A network of support for transgender children is growing in Canada, at clinics working to help youth transition from one gender to another.​

But critics say it raises ethical questions about when children are able to make medical decisions.

In Winnipeg, the Gender Dysphoria Assessment and Action for Youth (GDAAY) clinic helps young people who feel they were born in the wrong body.

The clinic helps people such as 18-year-old Xavier Raddysh, who says he knew from a young age he was a man.

Raddysh was identified as a girl at birth and named Kenzie, but says he doesn’t remember ever feeling female.

If young people are saying they want to transition, the question is, is that truly an autonomous, independent wish that’s reflective of their values, or are they internalizing a lot of very negative messages and stereotypes in society? -— University of Toronto bioethicist Kerry Bowman

“I've definitely always been more of a male person. When I was little, I wouldn't play with the Barbies my parents got me. People would call me by my birth name, but I never did feel female, no,” said the Winnipeg teen.

Later, those feelings intensified.

“I was very uncomfortable when I hit puberty as a female. I would feel very sad and upset when I would get my period or when I started to get a higher voice,” he said. “When I started growing breasts, I was just so upset and I didn't know why.”

Raddysh didn’t hear the term transgender until he was 15, but when he finally did, he said he instantly identified with it.

Coming out as a male presented its own set of problems, though. He suffered immense bullying, which led to depression.

Suicide rates higher among transgender youth

“I’ve tried to commit suicide at least three times. I’ve self-harmed,” said Raddysh.

His experience isn’t unique, according to the Public Health Agency of Canada, which says 20 to 30 per cent of transgender youth have attempted suicide.

Younger children should know they have the option if they don’t feel like the gender they are — they can change that. — Xavier Raddysh

An Ontario study found 47 per cent of transgender youth reported seriously considering suicide.

Statistics such as those are part of what convinced psychiatrist Simon Trepel to start the GDAAY clinic in Winnipeg, to help children and young people diagnosed with gender dysphoria.

Raddysh credits the clinic with changing his life and helping him find the resources he needed.

“Once I figured out I could get more hormone replacement therapy and get surgeries to feel more like me, I changed as fast as I could,” explained Raddysh. “I would’ve been way depressed if they hadn’t helped me, and I’m very glad they have clinics like that.”

Limited access to youth and child-focused care

But access to the clinics is limited, as there are only five in Canada so far.

As we’re going to see in the next five to 10 years, as this population becomes larger, there will be more options in Canada. — Psychiatrist Simon Trepel of the Gender Dysphoria Assessment and Action for Youth in Winnipeg

“This is still a fairly new issue in our world and North American society,” said Trepel. “Right now, the data shows, as a child expressing transgender identity, a majority won't go on to have transgender issues in adolescent and adult years, whereas teens presenting with transgender ideation often will.”

Trepel’s clinic currently treats children as young as four years old, and the therapies available to them depend on their age.

Currently, children as young as seven or eight years old can take hormones to block the physical changes of puberty, a therapy that is completely reversible.

By their early teens, they can opt for cross-hormone therapy, which is more difficult to reverse.

As for sex reassignment surgery, most will have to be at least 18 to obtain it.

Trepel said that options for youth are limited right now, but he expects that to change.

“It’s definitely not offered everywhere,” said Trepel. “It hasn’t attracted a lot of surgical specialists doing this kind of work, but as we’re going to see in the next five to 10 years, as this population becomes larger, there will be more options in Canada.”

Issue 'triggers powerful taboos,' says bioethicist

University of Toronto bioethicist Kerry Bowman worries that some children are being asked to “pick a side” too early.

“I actually do think in many situations, young people have the right to make more medical choice than they’re given in society,” he said.

Bowman said he does believe children can understand and appreciate the implications of their decisions, “but it’s different in this domain. If young people are saying they want to transition, the question is, is that truly an autonomous, independent wish that’s reflective of their values, or are they internalizing a lot of very negative messages and stereotypes in society?”

Bowman added the issue has become highly charged “because it’s linked with sexuality and sex roles. It triggers powerful taboos in Western culture.”

Reassignment surgery

Plastic surgeons in most Canadian cities will perform “top body surgeries,” which include removing breasts.

As for "bottom surgeries," which involve altering the genitals, the Gender Variance Program at the Montreal Children’s Hospital refers adult patients to a gender surgery clinic that is run by Dr. Pierre Brassard — one of the only places in Canada where gender reassignment surgery occurs.

Now 18, Raddysh is hoping to have that surgery. He started testosterone treatments eight months ago and plans to have a double mastectomy next month.

“I really just want to get surgery over with, and I know I’ll feel a thousand times better after surgery,” he said. “Younger children should know they have the option if they don’t feel like the gender they are — they can change that.”