Frequently asked questions

There is no easy answer to this question. Ultimately, only you have the answer.

That said, asking yourself the question generally indicates that you need help, information, or both.

One barrier to seeking support may be internalized transphobia, the assimilation of negative beliefs and attitudes towards transness. These beliefs can affect a person’s thoughts and judgements about themselves.

Sometimes, gender identity questioning can arise when a person has traits that go against the “norm” in relation to the gender they were assigned at birth.

For example, a person assigned male at birth might have interests that are considered typically feminine, or vice versa.

Whatever the reason for your questioning, you don’t have to be alone with your thoughts. You can obtain relevant information on the subject from people who understand these issues and have a positive attitude towards them. Whether indirectly, such as by reading or listening to videos, or directly, by talking with other people, it is beneficial to seek connection and information.

Speaking of which, ATQ offers support groups where attendees can talk and listen to others who are going through similar experiences. The goal of these meet-ups is to help you explore your questions in a compassionate and respectful environment.

There is no obligation to do anything during transition.

Whether transitioning medically, socially, or legally, the choice to move forward and undertake certain steps is up to the person transitioning. This choice should correspond to their needs and gender identity.

While this may have been the case in the past, there is no longer a common narrative around transitioning. Everyone can transition as they see fit, freely and flexibly. For example, it is now possible to have gender affirmation surgery without first undergoing hormone therapy.

A letter of recommendation is no longer required to access hormone therapy, but it is nonetheless often requested by healthcare professionals.

On the other hand, a letter of recommendation remains mandatory to obtain gender affirmation surgery.

While this is a common question, it’s unfortunately too vague to give a precise answer. In reality, a gender transition is the sum of many possible actions, steps, and procedures for any given person.

No step is mandatory. However, certain steps do have prerequisites.

That being said, it is possible to answer certain questions about more specific steps, such as:

• Legal name or gender designation change

• Hormone therapy

• Surgical procedures, including gender affirmation surgeries

It is important not to be left alone with all your questions if you are still in the process of questioning your gender identity and need information to help you better navigate and understand your gender. Among other things, You can:

• Join social media or other online communities, which can take various forms.

• Meet with someone who can offer you support and/or answer your questions: meet with a transaffirmative therapist or attend an individual session with an ATQ worker.

• Attend support groups offered by several community organizations, including ATQ.

Medical, social, and legal transition are broad categories that define different aspects of gender transition.

Medical transition concerns anything related to medicine. This includes all gender affirmation surgeries (this term is often used to refer to gender affirming mastectomies and genital surgeries). It also includes any other surgery that modifies a person’s body to allow them to feel that their body matches their gender identity. Medical transition also includes hormone therapy and puberty blockers.

Social transition affects everything related to social interactions in society. Coming out, or voluntary disclosure of one’s gender identity, is one element of social transition. Nonmedical changes to one’s appearance such as clothing, hairstyle, makeup, and any other means of changing one’s appearance to be perceived differently by others are also part of social transition.

Legal transition involves government-recognized forms of identification, typically first names and gender. This information is first associated with a person’s birth certificate, and then any other record file containing their name and gender.

It all depends on the type of transition.

For social transition, there is no minimum age requirement. For younger children in particular, acceptance by and attitude of their parents and social environment can be vital.

Legal transition is possible at any age, although there are certain restrictions for minors. Recognition by an appropriate healthcare professional and parental consent may be required. You can visit the Juritrans website for more information.

For medical transition (in Quebec), some minimum age requirements must be considered:

• For hormone therapy, the minimum age is 16 years old.

• For mastectomy (breast removal), the minimum age is 16 years old. The request can be initiated before a person turns 16.

• For genital surgeries, the World Professional Association for Transgender Health (WPATH) recommends that a person be at least 18 years old.

It is also necessary to account for the waiting periods related to assessment and administration when planning to access care.

WPATH (World Professional Association for Transgender Health) is an international organization that works to develop and improve the standards of care for trans and nonbinary people.

You must make a name and/or sex designation change request to the Directeur de l’état civil du Québec (Director of Civil Status of Quebec).

Which form to complete and how it will be processed depends on the age of the person submitting the request: under 14 years old, between 14 and 17, and 18 and over. For more information, consult the Juritrans website.

First, it is important to distinguish between puberty blockers and hormone therapy.

Puberty blockers are used to slow down puberty to the point that it is effectively stopped. They allow trans and gender-questioning youth to avoid unwanted puberty-induced bodily changes and reduce their related distress. A person starts this treatment at the first signs of puberty (in medical terms,Tanner stage 2), which typically begins between the ages of 9 and 14 at the average age of 11 or 12.

Hormone therapy involves taking feminizing or masculinizing hormones that the body cannot produce on its own in sufficient quantities. With hormone therapy, a person can develop the desired secondary sex characteristics.

It is difficult to determine a minimum agerequirement for hormone therapy, given that this treatment is linked to puberty, a variable process. In Quebec, in most cases, the medical consensus tends to be that 16 years old should be the minimum age, with adjustments possible on a case-by-case basis.

Note that the informed consent model is currently the most commonly advanced approach to hormone therapy.

The informed consent approach aims to ensure that the decision to pursue treatment is made by the individual themselves, out of respect for their right to self-determination and bodily autonomy.

This approach requires that thorough information be provided about the treatment(s) in question, including:

• possible effects

• the reversibility, semipermanence or permanence of certain effects

• potential risks, such as fertility loss and options to preserve gametes (eggs or sperm)

• the possibility of experiencing regret

It is also important to provide answers or resources that can help answer the questions of the person considering treatment.

Depending on the case and whether it’s desired, there may also be support in the form of counselling or therapy to help the person explore their questions in greater depth. This should be presented to the person as an option and not an obligation.

You must consult a doctor or an endocrinologist to start such treatment.

In Quebec, the most common approach to starting hormone therapy is informed consent.

Medical staff may also request a letter of recommendation for hormone therapy.

You must meet with a person who is qualified to provide such a letter, such as a transaffirmative therapist. A single appointment is usually enough to obtain one, but this can vary depending on the situation.

To obtain a letter, you can also schedule an individual appointment with an ATQ worker. To do this, you must specify in your application that you wish to obtain a letter of recommendation.

It all depends on the effect.

Essentially, the body responds to hormones just as it does during puberty.

The pace of these bodily changes is difficult to predict accurately, as it varies according to several factors, such as the hormone levels achieved, and genetics, to name just a few.

That said, there are resources that can give you a general idea about the effects of different ​​hormone therapies. You can find some good information on the subject here.

First, it is important to keep in mind that medical transition is not limited to mastectomy and genital surgery (vaginoplasty, phalloplasty, or metoidioplasty). While these surgeries are covered by the Quebec healthcare system, they are associated with a long administrative process and wait times.

There are a number of other  plastic surgeries, although they may only be accessible to people who can afford them, given that these procedures can be expensive.

Genital surgeries and mastectomies are, among others, offered by GrS Montreal, right here in Quebec. For these surgeries, you must obtain a letter of recommendation from a qualified professional, often a sexologist or psychologist.

Obtaining this letter generally takes a few sessions, which may vary depending on the professional and the situation of the person requesting the letter.

Finally, surgeons take different  physical health criteria  into account, and they may request certain medical tests to plan treatment.

In Quebec, it is illegal for a person to harrass or discriminate against you because of your gender identity or expression, including in the workplace.

The Charter of Human Rights and Freedoms prohibits anyone from:

• Treating someone differently because of their gender identity or expression.

• Repeatedly making offensive comments to someone related to their gender identity or expression.

• Repeatedly engaging in offensive behaviours towards you due to your gender identity or expression.

If you are experiencing discrimination at work and would like more information on the remedies available to you, we invite you to contact the Human Rights Commission.

You can also inform your employer about their duties and how to create a positive, respectful work environment for trans and nonbinary individuals. The Intégrer les personnes trans en milieu de travail [Integrating Trans People into the Workplace] guide can be useful in this situation.

A list of transaffirmative professionals is available in the resource section of the Institute for Trans Health’s website.