Care and Empathy

Margaret, who has used a wheelchair since a biking accident in 1983, poses in her Ottawa garden amid a backdrop of abundant spring blooms.

Dr. Margaret LAWSON’80 is one of Canada’s leading medical specialists in helping transgender youth

By Patricia Hluchy Photo by Jonathan Barker

In 2006, pediatric endocrinologist Dr. Margaret Lawson started getting a few calls from psychologists who treat transgender adults. Th ey had been hearing from trans youth looking for medical treatment and were hoping Margaret could provide it. For Margaret, who was—and still is—on staff at CHEO, a pediatric health and research centre in Ottawa, it was a catalyst: she recognized that these young people needed care. But it was a bit of a challenge to fi gure out just what that treatment should be.

“Before then,” she says, “pediatric endocrinologists were not being taught about or exposed to the needs and care of trans and non-binary individuals.

When I read journal articles which reported on the very poor health and social outcomes for trans adults at that time, I realized that I could help young people avoid those outcomes and have goals for their future—and for their families to accept them as their true selves. Because, I knew how to block hormones that shouldn’t be there and, if required, how to replace hormones that aren’t being made.”

And so began her work with trans and non-binary youth at CHEO.

Margaret soon understood that it was as important to care for parents as for their trans or non-binary children. She was the only physician at CHEO providing treatment to these kids and their families until November 2011, when she co-founded its Gender Diversity Clinic, the fi rst of its kind in

Ontario and the second in Canada. Th ere, young people who have started puberty, along with their parents, are cared for and supported by a team that includes a social worker, adolescent health physicians, endocrinologists and endocrine nurses. (continued on page 18)

(continued from page 17)

Clinical work takes up about 40 per cent of Margaret’s working time and primarily involves treating trans and non-binary youth, with most of the remainder devoted to research. Endocrine care for young persons diagnosed with gender dysphoria begins with a two-hour appointment for them and their family. Th at involves an affirming-gender assessment and counselling, and under an informed-consent model, initiation of reversible hormone blockers, which put a pause on puberty. At least six months later, if the youth is at least 14 or 15, gender-affi rming hormones may become part of treatment. Th e clinic’s role throughout is to support the young people and their parents through their gender journey.

About three-quarters of the trans young people presenting to CHEO are trans males, which is also the case across Canada and abroad, Margaret says. That outsized percentage may be explained in part because youth assigned female at birth start puberty earlier than those assigned male. As well, she adds, “Non-normative gender expression in assigned-female young people is oft en supported. In contrast, trans-feminine youth are oft en disapproved of, victimized or unsupported. Transmisogyny may delay coming out and acceptance.”

At CHEO and across Canada, Margaret notes, less than one per cent of trans youth change their minds and decide to return to the gender they were assigned at birth, “with each saying they have no regrets and had to go through this journey to fi gure out who they are.”

Because of broader social awareness of trans people in recent years, the demand for treatment at the Gender Diversity Clinic has grown “exponentially,” says Margaret. “We stopped counting because we were so busy providing care.”

As the need has grown, so has Margaret’s passion for her work. “You see these kids who come in—they may not be attending school, or if they are, they’re not relating to their classmates or to their friends, they’re not talking to their families. Th ey may be hiding in their rooms, not communicating and not having hope for their future.”

Margaret had already accomplished a great deal before shifting her attention to trans youth. Aft er earning her B.Sc. in 1984 at the University of Toronto (Trinity College, where she became Head of College), she gained a master’s in health administration, and graduated from medical school at McMaster University. While undertaking her pediatric endocrinology fellowship at Toronto’s Hospital for Sick Children, she began another master’s degree, in clinical epidemiology, at McMaster before joining CHEO and the University of Ottawa’s Faculty of Medicine in 1995.

At CHEO, Margaret became division chief of endocrinology and metabolism for more than a decade before taking a research sabbatical. Th en she became senior scientist at the CHEO Research Institute and full professor at U of O. Her research is now almost exclusively devoted to trans and non-binary youth. She is the co-principal investigator and the clinical lead for Trans Youth CAN!, a groundbreaking, multidisciplinary research study funded by the Canadian Institutes of Health Research examining the medical, social and—in a world fi rst—family outcomes for transgender and non-binary youth (transyouthcan.ca). Starting in 2019, the study has been following 178 youth and 164 parents/ caregivers referred to 10 gender-affi rming clinics across Canada.

Margaret’s empathy for these young people and their families leads her to put in long hours. “I defi nitely struggle with work-life balance,” says the mother of 21-year-old Sophie and 19-year-old Is, both university students. Margaret is married to Jonathan Barker, a lawyer who is co-founder of an Ottawa medical research soft ware company. “As our kids and my mother will tell you,” she says, “I spend too much time working. I truly love my job—providing care for the youth I see in my diversity clinic and my research. Still, my most important ‘job’ will always be that of parent. In her off time she is enthusiastic about the Toronto

“Once the youth begins to receive gender-affi rming care and support, their anxiety usually begins to decrease, as do other mental-health issues,” says Margaret. “They start having hope for their future.”

In her CHEO offi ce in 2019, Margaret advises youth and parents as they share their gender story.

Blue Jays, international travel with her family, her book club and “all kinds of news.”

Margaret says the inspiration for her choice of medicine goes back to her time at Branksome, which she attended from Grade 8 through 13, and where several other family members, including her mother, Wendy WILSON Lawson’52, studied. Branksome has been very proactive in creating gender-affi rming policies and accommodations for its students (see story at right). “Th ings are evolving at schools,” says Margaret, “but many Canadian trans youth still struggle.” Last year, Trans Youth CAN! presented some sobering information about school experiences reported by the youth and parents in the study. Among its fi ndings: 40 per cent of parents had to get involved with their trans/non-binary children’s schools regarding gender issues; 19 per cent of students did not feel safe at school; 63 per cent of youth were avoiding change rooms or school washrooms; and 14 per cent of youth felt they had to change schools because others had issues with their gender.

Parental and caregiver support is critical for trans young people, Margaret adds. “I’ve seen all kinds of reactions when the youth fi nally tells them. Some parents say, ‘I love you no matter who you are.’ Others think it’s a phase. Others are completely against it. But ultimately, the parents always come on side, realizing that love and acceptance never hurt anybody. Once the youth begins to receive gender-affirming care and support, their anxiety usually begins to decrease, as do other mental-health issues. Th ey start talking to their parents and siblings again and attending school, and start having hope for their future. Parents realize that their child is the same person they have always loved.

“It’s a tremendous amount of work,” concludes Margaret, “but it’s so worth it in terms of the diff erence it makes in the lives of these youth and their parents. It’s the most satisfying and amazing thing I’ve ever done in my life.” R

Patricia Hluchy is a Toronto freelance writer and editor who has worked for Maclean’s, the Toronto Star and other publications.

Five Years Later

Branksome’s transgender guidelines have led to some changes, including dress and language

Branksome Hall has taken a leading and quite public role in supporting transgender students and alums. The award-winning Winter 2015-16 issue of The READ featured two trans male alums on its cover, and articles about each of them soon headlined in the Toronto Star as “The Boys of Branksome”. At the same time, the school was taking action.

In 2015, the school created a Transgender Working Group whose participants included those two alums, Andy SPRUNG’04 and Reed WANLESS’04, as well as current students, staff , faculty, parents and an outside transgender consultant. The group developed Transgender Guiding Principles, which were approved by Branksome’s administration in 2016.

“Transitioning, transgender or gender-diverse students have the right to express openly who they are,” the document states. “This includes expressing their gender identity without fear of unwanted consequences and with the expectation of being treated with dignity and respect.”

Deputy Principal Karrie Weinstock and Lead Social Worker Joelle Therriault led the Transgender Working Group and realized that once the guidelines were published, it was important to meet regularly with interested students to discuss how to apply the guidelines and address individuals’ needs. Student input has resulted in, among other things, the creation of male-designated washrooms and shower stalls for students in the school (trans male students indicated they really wanted “male spaces”). Pants are now an optional part of the school uniform, which traditionally only included kilts.

As well, Branksome has altered its practices regarding language and pronouns to refl ect the gender fl uidity of the student body. “This is about removing obstacles, so all students are able to participate fully at Branksome in a way that feels safe and inclusive,” says Therriault.

Previously at Findlay Law in Hamilton, lawyer Andy Sprung is currently an investigator at Barker Hutchinson & Associates, Toronto. Reed Wanless Patterson teaches science and social studies at St. Clement’s School, Toronto, where he is also a faculty advisor for the Gender Sexuality Alliance and a member of the school’s Diversity, Equity, and Inclusion committee.

Patricia Hluchy