Our Nurse Practitioner, Julie Hunter recently embarked on a journey that would take her over the ocean to further her understanding of Transgender Health. Julie has written a summary of her time in Lisbon, Portugal.
I recently had the privilege of attending the World Professional Association for Transgender Health (WPATH) 28th Scientific Symposium, held from September 26th to 30th in Lisbon, Portugal.
The theme of this global conference was “A Gender Diverse World in Global Unity.”
Thanks to the transformational leadership of the Wawa Family Health Team Executive and Board Members, I have the opportunity to attend to the primary healthcare needs of many trans patients in Northern Ontario.
I have completed Rainbow Health Ontario training courses, including ‘2SLGBTQ Foundations’ and ‘Autism & Gender Identity' and as a member of WPATH and a trans healthcare service provider listed in Rainbow Health Ontario’s directory, I am committed to providing competent and welcoming care to 2SLGBTQ people in Ontario.
My education and clinic accessibility, including virtual appointments via telephone or video, have enabled me to break down barriers and overcome the obstacles involved in reaching the most remote and marginalized patients in Northern Ontario.
What I learned at the Symposium…
“Biases”
The Opening Plenary was hosted by Zooey Zephyr, an American politician and university administrator who represents the Missoula 100th district in the Montana House of Representatives. She was the first openly transgender person to be elected to the Montana Legislature after winning in the 2022 election. Ms. Zephyr has been a vocal opponent of multiple anti-LGBT bills introduced during the 2023 legislative session. Ms. Zephyr provided insight into the many systemic biases that trans persons face, including access to equitable and effective health care. Completing clinical transgender training is imperative so as to avoid “implicit biases,” which are the “unconsciously internalized stereotypes [we have] even when we consider ourselves ‘woke’”. My social and cultural upbringing prevented me from being involved with the transgender community. I am nonetheless committed to continuing my education in order to reduce the impact of my implicit biases while delivering primary care to transgender patients. (Resource: https://files.lalgbtcenter.org/pdf/rise/Los-Angeles-LGBT-Center-RISE-Internalized-Bias.pdf)
"Country Policies"
The many themes of the conference included trauma-informed care, intersex care, and new approaches to hormone therapy. However, what seemed most impactful to me is how trans healthcare policies are different in every country of the world. Research presenters provided slides from the “Trans Rights Map” website showing Europe and Central Asia 2024 indicators related to transgender policies. It includes categories like legal gender recognition availability, hormonal treatment, wait times, and access to care (Trans Rights Map, 2024).
Most shocking to me was learning that 20 countries in Europe, including Belgium, Switzerland, Slovakia, Greece, and Turkey, to name a few, require sterilization for legal gender recognition even though the European Court of Human Rights ruled that this is a violation of human rights. It is nearly impossible to find literature on why this is considered legal but the document “License to be Yourself: Forced Sterilization” (Open Society Foundations, Nov 2014) provides in-depth history on the subject, including explanations and rebuttals of arguments for why sterilization has been necessary (starting on page 12).
In our own country of Canada, Alberta is imposing changes to their rules for the care of transgender youth. These are the strictest in the country and place the province at odds with the rest of Canada. Since, the Canadian Paediatric Society, Canadian Medical Association, Alberta Medical Association, and Alberta Psychiatric Association have all stated their support of gender-affirming care for kids and teens, transgender care providers consider Alberta’s move to be politically strategic.
New Evidence
Lastly, I was saddened to learn of the lack of quantitative and robust world research in transgender care. Researchers presenting at WPATH were mostly American and European. The size of the populations studied were small and often excluded low-education and underrepresented individuals, which suggests surveys have a strong education bias. Low-capacity clinics and low availability of providers was considered a barrier for survey administration. New participant enrollment and follow-up was difficult for researchers because many clinics were soon closed due to lack of funding or political opposition. Fortunately, WPATH translates the research that is completed and uses it to create guidelines on which countries can base their own guidelines. One example is the Canadian Sherbourne’s Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients (4th Ed., 2023). The Rainbow Health Ontario website is based on these guidelines.
Researchers and world leaders in transgender care, including the World Health Organization (WHO), have come together and determined that “Gender Dysphoria” is no longer a valid mental health diagnosis for a transgender person in the International Classification of Diseases (IDC). The new term is “Gender Incongruence,” which “requires a marked and persistent gender incongruence for a diagnosis of Gender Incongruence to be made” (DSM-V and ICD-11). Crocq (2021), in “How gender dysphoria and incongruence became medical diagnoses – a medical review,” states:
“The diagnosis of gender incongruence was included in the ICD-11 to preserve access to health services, but it was moved from the ICD-11 chapter on Mental and Behavioural Disorders to the chapter on Sexual Health. Following DSM-5, The ICD-11 abandoned ICD-10 terms such as ‘opposite sex’ and ‘anatomic sex,’ using more contemporary and less binary terms such as ‘experienced gender’ and ‘assigned sex.’ Unlike ICD-10, but like DSM-5, the proposed ICD-11 diagnostic guidelines do not implicitly presume that all individuals seek or desire complete transition to the ‘opposite’ gender.”
In ICD-11 (Reed et al. 2016), gender incongruence is characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex. Gender variant behaviour and preferences alone are not a basis for assigning gender incongruence diagnoses in this group, whether in adolescents, adults, or children. This new term is considered a step toward depathologizing gender identity. By no longer classifying being transgender as a mental illness, “Gender Incongruence” should reduce medical stigma and the harm to transgender people’s human rights.
Key Note
“Let people be who they are”
Former WPATH President Marci Bowers emphasized in her farewell speech that the world still views transgender people as threatening because they seemingly jeopardize societal binary gender. The resulting censure and pathologization of trans people is due to the misunderstanding that birth anatomy (sex) equates with gender. In reality, a person who is transgender has a gender IDENTITY that does not correspond with the sex registered for them at birth. Instead of embracing gender diversity, the transgender person is othered by society, including the medical world. Some may see my service as activism, but I simply feel that I am “normalizing trans care,” and “shar[ing] their joy” during 1 on 1 private medical encounters with my transgender patients.
In my role as a Nurse Practitioner primary care provider, I treat transgender patients as individuals not with a medical disorder, but as individuals with unique healthcare needs. I meet my patients where they are at, accept their whole identity, and work with them to provide evidence-based healthcare they require.
You can book in with Julie Hunter via our online booking system or by calling the clinic.
Please review Transgender Care, in our Sexual and Reproductive Health program section to see if it is a good fit for you.
If you have any further questions, please contact the Wawa Family Health Team at 705-856-1313.