Guest editors reply to Drs Sinai, Regenstreif, and Leising

As the guest editors of the two-part Gender-affirming care in BC series, we thank you for your responses.[1-3] In reply, we emphasize that the current standards of care guiding health care providers in BC (Standards of Care Version 7)[4] and the approach taken by the team at BC Children’s Hospital require a comprehensive psychosocial assessment of an individual before providing gender-affirming hormones or surgery, especially where youth are involved. It is emphatically not “hormones or surgery on demand.”

We know that for youth, the best predictor of quality of life post-transition is parental support,[5] so where a youth consents, the process mandates significant efforts to educate parents and to encourage them to support their child.

The World Professional Association for Transgender Health is expected to publish version 8 of its Standards of Care[6] in 2022. As BC was the first jurisdiction in Canada to follow version 7, we are confident the Ministry of Health will follow suit with version 8, which will then become the standards of care guiding physicians in British Columbia.

Like abortion, the provision of medical care to trans and gender-diverse people is controversial in some quarters, but it is the obligation of health care providers to follow the accepted standards of care.

The current Standards of Care (version 7) do not mandate “treatment on demand.” On the contrary, they require a comprehensive psychosocial assessment, especially for youth.

We encourage health care providers to educate themselves with the best available research to provide compassionate and competent health care to transgender and gender-diverse people. Dr Leising[1] has written a detailed response[7] to the issues raised by Drs Sinai and Regenstreif.[2,3]
—Gail Knudson, MD
—barbara findlay, QC
—Daniel Metzger, MD

This letter was submitted in response to “The current gender-affirming care model in BC is unvalidated and outdated,” “Informed consent for gender-questioning youth seeking gender-affirmative care is a complex issue,” and “A closer look at the evidence for gender-affirming care.”


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Gail Knudson, MD, MEd, FRCPC, barbara findlay, MA, LLB, QC, Daniel L. Metzger, MD, FAAP, FRCPC. Guest editors reply to Drs Sinai, Regenstreif, and Leising. BCMJ, Vol. 64, No. 7, September, 2022, Page(s) 287 - Letters.

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