Dr James Makokis. (Screenshot/AJPlusTwitter)

A two-spirit doctor in Canada has dedicated his life to treating young trans patients and teaching them about being two-spirit – an umbrella term used by many indigenous LGBT+ people.

Doctor James Makokis came out as gay at 17-years-old to a father who struggled to accept him.

Now 37, Makokis is a First Nations family doctor from Saddle Lake Cree Nation who identifies as two-spirit.

Two-spirit, which is a term that goes back to pre-colonial third-gender roles, is used by indigenous people who identify with both masculinity and femininity.

Although his mother accepted him when he came out at 17, he moved away from home, in a small rural community northeast of Edmonton, to the city to finish his last year of school.

“Reflecting now as a physician, I had all the characteristics of depression,” Makokis told the Thomson Reuters Foundation.

“It was really important that I … physically move away to be in a place like Edmonton that is more diverse,” he added.

After training as a doctor, he decided to focus on treating trans patients: advising them on transition, prescribing hormones, and teaching indigenous culture to younger people, who number around 15 of his approximately 300 patients.

“I thought if I practiced trans medicine I will be working to address this issue of homophobia, transphobia that has come to exist in our nations now … and help to empower two-spirit people to belong again,” Makokis said.

There is no data on the number of LGBT+ or two-spirit people in Canada, according to the Thomson Reuters Foundation.

But estimates suggest that the number of indigenous LGBT+ people could be as many as 39,000 to 100,000.

“Our people always accepted diversity and a lot of times our people have forgotten that because of what we’ve gone through,” Makokis said.

“The teachings are written on the land … So that we don’t forget who we are.”