused) and place a higher emphasis on professional knowledge over that of the lived experience of 2STIGD people. Importantly, while WPATH is an international association, the organization’s views on gender identity, expression, and medicine predominantly reflect those of white and Western culture. As such, care providers need to allow patients the space to describe how they experience themselves, rather than assume care needs based on their perception of a patient’s gender identity.
Children and Youth
Although the SoC-8 made some progressive adjustments regarding the minimum age of care, a bulk of the documents' regressive elements are located in the chapter on Children and Youth. With the current onslaught of anti-trans legislation directed at 2STIGD youth, the SoC-8 recommendations for adolescents is particularly troublesome and runs the risk further pathologizing gender diversity in young people.
Perhaps most concerning is the SoC-8’s adolescent chapter legitimization of rapid onset gender dysphoria (ROGD) and promotion of gatekeeping of adolescents from puberty suppression or confirming hormonal care.
ROGD was proposed in 2016 as a phenomenon in youth with gender dysphoria that emerges at or after puberty, with the suggested cause being peer influence and social cognition.This theory has now been entirely debunked. Although not directly referenced as ROGD in SoC-8, WPATH describes the “trend” of gender diversity in adolescence as the result of an “increase in visibility of transgender and gender-diverse identities.” The same section also references the work of Lisa Littman, who coined ROGD, stating that “another phenomenon is adolescents seeking care who have not apparently experienced and/or expressed gender diversity during their childhood.” Failing to reference literature debunking ROGD, SoC-8 merely addresses errors in Littman’s (2018) methodology and instead states that “for a select subgroup of young people, in the context of exploration, social influence on gender may be a relevant issue and an important differential.” Finally, the section makes reference to prioritizing a caregiver’s doubts over the “very recent and/or sudden self-awareness of gender diversity,” and encourages providers to give precedence to “several years” of well-documented “gender incongruence or gender diversity” over the adolescent’s own identification, bodily autonomy, and right to self-determination. Such a recommendation fails to consider or address the many valid reasons a child or adolescent may not disclose their gender identity or desire to explore their health care options to a parental figure. Additionally, it ignores that children may not experience or recognize dysphoria/gender incongruence until puberty. Puberty kicks off a series of changes to the body that the individual has never experienced and for 2SITGD people this is often the catalyst to realizing that they identify differently than their peers who are experiencing no distress or even excitement over those changes.
Giving priority to caregiver distress is also seen in the SoC-8’s chapter on Intersex peoples, where the SoC-8 affirms caregiver distress instead of Intersex patients themselves. Here, caregiver distress is noted as a reason for supporting medical interventions on children with Intersex variations as a means to minimize the “effect Intersexuality may have on parental care”. Caregiver distress should not be considered as a reason to perform binary sex assignment surgery. Unsupportive caregiver opinions should never be given precedence over the Intersex child’s bodily autonomy and right to self-determination.
Lastly, the Children and Youth chapter describes gender-exploratory therapy (GET) as a “key step” for 2STIGD people, based on an article written by Dr. Edwards-Leeper (chair of the Child and Youth chapter) where she recommends GET over the more commonly recommended gender-affirmative therapy (GAT). Whereas GAT is founded on the position that no gender identity, expression, or experience is any more valid, ‘natural’ or ‘normal’ than any other, GET seeks to reduce gender dysphoria therapeutically (i.e., through counseling), only offering medical transition as a last resort and often drastically lengthening the period of waiting before transition. It is important to note that GET is a form of conversion therapy that aims to limit or erasure gender diversity within the child. In GET the medical provider dictates the path of care, thus rejecting a collaborative and affirmative therapeutic relationship with the child or youth. Wherever possible, gender-affirmative therapy (GAT) is a more affirming and collaborative option for children and youth.