For kids who identify with a gender they weren’t born with, resources are scarce—and critical

Mason and his mom sit in a waiting room at BC Children’s Hospital. The 12-year-old with rosy cheeks and bright brown eyes—dressed in a baggy T-shirt, droopy soccer shorts and Converse All Star high tops—looks like the picture of health. But looks can be deceiving. Mason and his mom, Lisa, are about to consult with a specialist about a medical intervention that could save his life. Lisa starts to cry the moment she starts chronicling their uphill journey since her firstborn child started preschool, or perhaps since the moment he was born and the doctor exclaimed, "It's a girl." Mason does not identify as a girl. He says he feels like a boy “stuck in a girl’s body.” Six months ago, that prepubescent body started its biological march into womanhood, when Mason got his period. After many years of silent suffering, it was the catalyst for him to come out of the closet, starting with a desperate cry for help to his younger sister, asking, “Do you think Mom and Dad would prefer a son or a dead daughter?” If you think that sounds like typical overwrought tween drama, consider these staggering statistics. Suicide attempt rates among transgender youth are as high as 45 percent, according to a 2014 U.S. national survey. An Ontario study from 2010 found that 47 percent of transgender youth had seriously considered suicide in the past year (compared to 11 percent of non-trans Ontario youth in a separate study). Of 923 transgender Canadian youth who participated in a 2015 survey, one in three attempted suicide in the past year and 70 percent suffered sexual harassment. Almost half of these Canadian youth felt “quite” or “extremely hopeless and overwhelmed,” and 71 percent hadn’t accessed support services because they didn’t want their parents to know. Conversely, those with supportive parents were four times more likely to be mentally healthy, which ranks as a key factor in the overall health of transgender youth, according to the survey. At Mason's photo shoot, he decided he wanted his face to appear in this story. When Mason came out to his parents at age 11, there was no question they would support his needs. But they had no clue how to do that and soon discovered that even gender specialists have contradictory theories and protocols when it comes to childhood gender variance. Mason’s family was lucky to find a groundbreaking local program for transgender children and their families, which helped plot a path forward. Indeed, Vancouver is a better city than most in providing resources for trans youth—but it’s not without work to be done. For Mason, his path included a hormone-readiness assessment, which gave him the rubber stamp for today’s visit with endocrinologist Dr. Dan Metzger at the BCCH. Mason is here to receive a drug treatment that will stall his puberty by temporarily stopping production of estrogen and progestins. For trans girls, it’s used to block testosterone. Blockers have been used in young children with precocious puberty since the early ’90s. It might temporarily decrease Mason’s bone density, but it will curb his psychological stress and help the family buy time until he’s 15 or 16, at which point they will contemplate partially irreversible cross-hormone drugs and, after age 18, perhaps also irreversible breast and genital surgeries. Yet prepubescent transition is still considered a highly contentious subject. It’s so controversial that there are few resources available to trans kids and their loved ones in North America. This is true even in Vancouver, a transgender pioneer since 1984, when Vancouver General Hospital’s transgender clinic helped pave the way for medical protocols that have since informed the World Professional Association for Transgender Health’s “Standards of Care” guidelines, considered the global bible for trans health care.

When people are stigmatized by a transphobic society and treated like freaks or not allowed to be who they are, naturally they will suffer.” —Dr. Wallace Wong

Some of them talk about running away because their parents won’t accept who they are. I’m lucky because my parents want me to be happy.” —Mason

Vancouver is a transgender-progressive city on many other fronts. We have had a handful of youth and adult support groups and a range of services through the Provincial Health Services Authority since 2003. In 2014, the Vancouver School Board formalized a transgender-inclusive policy, and the Vancouver Park Board is working on a similar plan. Yet there are still no government-sponsored programs in Vancouver for gender-variant children and their families. The Provincial Health Services Authority says it’s in the early stages of starting one. There is also currently a six-month backlog for the hormone-readiness assessments required to receive BCCH medical interventions. Among the handful of private therapists in Vancouver specializing in transgender youth, meanwhile, wait-lists are up to six months. That wait could be a death sentence for some transgender children. We know that since the BCCH’s program began in 1998, 12 percent of their 84 patients had attempted suicide prior to their first consultation—after consultation, it dropped to five percent. Mason is lucky to live in Surrey, where approximately 35 kids aged three to 12 currently receive support through the Ministry’s Child and Youth Gender Program, which offers an innovative group session called Learning About Me and Myself. Operating on a shoestring budget since 2014, it’s headed by Dr. Wallace Wong, one of only six B.C. mental health specialists with expertise in providing transgender children and youth the clinical assessments necessary for kids like Mason to receive puberty blockers. “Very few specialists want to work with this population or even talk about them,” Wong says of trans children. That’s because many specialists recommend a wait-and-see approach, based on dubious historical research, which presupposes that many gender-variant kids will ultimately identify as gay. Some specialists even believe that gender is pliable in young kids, and they endorse conversion therapy of the type once done on gay people. Wong’s methods are controversial and revolutionary because he takes an altogether different approach. “I provide affirmative therapy, which isn’t about encouraging or discouraging children to pick a gender. It’s to help build confidence and resilience, find a place on the gender spectrum and eventually develop a plan to live in the gender they fit.” He says that while some gender-variant children experience no psychological distress, even when they go through puberty, many of the kids he sees “have serious behavioural and developmental issues because they’re under such emotional distress. They’re anxious, ashamed, depressed, suicidal”—particularly if they’re not allowed to express gender variance and have little to no parental and community support. Wong’s Learning About Me and Myself group sessions give kids a safe, nurturing environment to explore gender identity. “The focus is on creative play,” he says, “activities that help kids discover and realize the authentic self without stress or shame”—including everything from making snowflakes (to explore the notion that all of us are unique) to playing Mr. Potato Head (to experiment with gender identification). “Another goal is to facilitate friendships among kids that share gender variance so that they realize, ‘I’m not alone, I’m not a weirdo,’” Wong says. “You should have seen the joy on Mason’s face when he met a boy just like him at Dr. Wong’s group session,” Lisa says. “Suddenly, he realizes it’s OK to be who he is.” Wong also counselled Mason and his family privately to rule out family dysfunction or mental health issues. “He had so many questions,” Mason says. “Like, ‘What kind of person do you want to be? How do you feel about your body?’ I said, ‘I want a beard. I want a deep voice. I want all the boy things. I want to be happy.’”Mason’s unhappiness started at preschool. He wanted to play with the boys, and he felt “weird” and “sad” that he couldn’t do so. He became so withdrawn that his kindergarten teacher thought he was a selective mute. As his grades got worse, his parents suspected he had a learning disability and spent more than $10,000 on extracurricular tutoring. By Grade 5 he was saying things like “I’m so stupid” and “I want to die.” “I looked in the mirror and I didn’t like what I saw,” Mason recalls. “I hated the long hair, the dresses, the school uniform.” Mason’s parents didn’t force him to look and act like a girl. His sister is a tomboy who prefers trucks to dolls, and he understood that it’s perfectly acceptable to be gay or lesbian. But he’d never even heard the word transgender until 2014. His mom happened to be watching a video on YouTube. “I was so happy to know there were other people where the outside doesn’t match the way you feel inside,” he says. “I knew I wasn’t weird.” Mason’s school grades immediately improved, but he didn’t come out to his parents because he “didn’t want to disappoint them,” he says. “I like to keep people happy. But then all the girly things started to happen. In December I got my period and it was really, really bad.” In January, he came out to his parents. “It felt like a thousand pounds went off my shoulders.” Three days later, Mason got nine inches of hair cut and they went shopping for new clothes. “In the mall, I used the boys’ washroom for the first time and I got no funny looks,” he says. “It felt so good.” Lisa’s tears start to spill again. This is an exciting day for Mason, but for his parents it’s the culmination of a six-month crash course with a steep learning curve. Wong’s parents’ support group has provided a safe harbour for them to share their highs and lows and plot the road ahead. “We do a lot of crying at the group—‘Why me? Why us?’” Lisa admits. “A lot of us feel like we’re mourning. I’m mourning the daughter that I thought I had. But I’m also very happy now with the son I didn’t know I had. We know his safety and happiness are at stake. So when I hear that we shouldn’t let kids transition early, I think that’s a bunch of baloney. These kids know who they are. Why can’t we let them be themselves?” Lisa is alluding to the conventional theories that gender may not be fixed in children and that many gender-variant kids will outgrow it and identify as homosexual, based on historical research done in the ’70s and ’80s, when transgender was considered a mental disorder. The brave few who did come out faced discrimination and abuse, which led to high drug addiction, joblessness, prostitution, homelessness, violence, murder and suicide—and a scarcity of safe medical interventions. Improved resources, research and our growing cultural acceptance have brought higher rates of healthy transition, often galvanized by loud and proud transgender kids like Tru Wilson, who came out to her parents in 2012 at aged nine (and was featured on the cover ofin December). The Wilsons sought counselling and attended Wong’s children’s program, and Tru started taking puberty blockers. Later that year, the family lodged a complaint with the Human Rights Tribunal against Tru’s Catholic school, Sacred Heart Elementary, when the school refused to accommodate her transition. Ultimately, the Catholic Independent Schools of Vancouver Archdiocese agreed to pay the Wilsons an undisclosed settlement and initiated a new gender-inclusive policy in 2014, the same year the Vancouver School Board formalized one of its own.We ranked Tru Wilson, a trans child who took on her school board and won, among the most influential Vancouverites in our December Power 50 issue. Despite scientific evidence that transgender people have genetic and biological characteristics matching their transgender identity, families are still often cautioned against early transition. And conversion therapy, which strongly discourages transgender expression and behaviours, is still endorsed by some experts, including Toronto-based Dr. Ken Zucker, former chief of the Gender Identity Service at the Centre for Addiction and Mental Health, Canada’s biggest transgender clinic. Conversion therapy caused a public uproar in North America after its use led to the suicide of an Ohio teen, who left a note begging, “Fix society. Please.” Ontario ultimately banned conversion therapy and Zucker’s clinic was closed late last year. “Sadly, Zucker’s theories on conversion therapy changed the way many psychologists have practised, and it could have done a lot of damage to kids with gender dysphoria,” says Wong, who explains that some parents come to him as a “last resort,” wanting him to “punish or fix” their child. Some have already tried conversion therapy. “They find that it actually makes their child’s core identity stronger,” he says. To Wong, the historical theory that a majority of transgender kids are merely confused about sexuality is plagued by bias against both gay and trans people and lacks a strong evidence base. Modern gender identity specialists understand the critical distinction between gender and sexuality—the oft-used idiom is that gender is who you go to bed as, while sexuality is whom you go to bed with. “More than 90 percent of the kids I see with gender dysphoria stay on the transgender spectrum,” he says. “Transgender isn’t a pathology or a mental disorder needing a cure. Many trans people have gender dysphoria, and some have mental health issues, but when people are stigmatized by a transphobic society and treated like freaks or not allowed to be who they are, naturally they will suffer.” As of April 2016, the BCCH clinic had seen more than 250 youths. “Typically I meet them at puberty, when transgender kids often start to fall apart. There’s a lot of stress around those unwanted physical changes,” says Dan Metzger, the BCCH endocrinologist who provides pre-approved youth hormone therapies. “We need more services for the growing number of transgender kids,” he adds. “Often safety is a big issue for early transition, especially in smaller, less tolerant communities. But in B.C. that’s less of an issue as long as parents are supportive.”B.C.’s progressive approach appears to be bearing fruit. According to the 2015 Canadian survey of almost 1,000 trans youth, including more than 200 in B.C., those in this province are the most likely to be living in their felt gender. Over 50 percent are full-timers (compared to 31 percent in Atlantic provinces), and they’re more likely to report good or excellent health. Generally, kids are twice as likely to report good mental health if they have a supportive school environment, with B.C. youth reporting the second highest rates of that, after Quebec. After a three-hour consultation with Metzger, Mason gets his first puberty-blocking shot, which he’ll take monthly until he’s 15 or 16, when he can consider switching to cross-hormones. They’ll discuss the potential risks, including cardiovascular disease and Type 2 diabetes. Mason will also have to consider whether he should freeze his eggs in case he wants to have children. But today, he’s still a kid and those decisions can wait. A few weeks later, at Wong’s end-of-year social, Mason is towering over a gaggle of little girls in frilly dresses and boys wearing ties or fedoras. Compared to the majority of us, wearing our more gender-neutral clothing, they look like throwbacks to a bygone era. Yet they’re representatives of a new wave, a cultural paradigm shift in the way we define and think about gender. And while Mason has yet to come out officially at school, he recently told his classmates. It wasn’t a surprise or a big deal to them. He also graduated to Wong’s youth group. “The older kids were cool and made me feel good,” he says. “They talked about getting weird looks or being teased. Or good stuff, like their voices changing from hormones. Some of them talk about running away because their parents won’t accept who they are. I’m lucky because my parents want me to be happy. They want the outside to match the way I feel inside.”