The Canadian Position on treatment of gender variant youngsters

There are two major centres in Canada in Vancouver and Toronto.


E-mail from Daniel L. Metzger, MD, FAAP, FRCPC
British Columbia’s Children’s Hospital

We’d very much like to be listed as a pediatric endocrine centre offering treatment for children with gender dysphoria, we’ve been involved in this for the past decade. We do indeed offer GnRH agonist therapy for these cases. We’ve treated about 20 kids or so over the past 10 years. If possible, I would start at the very first hint of puberty (early Tanner 2); unfortunately, many of these kids come to us much later.

Endocrinology & Diabetes Unit
4480 Oak Street, Room K4-213
Vancouver, BC V6H 3V4 CANADA
Phone: (604) 875-2117
FAX: (604) 875-3231


Dr. Kenneth Zucker practices at the Child and Adolescent Gender Identity Clinic in Toronto. He has an enormous wealth of experience in treating Gender Identity Disorder in children and adolescents and has published extensively in this field. Over the past 30 years, he has treated about 500 preadolescent gender-variant children. He may have diagnosed more children and adolescents with gender identity disorder (GID) than any other facility in the world.

Dr Zucker’s studies indicate that “80 percent grow out of the behavior, but 15 percent to 20 percent continue to be distressed about their gender and may ultimately change their sex.”

For instance, in the case of M, an adolescent aged 13 with GID and female phenotype, Dr Zucker was asked “Does M, at age 13, truly know what he will want in 5 or 10 years?” Dr Zucker replied “Most likely, yes,” “The chance that M could change his mind at this point is close to zero. If he has been so consistently boy-identified from an early age and is reasonably psychologically stable, he seems like a possible candidate for puberty-blocking medication. But to find that out, he needs to be evaluated by an expert. And he needs to be seeing a therapist who can help him in talking about all this, planning ahead and in learning how to negotiate disclosure to his romantic partners.”

Dr. Zucker was asked: “Does your clinic offer suspension of puberty to adolescents who have been diagnosed with profound GID that is likely to persist?”

He replied “Yes and we are doing this routinely now for clients who we feel would benefit from it. For these clients, we also require that they participate in counselling sessions that helps us verify the persistence parameter and also to work on their other psychosocial/psychologic/psychiatric issues (of which our clients tend to have many)”.

London and other centres that still insist on full pubertal development before any endocrine intervention may find Dr Zucker’s response informative.